pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	pbp_a_contract_partd_flag	pbp_a_platino_flag	pbp_a_snp_pct	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_dsnp_zerodollar	pbp_a_snp_cond	pbp_a_snp_state_cvg_yn	pbp_a_pharmacy_website	pbp_a_formulary_web_addr	pbp_a_phys_web_addr	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	pbp_a_tier_yn	pbp_a_tier_bendesc_bens	pbp_a_tier_mc_bendesc_cats	pbp_a_tier_nmc_bendesc_cats
E0654	801	0		30	13	E0654_801_0	1	1			05/31/2019	2020.01	05/31/2019 06:41:07 PM Eastern Daylight Time					05/31/2019 06:55:59 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	2020	National		1					2						www.teamstarpartd.com	www.teamstarpartd.com										(866)524-4173		(866)524-4173		(866)524-4173		(866)524-4173										(711)-		(711)-		(711)-		(711)-																
E3014	801	0		30	13	E3014_801_0	1	1			05/24/2019	2020.01	05/24/2019 03:05:03 PM Eastern Daylight Time					05/24/2019 03:05:51 PM Eastern Daylight Time	PSERS HOP PROGRAM	Pennsylvania Public School Employees Retirement Sy	www.hopbenefits.com	PSERS Health Options Program (Employer PDP)	13	30					E3014	801	0	2020	National		1					2						www.hopbenefits.com	www.hopbenefits.com										(888)239-1301		(888)239-1301		(800)773-7725		(800)773-7725										(800)498-5428		(800)498-5428		(800)498-5428		(800)498-5428																
E3014	802	0		30	13	E3014_802_0	1	1			05/24/2019	2020.01	05/24/2019 03:05:26 PM Eastern Daylight Time					05/24/2019 03:05:51 PM Eastern Daylight Time	PSERS HOP PROGRAM	Pennsylvania Public School Employees Retirement Sy	www.hopbenefits.com	PSERS Health Options Program Value (Employer PDP)	13	30					E3014	802	0	2020	National		1					2						www.hopbenefits.com	www.hopbenefits.com										(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			05/30/2019	2020.01	05/30/2019 02:15:06 PM Mountain Daylight Time					05/30/2019 02:15:25 PM Mountain Daylight Time	MODOT/MSHP MEDICAL AND LIFE INSURANCE PLAN	MISSOURI DEPARTMENT OF TRANSPORTATION	http://www.modot.org/newsandinfo/GeneralInfo.htm	Missouri Department of Transportatio/ Highway Patr (Employer PDP)	13	30					E4744	801	0	2020	National		1					2						https://mp.medimpact.com/pharmacyportal/public/Login.jsp	http://www.modot.org/newsandinfo/GeneralInfo/documents/Formulary.htm										(844)513-6006		(844)513-6006		(877)863-9406		(573)751-2551										(711)-		(711)-		(711)-		(711)-																
H0022	1	0	1	48	5	H0022_001_0	5	1			08/22/2019	2020.01	08/22/2019 03:27:34 PM Pacific Daylight Time					08/22/2019 06:10:46 PM Pacific Daylight Time	"BUCKEYE COMMUNITY HEALTH PLAN, INC."	Buckeye Health Plan - MyCare Ohio	mmp.buckeyehealthplan.com	Buckeye Health Plan - MyCare Ohio (Medicare-Medicaid Plan)	5	48		1			H0022	1	0	2020	"CL, CU, FU, GE, GR, LA, LO, LU, ME, MO, OT, WO"		2	13593	2			2						mmp.buckeyehealthplan.com/findadoctor	mmp.buckeyehealthplan.com/formulary	mmp.buckeyehealthplan.com/findadoctor	(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0028	4	0	1	1	1	H0028_004_0	3	1			08/01/2019	2020.01	08/01/2019 03:46:20 PM Eastern Daylight Time	08/03/2019 10:21:16 AM Eastern Daylight Time	08/02/2019 01:17:49 PM Eastern Daylight Time			08/05/2019 11:12:37 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-004 (HMO)	1	1		1			H0028	4	0	2020	"Honolulu, Kauai and Maui counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	7	0	1	1	1	H0028_007_0	6	1	2	1	07/19/2019	2020.01	07/19/2019 03:10:25 PM Eastern Daylight Time	08/04/2019 03:19:42 PM Eastern Daylight Time	08/02/2019 01:17:49 PM Eastern Daylight Time			08/05/2019 11:23:48 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)	1	1		1			H0028	7	0	2020	Omaha		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	11	0	1	1	1	H0028_011_0	4	1			08/01/2019	2020.01	08/01/2019 03:00:03 PM Eastern Daylight Time	08/04/2019 03:29:57 PM Eastern Daylight Time	08/02/2019 01:17:49 PM Eastern Daylight Time			08/05/2019 11:04:16 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-011 (HMO)	1	1		1			H0028	11	0	2020	Heartland		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	12	0	1	1	1	H0028_012_0	4	1			07/15/2019	2020.01	07/15/2019 10:54:58 AM Eastern Daylight Time	05/31/2019 02:55:09 PM Eastern Daylight Time				07/16/2019 05:28:45 PM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-012 (HMO)	1	1		1			H0028	12	0	2020	Kansas City Metro area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0028	13	0	1	1	1	H0028_013_0	2	1			08/01/2019	2020.01	08/01/2019 02:30:02 PM Eastern Daylight Time	08/02/2019 09:45:12 AM Eastern Daylight Time	08/02/2019 01:17:49 PM Eastern Daylight Time			08/05/2019 10:50:23 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-013 (HMO)	1	1		1			H0028	13	0	2020	Wichita area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	14	0	1	1	1	H0028_014_0	3	1			08/01/2019	2020.01	08/01/2019 02:32:49 PM Eastern Daylight Time	08/02/2019 09:36:50 AM Eastern Daylight Time	08/02/2019 01:17:50 PM Eastern Daylight Time			08/05/2019 10:50:23 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-014 (HMO)	1	1		1			H0028	14	0	2020	St. Louis Metro area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	15	0	1	1	1	H0028_015_0	7	1	2	1	07/19/2019	2020.01	07/19/2019 03:06:54 PM Eastern Daylight Time	08/02/2019 09:27:49 AM Eastern Daylight Time	08/02/2019 01:17:50 PM Eastern Daylight Time			08/05/2019 10:50:23 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-015 (HMO D-SNP)	1	1		1			H0028	15	0	2020	Select Counties in Missouri		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	16	0	1	1	1	H0028_016_0	3	1			08/02/2019	2020.01	08/02/2019 03:33:14 PM Eastern Daylight Time	08/02/2019 09:41:21 AM Eastern Daylight Time	08/02/2019 01:17:50 PM Eastern Daylight Time			08/05/2019 10:50:23 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-016 (HMO)	1	1		1			H0028	16	0	2020	Springfield/Joplin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	17	0	1	1	1	H0028_017_0	3	1			08/01/2019	2020.01	08/01/2019 02:34:34 PM Eastern Daylight Time	08/02/2019 09:39:39 AM Eastern Daylight Time	08/02/2019 01:17:50 PM Eastern Daylight Time			08/05/2019 10:50:23 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-017 (HMO)	1	1		1			H0028	17	0	2020	Kansas City		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	18	0	1	1	1	H0028_018_0	2	1			06/24/2019	2020.01	06/24/2019 11:38:27 AM Eastern Daylight Time	08/02/2019 09:55:34 AM Eastern Daylight Time	08/02/2019 01:17:50 PM Eastern Daylight Time			08/05/2019 10:50:23 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Value Plus H0028-018 (HMO)	1	1		1			H0028	18	0	2020	Select Counties in Kansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	19	0	1	1	1	H0028_019_0	2	1			08/01/2019	2020.01	08/01/2019 02:54:55 PM Eastern Daylight Time	08/04/2019 11:11:26 AM Eastern Daylight Time	08/02/2019 01:17:50 PM Eastern Daylight Time			08/05/2019 10:50:34 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-019 (HMO)	1	1		1			H0028	19	0	2020	Albuquerque Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	4b;8a1;8a2;8b3;	
H0028	20	0	1	1	1	H0028_020_0	2	1			05/31/2019	2020.01	05/31/2019 01:41:30 PM Eastern Daylight Time	08/04/2019 11:13:58 AM Eastern Daylight Time	08/02/2019 01:17:50 PM Eastern Daylight Time			08/05/2019 10:50:34 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-020 (HMO)	1	1		1			H0028	20	0	2020	Maricopa County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	21	0	1	1	1	H0028_021_0	2	1			08/01/2019	2020.01	08/01/2019 03:00:35 PM Eastern Daylight Time	08/04/2019 11:16:23 AM Eastern Daylight Time	08/02/2019 01:17:50 PM Eastern Daylight Time			08/05/2019 10:50:34 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-021 (HMO)	1	1		1			H0028	21	0	2020	Pima County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	22	0	1	1	1	H0028_022_0	2	1			05/31/2019	2020.01	05/31/2019 01:42:13 PM Eastern Daylight Time	08/04/2019 11:18:55 AM Eastern Daylight Time	08/02/2019 01:17:51 PM Eastern Daylight Time			08/05/2019 10:50:34 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-022 (HMO)	1	1		1			H0028	22	0	2020	La Paz and Mohave counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	23	0	1	1	1	H0028_023_0	2	1			05/31/2019	2020.01	05/31/2019 01:42:27 PM Eastern Daylight Time	08/04/2019 11:21:17 AM Eastern Daylight Time	08/02/2019 01:17:51 PM Eastern Daylight Time			08/05/2019 10:50:34 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-023 (HMO)	1	1		1			H0028	23	0	2020	Yavapai County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	24	0	1	1	1	H0028_024_0	2	1			08/01/2019	2020.01	08/01/2019 03:02:37 PM Eastern Daylight Time	08/04/2019 11:23:41 AM Eastern Daylight Time	08/02/2019 01:17:51 PM Eastern Daylight Time			08/05/2019 10:50:34 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-024 (HMO)	1	1		1			H0028	24	0	2020	La Paz and Mohave counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	25	1	1	1	1	H0028_025_1	2	1			08/01/2019	2020.01	08/01/2019 03:33:25 PM Eastern Daylight Time	08/04/2019 11:40:38 AM Eastern Daylight Time	08/02/2019 01:17:51 PM Eastern Daylight Time			08/05/2019 10:50:34 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-025 (HMO)	1	1		1			H0028	25	1	2020	Colorado	Denver Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	4b;8a1;8b3;	
H0028	25	2	1	1	1	H0028_025_2	2	1			08/01/2019	2020.01	08/01/2019 03:37:13 PM Eastern Daylight Time	08/04/2019 11:43:04 AM Eastern Daylight Time	08/02/2019 01:17:51 PM Eastern Daylight Time			08/05/2019 10:50:34 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-025 (HMO)	1	1		1			H0028	25	2	2020	Colorado	North and South Colorado Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	4b;8a1;8a2;8b3;	
H0028	26	1	1	1	1	H0028_026_1	2	1			05/31/2019	2020.01	05/31/2019 01:43:28 PM Eastern Daylight Time	08/04/2019 11:26:02 AM Eastern Daylight Time	08/02/2019 01:17:51 PM Eastern Daylight Time			08/05/2019 10:50:34 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-026 (HMO)	1	1		1			H0028	26	1	2020	Denver Metro Area	Denver Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	4b;8a1;8a2;8b3;	
H0028	26	2	1	1	1	H0028_026_2	2	1			05/31/2019	2020.01	05/31/2019 01:43:45 PM Eastern Daylight Time	08/04/2019 11:28:24 AM Eastern Daylight Time	08/02/2019 01:17:51 PM Eastern Daylight Time			08/05/2019 10:50:34 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-026 (HMO)	1	1		1			H0028	26	2	2020	Denver Metro Area	North and South Colorado Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	4b;8a1;8b3;	
H0028	27	0	1	1	1	H0028_027_0	2	1			08/01/2019	2020.01	08/01/2019 03:45:57 PM Eastern Daylight Time	08/04/2019 11:30:44 AM Eastern Daylight Time	08/02/2019 01:17:52 PM Eastern Daylight Time			08/05/2019 11:12:35 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-027 (HMO)	1	1		1			H0028	27	0	2020	Maricopa County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	4b;7a;7g;8a1;8b3;	
H0028	28	0	1	1	1	H0028_028_0	2	1			08/01/2019	2020.01	08/01/2019 03:46:32 PM Eastern Daylight Time	08/04/2019 11:38:17 AM Eastern Daylight Time	08/02/2019 01:17:52 PM Eastern Daylight Time			08/05/2019 11:12:35 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-028 (HMO)	1	1		1			H0028	28	0	2020	Maricopa County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	29	0	1	1	1	H0028_029_0	3	1			08/01/2019	2020.01	08/01/2019 06:46:23 PM Eastern Daylight Time	08/04/2019 03:38:58 PM Eastern Daylight Time	08/02/2019 01:17:52 PM Eastern Daylight Time			08/05/2019 11:17:05 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-029 (HMO)	1	1		1			H0028	29	0	2020	Corpus Christi Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	30	0	1	1	1	H0028_030_0	3	1			08/01/2019	2020.01	08/01/2019 06:47:03 PM Eastern Daylight Time	08/04/2019 03:40:06 PM Eastern Daylight Time	08/02/2019 01:17:52 PM Eastern Daylight Time			08/05/2019 11:17:05 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-030 (HMO)	1	1		1			H0028	30	0	2020	San Antonio Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	31	0	1	1	1	H0028_031_0	3	1	2	1	08/01/2019	2020.01	08/01/2019 06:58:14 PM Eastern Daylight Time	08/04/2019 03:41:14 PM Eastern Daylight Time	08/02/2019 01:17:52 PM Eastern Daylight Time			08/05/2019 11:21:16 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-031 (HMO D-SNP)	1	1		1			H0028	31	0	2020	Select Counties in Texas		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	32	0	1	1	1	H0028_032_0	3	1	2	1	08/01/2019	2020.01	08/01/2019 06:59:07 PM Eastern Daylight Time	08/04/2019 03:53:51 PM Eastern Daylight Time	08/02/2019 01:17:52 PM Eastern Daylight Time			08/05/2019 11:21:16 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP)	1	1		1			H0028	32	0	2020	Select Counties in Texas		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	33	0	1	1	1	H0028_033_0	3	1	2	1	08/01/2019	2020.01	08/01/2019 07:00:03 PM Eastern Daylight Time	08/04/2019 03:54:59 PM Eastern Daylight Time	08/02/2019 01:17:52 PM Eastern Daylight Time			08/05/2019 11:21:16 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-033 (HMO D-SNP)	1	1		1			H0028	33	0	2020	"Fort Bend, Harris and Montgomery counties"		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	34	0	1	1	1	H0028_034_0	6	1	2	1	07/19/2019	2020.01	07/19/2019 03:06:43 PM Eastern Daylight Time	08/04/2019 03:56:07 PM Eastern Daylight Time	08/02/2019 01:17:52 PM Eastern Daylight Time			08/05/2019 11:21:16 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-034 (HMO D-SNP)	1	1		1			H0028	34	0	2020	El Paso County		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	35	0	1	1	1	H0028_035_0	3	1			08/02/2019	2020.01	08/02/2019 02:55:21 PM Eastern Daylight Time	08/04/2019 03:42:24 PM Eastern Daylight Time	08/02/2019 01:17:52 PM Eastern Daylight Time			08/05/2019 11:17:05 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-035 (HMO)	1	1		1			H0028	35	0	2020	El Paso County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	36	0	1	1	1	H0028_036_0	6	1	2	1	08/01/2019	2020.01	08/01/2019 07:02:13 PM Eastern Daylight Time	08/04/2019 03:43:31 PM Eastern Daylight Time	08/02/2019 01:17:53 PM Eastern Daylight Time			08/05/2019 11:21:16 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-036 (HMO D-SNP)	1	1		1			H0028	36	0	2020	Corpus Christi/San Antonio area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	37	0	1	1	1	H0028_037_0	3	1			08/01/2019	2020.01	08/01/2019 06:48:32 PM Eastern Daylight Time	08/04/2019 03:44:38 PM Eastern Daylight Time	08/02/2019 01:17:53 PM Eastern Daylight Time			08/05/2019 11:17:05 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-037 (HMO)	1	1		1			H0028	37	0	2020	"Hays, Travis and Williamson counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	39	0	1	1	1	H0028_039_0	3	1		1	08/01/2019	2020.01	08/01/2019 07:04:03 PM Eastern Daylight Time	08/04/2019 03:45:46 PM Eastern Daylight Time	08/02/2019 01:17:53 PM Eastern Daylight Time			08/05/2019 11:21:16 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	1	1		1			H0028	39	0	2020	Corpus Christi Metro Area		2		2			1	4			10		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	40	0	1	1	1	H0028_040_0	3	1		1	08/01/2019	2020.01	08/01/2019 07:04:38 PM Eastern Daylight Time	08/04/2019 03:46:54 PM Eastern Daylight Time	08/02/2019 01:17:53 PM Eastern Daylight Time			08/05/2019 11:21:16 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	1	1		1			H0028	40	0	2020	San Antonio Metro Area		2		2			1	4			10		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	41	0	1	1	1	H0028_041_0	3	1			07/15/2019	2020.01	07/15/2019 10:31:50 AM Eastern Daylight Time	08/04/2019 03:48:05 PM Eastern Daylight Time	08/02/2019 01:17:53 PM Eastern Daylight Time			08/05/2019 11:17:05 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-041 (HMO)	1	1		1			H0028	41	0	2020	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	42	0	1	1	1	H0028_042_0	3	1			08/01/2019	2020.01	08/01/2019 06:49:31 PM Eastern Daylight Time	08/04/2019 03:49:15 PM Eastern Daylight Time	08/02/2019 01:17:53 PM Eastern Daylight Time			08/05/2019 11:17:05 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-042 (HMO)	1	1		1			H0028	42	0	2020	Houston Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	43	1	1	1	1	H0028_043_1	3	1			08/01/2019	2020.01	08/01/2019 06:50:18 PM Eastern Daylight Time	08/04/2019 03:50:23 PM Eastern Daylight Time	08/02/2019 01:17:53 PM Eastern Daylight Time			08/05/2019 11:17:05 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-043 (HMO)	1	1		1			H0028	43	1	2020	Dallas area	Dallas area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	43	2	1	1	1	H0028_043_2	3	1			07/15/2019	2020.01	07/15/2019 10:32:35 AM Eastern Daylight Time	08/04/2019 03:51:30 PM Eastern Daylight Time	08/02/2019 01:17:53 PM Eastern Daylight Time			08/05/2019 11:17:05 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-043 (HMO)	1	1		1			H0028	43	2	2020	Dallas area	Dallas area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	44	0	1	1	1	H0028_044_0	3	1	2	1	08/01/2019	2020.01	08/01/2019 07:05:44 PM Eastern Daylight Time	08/04/2019 03:57:15 PM Eastern Daylight Time	08/02/2019 01:17:53 PM Eastern Daylight Time			08/05/2019 11:21:16 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP)	1	1		1			H0028	44	0	2020	"Hays, Travis and Williamson counties"		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	45	0	1	1	1	H0028_045_0	3	1	2	1	08/01/2019	2020.01	08/01/2019 07:06:28 PM Eastern Daylight Time	08/04/2019 03:58:22 PM Eastern Daylight Time	08/02/2019 01:17:54 PM Eastern Daylight Time			08/05/2019 11:21:16 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H0028-045 (HMO D-SNP)	1	1		1			H0028	45	0	2020	"Cameron, Hidalgo and Willacy counties"		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	46	0	1	1	1	H0028_046_0	3	1			08/01/2019	2020.01	08/01/2019 06:51:03 PM Eastern Daylight Time	08/04/2019 03:59:31 PM Eastern Daylight Time	08/02/2019 01:17:54 PM Eastern Daylight Time			08/05/2019 11:17:05 AM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0028-046 (HMO)	1	1		1			H0028	46	0	2020	"Cameron, Hidalgo and Willacy counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0028	801	0	1	1	1	H0028_801_0	2	1			05/29/2019	2020.01	05/29/2019 10:24:10 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H0028	801	0	2020	Select Counties in Multi States		1	44619	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0028	802	0	1	1	1	H0028_802_0	1	1			05/29/2019	2020.01	05/29/2019 10:25:05 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H0028	802	0	2020	Select Counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0028	804	0	1	1	1	H0028_804_0	1	1			05/29/2019	2020.01	05/29/2019 11:08:13 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H0028	804	0	2020	Select Counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H0028	805	0	1	1	1	H0028_805_0	1	1			05/29/2019	2020.01	05/29/2019 11:14:22 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"CHA HMO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H0028	805	0	2020	Select Counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H0029	801	0	1	1	1	H0029_801_0	2	1			05/13/2019	2020.01	05/13/2019 09:16:37 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"COORDINATED CARE OF WASHINGTON, INC."	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	1	1		1			H0029	801	0	2020	Pierce and Spokane Counties		1	100	2			2						allwell.coordinatedcarehealth.com/findadoctor	allwell.coordinatedcarehealth.com/formulary	allwell.coordinatedcarehealth.com/findadoctor	(855)848-6940		(855)848-6940		(877)893-7277		(877)893-7277		(855)848-6940		(855)848-6940		(877)893-7277		(877)893-7277		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0029	802	0	1	1	1	H0029_802_0	2	1			05/03/2019	2020.01	05/03/2019 09:15:11 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"COORDINATED CARE OF WASHINGTON, INC."	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	1	1		1			H0029	802	0	2020	Pierce and Spokane Counties		1	100	2			2						allwell.coordinatedcarehealth.com/findadoctor	allwell.coordinatedcarehealth.com/formulary	allwell.coordinatedcarehealth.com/findadoctor	(855)848-6940		(855)848-6940		(877)893-7277		(877)893-7277										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0029	803	0	1	1	1	H0029_803_0	2	1			05/03/2019	2020.01	05/03/2019 09:20:27 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"COORDINATED CARE OF WASHINGTON, INC."	Allwell	allwell.coordinatedcarehealth.com	Allwell Group (HMO)	1	1		1			H0029	803	0	2020	Pierce and Spokane Counties		1	660	2			2						allwell.coordinatedcarehealth.com/findadoctor	allwell.coordinatedcarehealth.com/formulary	allwell.coordinatedcarehealth.com/findadoctor	(855)848-6940		(855)848-6940		(877)893-7277		(877)893-7277		(855)848-6940		(855)848-6940		(877)893-7277		(877)893-7277		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0034	1	0	1	1	1	H0034_001_0	7	1	2	1	08/05/2019	2020.01	08/05/2019 09:44:36 AM Eastern Daylight Time	08/05/2019 10:14:00 AM Eastern Daylight Time	08/05/2019 10:16:39 AM Eastern Daylight Time			08/05/2019 03:51:35 PM Eastern Daylight Time	"HAMASPIK, INC."	"Hamaspik, Inc."	www.hamaspik.com	Hamaspik Medicare Select (HMO D-SNP)	1	1		1			H0034	1	0	2020	"New York City metro, Hudson Valley, Albany metro"		2		2			1	3		2		1	to be determined	to be determined	To be determined	(888)426-2774		(845)388-1199		(888)426-2774		(845)388-1199		(888)426-2774		(845)388-1199		(888)426-2774		(845)388-1199		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	1	0	1	1	1	H0062_001_0	5	1			08/01/2019	2020.01	08/01/2019 01:18:30 PM Eastern Daylight Time	08/05/2019 04:10:18 PM Central Daylight Time	08/05/2019 02:46:58 PM Central Daylight Time			08/05/2019 06:25:40 PM Central Daylight Time	"SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC."	Allwell	allwell.superiorhealthplan.com	Allwell Medicare (HMO)	1	1		1			H0062	1	0	2020	"San Antonio, El Paso & Corpus Christi Areas"		2		2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	2	0	1	1	1	H0062_002_0	4	1			08/01/2019	2020.01	08/01/2019 01:18:43 PM Eastern Daylight Time	08/05/2019 04:10:22 PM Central Daylight Time	08/05/2019 02:47:01 PM Central Daylight Time			08/05/2019 06:25:40 PM Central Daylight Time	"SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC."	Allwell	allwell.superiorhealthplan.com	Allwell Medicare (HMO)	1	1		1			H0062	2	0	2020	Dallas Metro		2		2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	3	0	1	1	1	H0062_003_0	4	1			08/01/2019	2020.01	08/01/2019 01:18:58 PM Eastern Daylight Time	08/05/2019 04:10:11 PM Central Daylight Time	08/05/2019 02:47:04 PM Central Daylight Time			08/05/2019 06:25:40 PM Central Daylight Time	"SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC."	Allwell	allwell.superiorhealthplan.com	Allwell Medicare (HMO)	1	1		1			H0062	3	0	2020	Rio Grande Valley Area		2		2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	9	0	1	1	1	H0062_009_0	3	1			08/01/2019	2020.01	08/01/2019 01:19:12 PM Eastern Daylight Time	08/05/2019 04:10:15 PM Central Daylight Time	08/05/2019 02:47:07 PM Central Daylight Time			08/05/2019 06:25:40 PM Central Daylight Time	"SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC."	Allwell	allwell.superiorhealthplan.com	Allwell Medicare (HMO)	1	1		1			H0062	9	0	2020	Suburban Houston		2		2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0062	801	0	1	1	1	H0062_801_0	1	1			05/03/2019	2020.01	05/03/2019 09:23:07 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC."	Allwell	allwell.superiorhealthplan.com	Allwell Group (HMO)	1	1		1			H0062	801	0	2020	Texas		1	100	2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0062	802	0	1	1	1	H0062_802_0	1	1			05/03/2019	2020.01	05/03/2019 09:26:15 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC."	Allwell	allwell.superiorhealthplan.com	Allwell Group (HMO)	1	1		1			H0062	802	0	2020	Texas		1	100	2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0062	803	0	1	1	1	H0062_803_0	1	1			05/03/2019	2020.01	05/03/2019 09:29:47 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"SUPERIOR HEALTHPLAN COMMUNITY SOLUTIONS, INC."	Allwell	allwell.superiorhealthplan.com	Allwell Group (HMO)	1	1		1			H0062	803	0	2020	Texas		1	100	2			2						allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(844)796-6811		(844)796-6811		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0088	1	0	1	4	1	H0088_001_0	9	1			07/11/2019	2020.01	07/11/2019 01:36:04 PM Eastern Daylight Time	08/02/2019 02:20:01 AM Eastern Daylight Time	07/30/2019 09:02:00 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H0088	1	0	2020	Select Counties in NY		2	6524	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0104	12	0	1	4	1	H0104_012_0	6	1			08/05/2019	2020.01	08/05/2019 02:47:31 PM Central Daylight Time	08/06/2019 09:28:19 AM Central Daylight Time	08/06/2019 09:28:20 AM Central Daylight Time			08/06/2019 10:28:46 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	1	4		1			H0104	12	0	2020	State of Alabama		2	495561	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(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						2			
H0104	14	0	1	4	1	H0104_014_0	6	1			08/05/2019	2020.01	08/05/2019 09:26:51 AM Central Daylight Time	08/06/2019 09:28:21 AM Central Daylight Time	08/06/2019 09:28:21 AM Central Daylight Time			08/06/2019 10:28:46 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	1	4		1			H0104	14	0	2020	Birmingham/Mobile		2	401569	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(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						2			
H0104	15	0	1	4	1	H0104_015_0	4	1			07/11/2019	2020.01	07/11/2019 03:01:38 PM Central Daylight Time	08/06/2019 09:28:22 AM Central Daylight Time	08/06/2019 09:28:23 AM Central Daylight Time			08/06/2019 10:20:34 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Premier (PPO)	1	4		1			H0104	15	0	2020	State of Alabama		2	77534	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(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						2			
H0104	801	0	1	4	1	H0104_801_0	2	1			05/21/2019	2020.01	05/21/2019 01:21:54 PM Central Daylight Time					05/31/2019 12:19:05 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 801 (PPO)	1	4		1			H0104	801	0	2020	State of Alabama		1	0	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(855)314-4990		(855)314-4990		(855)314-4990		(855)314-4990										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H0104	802	0	1	4	1	H0104_802_0	1	1			05/21/2019	2020.01	05/21/2019 01:36:57 PM Central Daylight Time					05/31/2019 03:23:53 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 802 (PPO)	1	4		1			H0104	802	0	2020	State of Alabama		1	260000	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(855)314-4990		(855)314-4990		(855)314-4990		(855)314-4990		(855)314-4990		(855)314-4990		(855)314-4990		(855)314-4990		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0104	804	0	1	4	1	H0104_804_0	1	1			05/21/2019	2020.01	05/21/2019 01:22:15 PM Central Daylight Time					05/31/2019 12:19:05 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 804 (PPO)	1	4		1			H0104	804	0	2020	State of Alabama		1	0	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(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	805	0	1	4	1	H0104_805_0	2	1			05/21/2019	2020.01	05/21/2019 01:22:42 PM Central Daylight Time					05/31/2019 12:29:28 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 805 (PPO)	1	4		1			H0104	805	0	2020	State of Alabama		1	0	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(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	806	0	1	4	1	H0104_806_0	1	1			05/23/2019	2020.01	05/23/2019 01:00:50 PM Central Daylight Time					05/31/2019 12:19:05 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 806 (PPO)	1	4		1			H0104	806	0	2020	State of Alabama		1	0	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(855)453-5185		(855)453-5185		(855)453-5185		(855)453-5185		(855)453-5185		(855)453-5185		(855)453-5185		(855)453-5185		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H0104	807	0	1	4	1	H0104_807_0	1	1			05/21/2019	2020.01	05/21/2019 01:37:46 PM Central Daylight Time					05/31/2019 03:23:53 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 807 (PPO)	1	4		1			H0104	807	0	2020	State of Alabama		1	264000	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(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	808	0	1	4	1	H0104_808_0	1	1			05/23/2019	2020.01	05/23/2019 01:02:40 PM Central Daylight Time					05/31/2019 12:19:05 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 808 (PPO)	1	4		1			H0104	808	0	2020	State of Alabama		1	0	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(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	809	0	1	4	1	H0104_809_0	1	1			05/23/2019	2020.01	05/23/2019 01:02:55 PM Central Daylight Time					05/31/2019 12:19:05 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Cross and Blue Shield of Alabama	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 809 (PPO)	1	4		1			H0104	809	0	2020	State of Alabma		1	0	2			2						www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com	(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	1	0	1	20	8	H0105_001_0	1	1			05/17/2019	2020.01	05/17/2019 02:37:29 PM Eastern Daylight Time		05/17/2019 02:11:49 PM Eastern Daylight Time			05/17/2019 02:42:10 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)	8	20		1			H0105	1	0	2020	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)535-1561																
H0105	2	0	1	20	8	H0105_002_0	1	1			05/17/2019	2020.01	05/17/2019 02:37:50 PM Eastern Daylight Time		05/17/2019 02:11:52 PM Eastern Daylight Time			05/17/2019 02:42:10 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)	8	20		1			H0105	2	0	2020	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)535-1561																
H0107	3	0	1	4	1	H0107_003_0	5	1			07/15/2019	2020.01	07/15/2019 10:09:56 AM Mountain Daylight Time	08/06/2019 01:24:28 PM Mountain Daylight Time	08/06/2019 01:24:32 PM Mountain Daylight Time			08/06/2019 02:45:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Medicare Advantage Classic (PPO)	1	4		1			H0107	3	0	2020	Montana		2	141564	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.com/providers	(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			
H0107	4	0	1	4	1	H0107_004_0	4	1			06/19/2019	2020.01	06/19/2019 10:29:53 AM Mountain Daylight Time	08/06/2019 01:24:28 PM Mountain Daylight Time	08/06/2019 01:24:32 PM Mountain Daylight Time			08/06/2019 02:45:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Medicare Advantage Optimum (PPO)	1	4		1			H0107	4	0	2020	Montana		2	39720	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.com/providers	(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			
H0107	801	0	1	4	1	H0107_801_0	2	1			05/29/2019	2020.01	05/29/2019 04:14:24 PM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Medicare Advantage Employer Ideal (PPO)	1	4		1			H0107	801	0	2020	Montana		1	12180	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.com/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H0107	802	0	1	4	1	H0107_802_0	2	1			05/29/2019	2020.01	05/29/2019 04:14:35 PM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Medicare Advantage Employer Expanded (PPO)	1	4		1			H0107	802	0	2020	Montana		1	1	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.com/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H0107	803	0	1	4	1	H0107_803_0	2	1			05/02/2019	2020.01	05/02/2019 03:28:58 PM Mountain Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.getbluemt.com/mapd	Blue Cross Medicare Advantage (PPO)	1	4		1			H0107	803	0	2020	State of Montana		1	1	2			2						www.getbluemt.com/pharmacies	www.getbluemt.com/mapd/druglist	www.getbluemt.com/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H0111	1	0	1	4	1	H0111_001_0	6	1			07/11/2019	2020.01	07/11/2019 12:41:43 PM Eastern Daylight Time	08/02/2019 02:21:51 AM Eastern Daylight Time	07/30/2019 09:02:37 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H0111	1	0	2020	Select counties in GA		2	38862	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0111	2	0	1	4	1	H0111_002_0	6	1			07/11/2019	2020.01	07/11/2019 12:56:12 PM Eastern Daylight Time	08/02/2019 02:23:40 AM Eastern Daylight Time	07/30/2019 09:03:13 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Prime (PPO)	1	4		1			H0111	2	0	2020	Select counties in GA		2	11437	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0111	3	0	1	4	1	H0111_003_0	6	1			07/11/2019	2020.01	07/11/2019 12:50:29 PM Eastern Daylight Time	08/02/2019 02:25:25 AM Eastern Daylight Time	07/30/2019 09:03:51 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Flex Complete (PPO)	1	4		1			H0111	3	0	2020	Select counties in GA		2	450	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0112	1	0	1	20	8	H0112_001_0	2	1			05/28/2019	2020.01	05/28/2019 09:24:18 AM Eastern Daylight Time		05/30/2019 09:26:05 AM Eastern Daylight Time			05/30/2019 09:27:44 AM Eastern Daylight Time	"MORSE LIFE HOME CARE, INC."	Palm Beach PACE	www.MorseLife.org	Palm Beach PACE (PACE)	8	20		1			H0112	1	0	2020	Palm Beach County (partial)		2		2			2						MorseLife.org	N/A										(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	2	0	1	20	8	H0112_002_0	2	1			05/28/2019	2020.01	05/28/2019 09:24:32 AM Eastern Daylight Time		05/30/2019 09:25:51 AM Eastern Daylight Time			05/30/2019 09:27:44 AM Eastern Daylight Time	"MORSE LIFE HOME CARE, INC."	Palm Beach PACE	www.MorseLife.org	Palm Beach PACE (PACE)	8	20		1			H0112	2	0	2020	Palm Beach County (partial)		2		2			2						MorseLife.org	N/A										(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	1	0	1	48	5	H0137_001_0	3	1			08/07/2019	2020.01	08/07/2019 12:20:37 PM Eastern Daylight Time					08/07/2019 12:22:41 PM Eastern Daylight Time	"COMMONWEALTH CARE ALLIANCE, INC."	"Commonwealth Care Alliance, Inc."	www.commonwealthonecare.org	Commonwealth Care Alliance (Medicare-Medicaid Plan)	5	48		1			H0137	1	0	2020	"BRI, ESS, FRA, HMD, HMP, MID, NOR, PLY, SUF, WOR."		2	303971	2			2						http://www.commonwealthcarealliance.org/members/pharmacy-program	http://www.commonwealthcarealliance.org/members/pharmacy-program/formulary-2019	www.commonwealthcarealliance.org	(866)610-2273		(866)610-2273		(800)225-5222		(800)225-5222		(866)610-2273		(866)610-2273		(800)225-5222		(800)225-5222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0148	1	0	1	48	5	H0148_001_0	4	1			08/21/2019	2020.01	08/21/2019 12:29:14 PM Pacific Daylight Time					08/21/2019 01:28:17 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/calmediconnect	Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)	5	48		1			H0148	1	0	2020	San Diego County		2		2			2						www.blueshieldca.com/promise/calmediconnect	www.blueshieldca.com/promise/calmediconnect	www.blueshieldca.com/promise/calmediconnect	(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)-																
H0148	2	0	1	48	5	H0148_002_0	4	1			08/21/2019	2020.01	08/21/2019 12:33:23 PM Pacific Daylight Time					08/21/2019 01:28:17 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/calmediconnect	Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan)	5	48		1			H0148	2	0	2020	Los Angeles County		2		2			2						www.blueshieldca.com/promise/calmediconnect	www.blueshieldca.com/promise/calmediconnect	www.blueshieldca.com/promise/calmediconnect	(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)-																
H0154	8	0	1	1	1	H0154_008_0	4	1			07/18/2019	2020.01	07/18/2019 03:21:28 PM Central Daylight Time	07/18/2019 03:54:11 PM Central Daylight Time				07/18/2019 03:55:27 PM Central Daylight Time	"TRITON HEALTH SYSTEMS, L.L.C."	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Select (HMO)	1	1		1			H0154	8	0	2020	"Northwest, Central, and South Alabama"		2		2			2						http://www.vivamedicaremember.com/Download.aspx?ID=992&Type=doc	http://www.vivamedicaremember.com/Download.aspx?ID=1326&Type=doc	www.vivahealth.com/medicare/MemberResources	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0154	11	0	1	1	1	H0154_011_0	4	1			07/24/2019	2020.01	07/24/2019 03:11:25 PM Central Daylight Time	08/01/2019 12:43:16 PM Central Daylight Time	08/01/2019 11:40:14 AM Central Daylight Time			08/04/2019 11:11:21 AM Central Daylight Time	"TRITON HEALTH SYSTEMS, L.L.C."	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Premier (HMO)	1	1		1			H0154	11	0	2020	"Northwest, Central and South Alabama"		2		2			2						www.vivahealth.com/medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/medicare/MemberResources/#Formularies	www.vivahealth.com/medicare/MemberResources	(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	2			
H0154	12	0	1	1	1	H0154_012_0	5	1	2	1	08/04/2019	2020.01	08/04/2019 10:53:46 AM Central Daylight Time	08/06/2019 04:40:33 PM Central Daylight Time	08/01/2019 11:41:22 AM Central Daylight Time			08/06/2019 04:41:26 PM Central Daylight Time	"TRITON HEALTH SYSTEMS, L.L.C."	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Extra Value (HMO D-SNP)	1	1		1			H0154	12	0	2020	"Northwest, Central, and South Alabama"		2		2			1	3		2		2	www.vivahealth.com/medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/medicare/MemberResources/#Formularies	www.vivahealth.com/medicare/MemberResources	(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	2			
H0154	14	0	1	1	1	H0154_014_0	4	1			07/09/2019	2020.01	07/09/2019 05:12:52 PM Central Daylight Time	08/01/2019 12:46:52 PM Central Daylight Time	08/01/2019 11:42:29 AM Central Daylight Time			08/04/2019 11:11:21 AM Central Daylight Time	"TRITON HEALTH SYSTEMS, L.L.C."	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Me (HMO)	1	1		1			H0154	14	0	2020	Central and Southeast Alabama		2		2			2						www.vivahealth.com/medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/medicare/MemberResources/#Formularies	www.vivahealth.com/medicare/MemberResources	(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	2			
H0154	15	1	1	1	1	H0154_015_1	4	1			06/02/2019	2020.01	06/02/2019 05:14:20 PM Central Daylight Time	08/01/2019 12:48:47 PM Central Daylight Time	08/01/2019 11:43:27 AM Central Daylight Time			08/04/2019 11:11:21 AM Central Daylight Time	"TRITON HEALTH SYSTEMS, L.L.C."	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Plus (HMO)	1	1		1			H0154	15	1	2020	"Northwest, Central, and South Alabama"	"Northwest, Central and South Alabama"	2		2			2						www.vivahealth.com/medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/medicare/MemberResources/#Formularies	www.vivahealth.com/medicare/MemberResources	(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	2			
H0154	15	2	1	1	1	H0154_015_2	4	1			07/09/2019	2020.01	07/09/2019 08:22:08 AM Central Daylight Time	08/01/2019 12:50:38 PM Central Daylight Time	08/01/2019 11:44:48 AM Central Daylight Time			08/04/2019 11:11:21 AM Central Daylight Time	"TRITON HEALTH SYSTEMS, L.L.C."	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Plus (HMO)	1	1		1			H0154	15	2	2020	"Northwest, Central, and South Alabama"	"Ft Payne, Troy, Jasper, Russellville Area"	2		2			2						www.vivahealth.com/medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/medicare/MemberResources/#Formularies	www.vivahealth.com/medicare/MemberResources	(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	2			
H0154	16	0	1	1	1	H0154_016_0	4	1			07/09/2019	2020.01	07/09/2019 08:26:13 AM Central Daylight Time	08/01/2019 12:52:31 PM Central Daylight Time	08/01/2019 11:45:46 AM Central Daylight Time			08/04/2019 11:11:21 AM Central Daylight Time	"TRITON HEALTH SYSTEMS, L.L.C."	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Prime (HMO)	1	1		1			H0154	16	0	2020	"Northwest, Central and South Alabama"		2		2			2						www.vivahealth.com/medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/medicare/MemberResources/#Formularies	www.vivahealth.com/medicare/MemberResources	(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	2			
H0154	801	0	1	1	1	H0154_801_0	2	1			06/03/2019	2020.01	06/03/2019 10:15:31 AM Central Daylight Time					06/03/2019 10:16:16 AM Central Daylight Time	"TRITON HEALTH SYSTEMS, L.L.C."	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Group Plan with Rx (CY) (HMO)	1	1		1			H0154	801	0	2020	State of Alabama		1	2100	2			2						www.vivahealth.com/medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/medicare/MemberResources/#Formularies	www.vivahealth.com/medicare/MemberResources	(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	1a;1b;2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;11c;12;15;16b;	1	7d;	1					2				
H0154	802	0	1	1	1	H0154_802_0	2	1			06/03/2019	2020.01	06/03/2019 10:02:35 AM Central Daylight Time					06/03/2019 10:16:16 AM Central Daylight Time	"TRITON HEALTH SYSTEMS, L.L.C."	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Group Plan (no Rx) (HMO)	1	1		1			H0154	802	0	2020	State of Alabama		1	2100	2			2						http://www.vivamedicaremember.com/Download.aspx?ID=992&Type=doc	http://www.vivamedicaremember.com/Download.aspx?ID=1326&Type=doc	www.vivahealth.com/medicare/MemberResources	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;11c;12;15;16b;	1	7d;	1					2				
H0154	803	0	1	1	1	H0154_803_0	2	1			06/03/2019	2020.01	06/03/2019 10:04:42 AM Central Daylight Time					06/03/2019 10:16:16 AM Central Daylight Time	"TRITON HEALTH SYSTEMS, L.L.C."	VIVA Medicare	www.vivahealth.com/Medicare	VIVA Medicare Plus Group Plan with Rx (not CY) (HMO)	1	1		1			H0154	803	0	2020	State of Alabama		1	2100	2			2						www.vivahealth.com/medicare/MemberResources/#PharmacyDirectories	www.vivahealth.com/medicare/MemberResources/#Formularies	www.vivahealth.com/medicare/MemberResources	(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	1a;1b;2;3-1;3-2;3-3;5;6;7c;7i;8a;8b1;8b2;9a1;9a2;9b;10a;11a;11b;11c;12;15;16b;	1	7d;	1					2				
H0169	1	0	1	1	1	H0169_001_0	5	1	2	1	07/11/2019	2020.01	07/11/2019 09:37:22 AM Central Daylight Time	08/02/2019 10:27:31 AM Central Daylight Time	07/30/2019 05:01:47 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDWEST, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H0169	1	0	2020	Select Counties in Iowa		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-6883		(844)368-6883		(888)834-3721		(888)834-3721		(844)368-6883		(844)368-6883		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0169	2	0	1	1	1	H0169_002_0	4	1	2	1	07/11/2019	2020.01	07/11/2019 01:53:29 PM Central Daylight Time	08/02/2019 10:27:54 AM Central Daylight Time	07/30/2019 05:02:22 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDWEST, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H0169	2	0	2020	Select Counties in Missouri		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-6886		(844)368-6886		(888)834-3721		(888)834-3721		(844)368-6886		(844)368-6886		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0169	3	0	1	1	1	H0169_003_0	3	1	2	1	07/11/2019	2020.01	07/11/2019 02:37:58 PM Central Daylight Time	08/02/2019 10:28:17 AM Central Daylight Time	07/30/2019 05:02:55 PM Central Daylight Time			08/06/2019 03:24:56 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDWEST, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H0169	3	0	2020	Select Counties in Nebraska		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-7149		(844)368-7149		(888)834-3721		(888)834-3721		(844)368-7149		(844)368-7149		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0169	4	0	1	1	1	H0169_004_0	4	1	2	1	07/11/2019	2020.01	07/11/2019 09:39:20 AM Central Daylight Time	08/02/2019 10:28:39 AM Central Daylight Time	07/30/2019 05:03:31 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDWEST, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP1 (HMO D-SNP)	1	1		1			H0169	4	0	2020	Select Counties in Kansas		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)262-9947		(866)262-9947		(888)834-3721		(888)834-3721		(866)262-9947		(866)262-9947		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	1	0	1	1	1	H0174_001_0	5	1	2	1	08/02/2019	2020.01	08/02/2019 01:58:48 PM Eastern Daylight Time	08/02/2019 01:42:16 PM Eastern Daylight Time	07/30/2019 09:04:29 PM Eastern Daylight Time			08/05/2019 04:03:16 PM Eastern Daylight Time	"WELLCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	WellCare TexanPlus Star (HMO D-SNP)	1	1		1			H0174	1	0	2020	Select counties in TX		2	16265	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)245-4143		(866)245-4143		(833)444-9089		(833)444-9089		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	2	0	1	1	1	H0174_002_0	6	1			07/17/2019	2020.01	07/17/2019 10:44:49 AM Eastern Daylight Time	08/02/2019 09:35:26 AM Eastern Daylight Time	07/30/2019 09:05:07 PM Eastern Daylight Time			08/05/2019 04:03:16 PM Eastern Daylight Time	"WELLCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	WellCare TexanPlus Classic (HMO)	1	1		1			H0174	2	0	2020	Select counties in TX		2	9019	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	3	0	1	1	1	H0174_003_0	5	1			07/16/2019	2020.01	07/16/2019 01:26:48 PM Eastern Daylight Time	08/02/2019 09:37:17 AM Eastern Daylight Time	07/30/2019 09:05:43 PM Eastern Daylight Time			08/05/2019 04:03:16 PM Eastern Daylight Time	"WELLCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	WellCare TexanPlus Classic (HMO)	1	1		1			H0174	3	0	2020	Select counties in TX		2	9109	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	4	0	1	1	1	H0174_004_0	5	1	2	1	08/05/2019	2020.01	08/05/2019 04:31:51 PM Eastern Daylight Time	08/02/2019 10:42:30 AM Eastern Daylight Time	07/30/2019 09:06:18 PM Eastern Daylight Time			08/05/2019 04:42:07 PM Eastern Daylight Time	"WELLCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H0174	4	0	2020	Select Counties in TX		2	104959	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)245-4143		(866)245-4143		(833)444-9089		(833)444-9089		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	5	0	1	2	1	H0174_005_0	4	1			07/16/2019	2020.01	07/16/2019 01:28:52 PM Eastern Daylight Time	08/02/2019 09:42:06 AM Eastern Daylight Time	07/30/2019 09:06:55 PM Eastern Daylight Time			08/05/2019 04:03:16 PM Eastern Daylight Time	"WELLCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	1	2		1			H0174	5	0	2020	Select Counties in TX		2	142084	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	6	0	1	1	1	H0174_006_0	5	1	2	1	08/05/2019	2020.01	08/05/2019 04:32:15 PM Eastern Daylight Time	08/02/2019 10:44:46 AM Eastern Daylight Time	07/30/2019 09:07:31 PM Eastern Daylight Time			08/05/2019 04:42:07 PM Eastern Daylight Time	"WELLCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H0174	6	0	2020	Select Counties in TX		2	43778	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)245-4143		(866)245-4143		(833)444-9089		(833)444-9089		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	7	0	1	1	1	H0174_007_0	4	1			07/16/2019	2020.01	07/16/2019 01:29:47 PM Eastern Daylight Time	08/02/2019 09:47:32 AM Eastern Daylight Time	07/30/2019 09:08:05 PM Eastern Daylight Time			08/05/2019 04:03:16 PM Eastern Daylight Time	"WELLCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	1	1		1			H0174	7	0	2020	Select Counties in TX		2	75605	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0174	8	0	1	1	1	H0174_008_0	4	1		1	07/16/2019	2020.01	07/16/2019 01:30:43 PM Eastern Daylight Time	08/02/2019 09:49:31 AM Eastern Daylight Time	07/30/2019 09:08:40 PM Eastern Daylight Time			08/05/2019 04:03:16 PM Eastern Daylight Time	"WELLCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	WellCare Guardian (HMO C-SNP)	1	1		1			H0174	8	0	2020	Select Counties in TX		2	4256	2			1	4			10		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)245-4143		(866)245-4143		(833)444-9089		(833)444-9089		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0192	1	0	1	48	5	H0192_001_0	1	1			05/30/2019	2020.01	05/30/2019 12:53:46 PM Central Daylight Time					06/03/2019 01:38:22 PM Central Daylight Time	"AMERIHEALTH MICHIGAN, INC."	AmeriHealth Caritas VIP Care Plus	www.amerihealthcaritasvipcareplus.com	AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan)	5	48		1			H0192	1	0	2020	Wayne and Macomb Counties		2		2			2						www.amerihealthcaritasvipcareplus.com	www.amerihealthcaritasvipcareplus.com	www.amerihealthcaritasvipcareplus.com	(888)667-0318		(888)667-0318		(877)716-8694		(877)716-8694		(888)667-0318		(888)667-0318		(877)716-8694		(877)716-8694		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0216	1	0	1	20	8	H0216_001_0	1	1			05/30/2019	2020.01	05/30/2019 11:36:58 AM Central Daylight Time		05/22/2019 07:02:20 AM Central Daylight Time			05/30/2019 11:39:57 AM Central Daylight Time	PACE IOWA	Immanuel Pathways Iowa	Immanuel.com	PACE Iowa (PACE)	8	20		1			H0216	1	0	2020	"Mills, Harrison, and Pottawattamie Counties"		2		2			2						www.immanuel.com	www.immanuel.com												(712)256-7284		(000)000-0000		(712)256-7284												(712)256-7284		(000)000-0000		(712)256-7284																
H0216	2	0	1	20	8	H0216_002_0	1	1			05/30/2019	2020.01	05/30/2019 11:37:40 AM Central Daylight Time		05/22/2019 07:02:26 AM Central Daylight Time			05/30/2019 11:39:57 AM Central Daylight Time	PACE IOWA	Immanuel Pathways Iowa	Immanuel.com	PACE Iowa (PACE)	8	20		1			H0216	2	0	2020	"Counties: PK, MR, SR, BN, DA, MD, JP, WA, MA"		2		2			2						www.immanuel.com	www.immanuel.com												(515)270-5000				(515)270-5000												(515)270-5000				(515)270-5000																
H0251	2	0	1	1	1	H0251_002_0	4	1	2	1	08/06/2019	2020.01	08/06/2019 11:42:40 AM Central Daylight Time	08/02/2019 10:29:01 AM Central Daylight Time	07/30/2019 05:04:04 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	"UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H0251	2	0	2020	Select Counties in Tennessee		2		2			1	3		1		1	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	2			
H0251	4	0	1	1	1	H0251_004_0	3	1	2	1	08/06/2019	2020.01	08/06/2019 11:42:50 AM Central Daylight Time	08/02/2019 10:29:24 AM Central Daylight Time	07/30/2019 05:04:40 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	"UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO D-SNP)	1	1		1			H0251	4	0	2020	Select Counties in Tennessee		2		2			1	3		1		1	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	2			
H0251	5	0	1	1	1	H0251_005_0	3	1	2	1	08/06/2019	2020.01	08/06/2019 11:43:01 AM Central Daylight Time	08/02/2019 01:35:12 PM Central Daylight Time	07/30/2019 05:05:13 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	"UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE Plus (HMO D-SNP)	1	1		1			H0251	5	0	2020	Select Counties in Tennessee		2		2			1	3		1		1	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	2			
H0270	1	0	1	4	1	H0270_001_0	5	1			07/16/2019	2020.01	07/16/2019 10:36:39 AM Eastern Daylight Time	08/02/2019 02:31:54 AM Eastern Daylight Time	07/30/2019 09:09:14 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H0270	1	0	2020	Select counties in AR		2	720	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	2	0	1	4	1	H0271_002_0	4	1			08/02/2019	2020.01	08/02/2019 08:52:56 AM Central Daylight Time	08/02/2019 10:13:07 AM Central Daylight Time	07/30/2019 05:05:47 PM Central Daylight Time			08/05/2019 06:03:25 PM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	1	4		1			H0271	2	0	2020	"Ada, Canyon, Gem, and Payette counties"		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	3	0	1	4	1	H0271_003_0	3	1			06/02/2019	2020.01	06/02/2019 11:52:23 AM Central Daylight Time	08/02/2019 10:13:48 AM Central Daylight Time	07/30/2019 05:06:24 PM Central Daylight Time			08/05/2019 06:03:25 PM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	1	4		1			H0271	3	0	2020	Select Counties in Utah		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	4	0	1	4	1	H0271_004_0	2	1			08/02/2019	2020.01	08/02/2019 12:01:16 PM Central Daylight Time	08/02/2019 10:14:33 AM Central Daylight Time	07/30/2019 05:07:00 PM Central Daylight Time			08/05/2019 04:04:35 PM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	1	4		1			H0271	4	0	2020	Cook County		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	5	0	1	4	1	H0271_005_0	2	1	2	1	06/01/2019	2020.01	06/01/2019 09:22:22 AM Central Daylight Time	08/02/2019 10:15:16 AM Central Daylight Time	07/30/2019 05:07:34 PM Central Daylight Time			08/06/2019 03:01:34 PM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO D-SNP)	1	4		1			H0271	5	0	2020	Select Counties in Indiana		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	6	0	1	4	1	H0271_006_0	3	1	2	1	08/06/2019	2020.01	08/06/2019 09:55:09 AM Central Daylight Time	08/02/2019 10:15:58 AM Central Daylight Time	07/30/2019 05:08:08 PM Central Daylight Time			08/06/2019 01:20:50 PM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO D-SNP)	1	4		1			H0271	6	0	2020	Select Counties in Maine		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	7	0	1	4	1	H0271_007_0	4	1			07/17/2019	2020.01	07/17/2019 12:28:53 PM Central Daylight Time	08/02/2019 10:16:40 AM Central Daylight Time	07/30/2019 05:08:42 PM Central Daylight Time			08/06/2019 01:20:50 PM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	1	4		1			H0271	7	0	2020	Select counties in New Hampshire		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	8	0	1	4	1	H0271_008_0	2	1			07/11/2019	2020.01	07/11/2019 03:25:27 PM Central Daylight Time	08/02/2019 10:17:22 AM Central Daylight Time	07/30/2019 05:09:20 PM Central Daylight Time			08/06/2019 02:44:08 PM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	1	4		1			H0271	8	0	2020	"Graham, Santa Cruz, and Yavapai counties"		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	10	0	1	4	1	H0271_010_0	4	1			07/17/2019	2020.01	07/17/2019 10:26:56 AM Central Daylight Time	08/02/2019 10:18:06 AM Central Daylight Time	07/30/2019 05:09:53 PM Central Daylight Time			08/06/2019 02:44:08 PM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	1	4		1			H0271	10	0	2020	Select Counties in New Mexico		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	11	0	1	4	1	H0271_011_0	2	1			05/28/2019	2020.01	05/28/2019 03:24:00 PM Central Daylight Time	08/02/2019 10:18:48 AM Central Daylight Time	07/30/2019 05:10:26 PM Central Daylight Time			08/06/2019 02:44:08 PM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	1	4		1			H0271	11	0	2020	"Dona Ana, Grant, Hidalgo, Luna, Sierra counties"		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	12	0	1	4	1	H0271_012_0	2	1			05/30/2019	2020.01	05/30/2019 03:34:40 PM Central Daylight Time	08/02/2019 10:19:34 AM Central Daylight Time	07/30/2019 05:11:00 PM Central Daylight Time			08/06/2019 01:20:50 PM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (PPO)	1	4		1			H0271	12	0	2020	Select counties in Vermont		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	13	0	1	4	1	H0271_013_0	3	1	2	1	08/05/2019	2020.01	08/05/2019 04:45:33 PM Central Daylight Time	08/02/2019 10:20:16 AM Central Daylight Time	07/30/2019 05:11:37 PM Central Daylight Time			08/06/2019 08:35:39 AM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO D-SNP)	1	4		1			H0271	13	0	2020	Select Counties in West Virginia		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0271	14	0	1	4	1	H0271_014_0	3	1	2	1	08/05/2019	2020.01	08/05/2019 04:46:18 PM Central Daylight Time	08/02/2019 10:20:58 AM Central Daylight Time	07/30/2019 05:12:12 PM Central Daylight Time			08/06/2019 08:35:39 AM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (PPO D-SNP)	1	4		1			H0271	14	0	2020	State of Connecticut		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0281	1	0	1	48	5	H0281_001_0	3	1			06/24/2019	2020.01	06/24/2019 08:49:45 AM Pacific Daylight Time					06/27/2019 02:13:47 PM Pacific Daylight Time	ILLINICARE HEALTH PLAN	IlliniCare Health	mmp.illinicare.com	IlliniCare Health - MMAI (Medicare-Medicaid Plan)	5	48		1			H0281	1	0	2020	"Cook, DuPage, Kane, Kankakee, Lake & Will Counties"		2	87000	2			2						mmp.illinicare.com/findadoctor	mmp.illinicare.com/formulary	mmp.illinicare.com/findadoctor	(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(877)941-0482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0292	1	0	1	1	1	H0292_001_0	3	1			08/01/2019	2020.01	08/01/2019 02:47:55 PM Eastern Daylight Time	08/04/2019 03:06:37 PM Eastern Daylight Time	08/02/2019 01:17:54 PM Eastern Daylight Time			08/05/2019 10:59:57 AM Eastern Daylight Time	"HUMANA HEALTH PLAN OF OHIO, INC."	Humana	www.humana.com/medicare	Humana Community (HMO)	1	1		1			H0292	1	0	2020	Select counties in Northern Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0292	2	0	1	1	1	H0292_002_0	3	1			08/01/2019	2020.01	08/01/2019 02:48:34 PM Eastern Daylight Time	08/04/2019 03:10:23 PM Eastern Daylight Time	08/02/2019 01:17:54 PM Eastern Daylight Time			08/05/2019 10:59:57 AM Eastern Daylight Time	"HUMANA HEALTH PLAN OF OHIO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H0292-002 (HMO)	1	1		1			H0292	2	0	2020	Select counties in Northern Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0294	2	0	1	4	1	H0294_002_0	2	1		1	08/06/2019	2020.01	08/06/2019 08:41:55 AM Central Daylight Time	08/02/2019 10:15:18 AM Central Daylight Time	07/30/2019 05:12:46 PM Central Daylight Time			08/06/2019 10:24:54 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assist (PPO C-SNP)	1	4		1			H0294	2	0	2020	Select counties in Wisconsin		2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0294	4	0	1	4	1	H0294_004_0	3	1			08/02/2019	2020.01	08/02/2019 10:23:30 AM Central Daylight Time	08/02/2019 10:15:40 AM Central Daylight Time	07/30/2019 05:13:20 PM Central Daylight Time			08/06/2019 10:24:54 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Open (PPO)	1	4		1			H0294	4	0	2020	Select counties in Wisconsin		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0294	10	0	1	4	1	H0294_010_0	3	1		1	08/06/2019	2020.01	08/06/2019 08:38:37 AM Central Daylight Time	08/02/2019 10:16:03 AM Central Daylight Time	07/30/2019 05:13:53 PM Central Daylight Time			08/06/2019 10:24:54 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assist (PPO C-SNP)	1	4		1			H0294	10	0	2020	Select counties in Wisconsin		2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0294	11	0	1	4	1	H0294_011_0	3	1			08/02/2019	2020.01	08/02/2019 10:26:42 AM Central Daylight Time	08/02/2019 10:16:25 AM Central Daylight Time	07/30/2019 05:14:24 PM Central Daylight Time			08/06/2019 10:24:54 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Open (PPO)	1	4		1			H0294	11	0	2020	Select counties in Wisconsin		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0294	12	0	1	4	1	H0294_012_0	3	1			08/02/2019	2020.01	08/02/2019 10:27:39 AM Central Daylight Time	08/02/2019 10:16:47 AM Central Daylight Time	07/30/2019 05:14:58 PM Central Daylight Time			08/06/2019 10:24:54 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Open Premier (PPO)	1	4		1			H0294	12	0	2020	Select counties in Wisconsin		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0294	14	0	1	4	1	H0294_014_0	2	1			07/11/2019	2020.01	07/11/2019 01:35:08 PM Central Daylight Time	05/31/2019 11:16:58 AM Central Daylight Time				07/12/2019 10:45:37 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Open Essential (PPO)	1	4		1			H0294	14	0	2020	Western Wisconsin Counties		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H0294	15	0	1	4	1	H0294_015_0	3	1			08/05/2019	2020.01	08/05/2019 09:48:53 AM Central Daylight Time	08/02/2019 10:17:32 AM Central Daylight Time	07/30/2019 05:15:32 PM Central Daylight Time			08/06/2019 10:24:54 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H0294	15	0	2020	"Brown, Kewaunee, and Outagamie Counties"		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0294	16	0	1	4	1	H0294_016_0	3	1			08/05/2019	2020.01	08/05/2019 09:49:06 AM Central Daylight Time	08/02/2019 10:17:54 AM Central Daylight Time	07/30/2019 05:16:05 PM Central Daylight Time			08/06/2019 10:24:54 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H0294	16	0	2020	Dane and Rock Counties		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0302	1	0	1	1	1	H0302_001_0	9	1			07/10/2019	2020.01	07/10/2019 11:52:44 AM US Mountain Standard Time	08/06/2019 03:26:18 PM US Mountain Standard Time	08/06/2019 11:51:26 AM US Mountain Standard Time			08/06/2019 05:02:40 PM US Mountain Standard Time	"MEDISUN, INC."	Blue Cross Blue Shield of Arizona Advantage	azbluemedicare.com	Blue Medicare Advantage Plus (HMO)	1	1		1			H0302	1	0	2020	Maricopa County and partial Pinal County		2	176592	2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0302	6	0	1	1	1	H0302_006_0	9	1			07/10/2019	2020.01	07/10/2019 11:56:53 AM US Mountain Standard Time	08/06/2019 03:37:42 PM US Mountain Standard Time	08/06/2019 11:51:26 AM US Mountain Standard Time			08/06/2019 05:02:40 PM US Mountain Standard Time	"MEDISUN, INC."	Blue Cross Blue Shield of Arizona Advantage	azbluemedicare.com	Blue Medicare Advantage Classic (HMO)	1	1		1			H0302	6	0	2020	Maricopa County and partial Pinal County		2	185112	2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0302	8	0	1	1	1	H0302_008_0	9	1			07/10/2019	2020.01	07/10/2019 11:57:43 AM US Mountain Standard Time	08/06/2019 03:42:16 PM US Mountain Standard Time	08/06/2019 11:51:26 AM US Mountain Standard Time			08/06/2019 05:02:40 PM US Mountain Standard Time	"MEDISUN, INC."	Blue Cross Blue Shield of Arizona Advantage	azbluemedicare.com	Blue Medicare Advantage Classic (HMO)	1	1		1			H0302	8	0	2020	Pima County		2	41484	2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0302	9	0	1	1	1	H0302_009_0	9	1			07/10/2019	2020.01	07/10/2019 11:58:25 AM US Mountain Standard Time	08/06/2019 03:45:31 PM US Mountain Standard Time	08/06/2019 11:51:26 AM US Mountain Standard Time			08/06/2019 05:02:40 PM US Mountain Standard Time	"MEDISUN, INC."	Blue Cross Blue Shield of Arizona Advantage	azbluemedicare.com	Blue Medicare Advantage Standard (HMO)	1	1		1			H0302	9	0	2020	Santa Cruz County		2	2868	2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0302	801	0	1	1	1	H0302_801_0	7	1			05/31/2019	2020.01	05/31/2019 03:09:44 PM US Mountain Standard Time					06/03/2019 05:11:15 PM US Mountain Standard Time	"MEDISUN, INC."	Blue Cross Blue Shield of Arizona Advantage	azbluemedicare.com	Blue Medicare Advantage Employer Plan (HMO)	1	1		1			H0302	801	0	2020	Arizona		1	60000	2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0321	2	0	1	1	1	H0321_002_0	6	1	2	1	08/06/2019	2020.01	08/06/2019 09:15:36 AM Central Daylight Time	08/02/2019 11:06:08 AM Central Daylight Time	07/30/2019 05:16:39 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	"ARIZONA PHYSICIANS IPA, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO D-SNP)	1	1		1			H0321	2	0	2020	Select counties in Arizona		2		2			1	3		2		2	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	2			
H0321	4	0	1	1	1	H0321_004_0	6	1	2	1	08/06/2019	2020.01	08/06/2019 09:08:34 AM Central Daylight Time	08/02/2019 11:06:38 AM Central Daylight Time	07/30/2019 05:17:13 PM Central Daylight Time			08/06/2019 09:21:24 AM Central Daylight Time	"ARIZONA PHYSICIANS IPA, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO D-SNP)	1	1		1			H0321	4	0	2020	Select counties in Arizona		2		2			1	3		2		2	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	2			
H0332	1	0	1	1	1	H0332_001_0	8	1			07/09/2019	2020.01	07/09/2019 03:17:46 PM Central Daylight Time	06/01/2019 04:02:08 PM Central Daylight Time				07/09/2019 03:23:56 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential (HMO)	1	1		1			H0332	1	0	2020	"Harris, Ft Bend, Galveston and Montgomery counties"		2	23951	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2	2			
H0332	2	0	1	1	1	H0332_002_0	10	1			08/02/2019	2020.01	08/02/2019 12:13:41 PM Central Daylight Time	08/06/2019 02:43:23 PM Central Daylight Time	08/06/2019 02:43:20 PM Central Daylight Time			08/06/2019 02:52:07 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx (HMO)	1	1		1			H0332	2	0	2020	"Harris, Ft Bend, Galveston and Montgomery counties"		2	363094	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(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	2			
H0332	3	0	1	2	1	H0332_003_0	8	1			07/09/2019	2020.01	07/09/2019 03:18:12 PM Central Daylight Time	06/01/2019 04:01:56 PM Central Daylight Time				07/09/2019 03:23:56 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice (HMO-POS)	1	2		1			H0332	3	0	2020	"Harris, Ft Bend, Galveston and Montgomery counties"		2	9752	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2	2			
H0332	4	0	1	2	1	H0332_004_0	10	1			08/02/2019	2020.01	08/02/2019 12:14:03 PM Central Daylight Time	08/06/2019 02:44:24 PM Central Daylight Time	08/06/2019 02:45:55 PM Central Daylight Time			08/06/2019 02:52:07 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice (HMO-POS)	1	2		1			H0332	4	0	2020	"Harris, Ft Bend, Galveston and Montgomery counties"		2	19667	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(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	2			
H0332	7	0	1	2	1	H0332_007_0	8	1			07/09/2019	2020.01	07/09/2019 03:18:40 PM Central Daylight Time	06/01/2019 04:03:43 PM Central Daylight Time				07/09/2019 03:23:56 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Select (HMO-POS)	1	2		1			H0332	7	0	2020	Gulf Coast Region		2	2914	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2	2			
H0332	8	0	1	2	1	H0332_008_0	10	1			08/02/2019	2020.01	08/02/2019 12:14:24 PM Central Daylight Time	08/06/2019 02:44:19 PM Central Daylight Time	08/06/2019 02:45:19 PM Central Daylight Time			08/06/2019 02:52:07 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Select (HMO-POS)	1	2		1			H0332	8	0	2020	Gulf coast region		2	2914	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(866)535-8343		(713)442-2273		(800)663-7146		(713)442-5646		(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	2			
H0332	801	0	1	1	1	H0332_801_0	5	1			05/27/2019	2020.01	05/27/2019 02:16:41 PM Central Daylight Time					06/01/2019 10:06:36 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	1	1		1			H0332	801	0	2020	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										1	2		2		1					1				
H0332	803	0	1	1	1	H0332_803_0	5	1			05/27/2019	2020.01	05/27/2019 02:16:52 PM Central Daylight Time					06/01/2019 10:06:36 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	1	1		1			H0332	803	0	2020	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	804	0	1	1	1	H0332_804_0	5	1			05/17/2019	2020.01	05/17/2019 11:39:02 AM Central Daylight Time					06/01/2019 10:06:36 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice Retiree (HMO)	1	1		1			H0332	804	0	2020	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										1	2		2		1					1				
H0332	805	0	1	1	1	H0332_805_0	5	1			05/17/2019	2020.01	05/17/2019 11:39:14 AM Central Daylight Time					06/01/2019 10:06:36 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice Retiree (HMO)	1	1		1			H0332	805	0	2020	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		2					1				
H0332	806	0	1	1	1	H0332_806_0	5	1			05/27/2019	2020.01	05/27/2019 02:17:12 PM Central Daylight Time					06/01/2019 10:06:36 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	1	1		1			H0332	806	0	2020	Texas		1	27112	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(877)853-9075		(713)442-2377		(877)853-9075		(713)442-2377										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										1	2		2		1					1				
H0332	807	0	1	1	1	H0332_807_0	5	1			05/27/2019	2020.01	05/27/2019 02:17:33 PM Central Daylight Time					06/01/2019 10:06:36 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	1	1		1			H0332	807	0	2020	Texas		1	857	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	808	0	1	1	1	H0332_808_0	5	1			05/27/2019	2020.01	05/27/2019 02:17:53 PM Central Daylight Time					06/01/2019 10:06:36 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice Retiree (HMO)	1	1		1			H0332	808	0	2020	Texas		1	4060	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										1	2		2		1					1				
H0332	809	0	1	1	1	H0332_809_0	5	1			05/27/2019	2020.01	05/27/2019 02:18:04 PM Central Daylight Time					06/01/2019 10:06:36 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice Retiree (HMO)	1	1		1			H0332	809	0	2020	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	810	0	1	1	1	H0332_810_0	5	1			05/27/2019	2020.01	05/27/2019 02:18:24 PM Central Daylight Time					06/01/2019 10:06:36 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	1	1		1			H0332	810	0	2020	Texas		1	3967	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	811	0	1	1	1	H0332_811_0	5	1			05/27/2019	2020.01	05/27/2019 02:18:44 PM Central Daylight Time					06/01/2019 10:06:36 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	1	1		1			H0332	811	0	2020	Texas		1	69014	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	812	0	1	1	1	H0332_812_0	5	1			05/27/2019	2020.01	05/27/2019 02:18:55 PM Central Daylight Time					06/01/2019 10:06:36 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	1	1		1			H0332	812	0	2020	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	813	0	1	1	1	H0332_813_0	5	1			05/27/2019	2020.01	05/27/2019 02:19:05 PM Central Daylight Time					06/01/2019 10:06:36 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage RX Retiree (HMO)	1	1		1			H0332	813	0	2020	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		1	2		2		1					1				
H0332	814	0	1	1	1	H0332_814_0	5	1			05/27/2019	2020.01	05/27/2019 02:19:15 PM Central Daylight Time					06/01/2019 10:06:36 PM Central Daylight Time	"KS PLAN ADMINISTRATORS, LLC"	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	1	1		1			H0332	814	0	2020	Texas		1	108	2			2						www.kelseycareadvantage.com	www.kelseycareadvantage.com	www.Kelseycareadvantage.com	(866)534-0554		(713)442-2273		(866)534-0554		(713)442-5646										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										1	2		2		1					1				
H0336	1	0	1	48	5	H0336_001_0	2	1			06/21/2019	2020.01	06/21/2019 11:54:08 AM Eastern Daylight Time					06/24/2019 01:04:31 PM Eastern Daylight Time	"HUMANA HEALTH PLAN, INC."	Humana	www.humana.com/medicare/medicaid-dual/illinois/	Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)	5	48		1			H0336	1	0	2020	Chicago Metro Area		2	90611	2			2						www.humana.com/medicare/medicaid-dual/illinois/pharmacy/	www.humana.com/medicare/medicaid-dual/illinois/pharmacy/	www.humana.com/medicare/medicaid-dual/illinois/help/	(800)787-3311		(800)787-3311		(855)635-9561		(855)635-9561		(800)787-3311		(800)787-3311		(855)635-9561		(855)635-9561		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0351	38	0	1	1	1	H0351_038_0	6	1		1	08/01/2019	2020.01	08/01/2019 09:26:36 AM Pacific Daylight Time	08/05/2019 03:51:32 PM Central Daylight Time	08/05/2019 02:52:19 PM Central Daylight Time			08/05/2019 04:23:35 PM Central Daylight Time	"HEALTH NET OF ARIZONA, INC."	Allwell	allwell.azcompletehealth.com	Allwell CHF/Diabetes Medicare (HMO C-SNP)	1	1		1			H0351	38	0	2020	Maricopa and Pinal Counties		2		2			1	4			100		allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(877)935-8020		(877)935-8020		(800)333-3930		(800)333-3930		(877)935-8020		(877)935-8020		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0351	44	1	1	1	1	H0351_044_1	6	1			07/08/2019	2020.01	07/08/2019 09:32:54 AM US Mountain Standard Time	08/05/2019 03:51:36 PM Central Daylight Time	08/05/2019 02:52:23 PM Central Daylight Time			08/05/2019 04:47:01 PM Central Daylight Time	"HEALTH NET OF ARIZONA, INC."	Allwell	allwell.azcompletehealth.com	Allwell Medicare (HMO)	1	1		1			H0351	44	1	2020	"Pima, Cochise, Santa Cruz Counties"	"Pima, Cochise, Santa Cruz Counties"	2		2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(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	2			
H0351	44	2	1	1	1	H0351_044_2	6	1			07/08/2019	2020.01	07/08/2019 09:34:00 AM US Mountain Standard Time	08/05/2019 03:51:18 PM Central Daylight Time	08/05/2019 02:52:26 PM Central Daylight Time			08/05/2019 04:53:14 PM Central Daylight Time	"HEALTH NET OF ARIZONA, INC."	Allwell	allwell.azcompletehealth.com	Allwell Medicare (HMO)	1	1		1			H0351	44	2	2020	"Pima, Cochise, Santa Cruz Counties"	"Pima, Cochise, Santa Cruz Counties"	2		2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(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	2			
H0351	50	0	1	1	1	H0351_050_0	6	1			08/01/2019	2020.01	08/01/2019 09:44:49 AM US Mountain Standard Time	08/05/2019 03:51:22 PM Central Daylight Time	08/05/2019 02:52:13 PM Central Daylight Time			08/05/2019 04:30:55 PM Central Daylight Time	"HEALTH NET OF ARIZONA, INC."	Allwell	allwell.azcompletehealth.com	Allwell Medicare Essentials II (HMO)	1	1		1			H0351	50	0	2020	Maricopa and Pinal Counties		2		2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(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	2			
H0351	51	0	1	1	1	H0351_051_0	6	1			07/08/2019	2020.01	07/08/2019 09:35:50 AM US Mountain Standard Time	08/05/2019 03:51:27 PM Central Daylight Time	08/05/2019 02:52:16 PM Central Daylight Time			08/05/2019 04:41:12 PM Central Daylight Time	"HEALTH NET OF ARIZONA, INC."	Allwell	allwell.azcompletehealth.com	Allwell Medicare Premier (HMO)	1	1		1			H0351	51	0	2020	Maricopa and Pinal Counties		2		2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(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	2			
H0351	801	0	1	1	1	H0351_801_0	2	1			05/13/2019	2020.01	05/13/2019 11:00:36 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"HEALTH NET OF ARIZONA, INC."	Allwell	allwell.azcompletehealth.com	Allwell CoCare (HMO)	1	1		1			H0351	801	0	2020	All AZ Counties		1	292	2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0351	803	0	1	1	1	H0351_803_0	2	1			05/13/2019	2020.01	05/13/2019 11:02:02 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"HEALTH NET OF ARIZONA, INC."	Allwell	allwell.azcompletehealth.com	Allwell CoCare (HMO)	1	1		1			H0351	803	0	2020	All AZ Counties		1	100	2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0351	804	0	1	1	1	H0351_804_0	2	1			05/10/2019	2020.01	05/10/2019 03:59:02 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"HEALTH NET OF ARIZONA, INC."	Allwell	allwell.azcompletehealth.com	Allwell CoCare (HMO)	1	1		1			H0351	804	0	2020	All AZ Counties		1	100	2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0354	1	0	1	1	1	H0354_001_0	5	1			07/08/2019	2020.01	07/08/2019 04:24:03 PM Central Daylight Time	07/31/2019 03:49:54 PM Central Daylight Time	07/30/2019 04:07:56 PM Central Daylight Time			08/02/2019 11:02:46 AM Central Daylight Time	"CIGNA HEALTHCARE OF ARIZONA, INC."	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H0354	1	0	2020	Maricopa Co. and Select Zip Codes in Pinal Co.		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0354	24	0	1	1	1	H0354_024_0	5	1			07/08/2019	2020.01	07/08/2019 04:24:42 PM Central Daylight Time	07/31/2019 03:47:22 PM Central Daylight Time	07/30/2019 04:08:09 PM Central Daylight Time			08/02/2019 11:02:46 AM Central Daylight Time	"CIGNA HEALTHCARE OF ARIZONA, INC."	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H0354	24	0	2020	Pima County		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)836-8905		(855)836-8905		(800)627-7534		(800)627-7534		(855)836-8905		(855)836-8905		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0354	27	0	1	1	1	H0354_027_0	4	1		1	07/01/2019	2020.01	07/01/2019 07:03:37 PM Central Daylight Time	07/31/2019 03:44:40 PM Central Daylight Time	07/30/2019 04:08:22 PM Central Daylight Time			08/02/2019 11:02:46 AM Central Daylight Time	"CIGNA HEALTHCARE OF ARIZONA, INC."	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Achieve Plus (HMO C-SNP)	1	1		1			H0354	27	0	2020	Maricopa Co. and Select Zip Codes in Pinal Co.		2		2			1	4			1E+13		www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0354	28	0	1	1	1	H0354_028_0	5	1			07/08/2019	2020.01	07/08/2019 04:25:35 PM Central Daylight Time	07/31/2019 03:42:08 PM Central Daylight Time	07/30/2019 04:08:36 PM Central Daylight Time			08/02/2019 11:02:46 AM Central Daylight Time	"CIGNA HEALTHCARE OF ARIZONA, INC."	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Alliance (HMO)	1	1		1			H0354	28	0	2020	Maricopa Co. and select zip codes in Pinal Co.		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0354	804	0	1	1	1	H0354_804_0	3	1			04/18/2019	2020.01	04/18/2019 12:12:43 PM Central Daylight Time					06/02/2019 08:53:26 PM Central Daylight Time	"CIGNA HEALTHCARE OF ARIZONA, INC."	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	1	1		1			H0354	804	0	2020	All Counties in Arizona		1	7308	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0354	805	0	1	1	1	H0354_805_0	3	1			04/18/2019	2020.01	04/18/2019 12:13:00 PM Central Daylight Time					06/02/2019 08:53:26 PM Central Daylight Time	"CIGNA HEALTHCARE OF ARIZONA, INC."	Cigna	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	1	1		1			H0354	805	0	2020	All Counties in Arizona		1	828	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(800)627-7534		(800)627-7534		(855)561-3811		(855)561-3811		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0390	1	0	1	20	8	H0390_001_0	1	1			05/24/2019	2020.01	05/24/2019 04:07:22 PM Eastern Daylight Time		05/24/2019 04:02:48 PM Eastern Daylight Time			05/24/2019 04:09:51 PM Eastern Daylight Time	"PACE OF SOUTHWEST MICHIGAN, INC."	PACE of Southwest Michigan	http://www.paceswmi.org/	PACE of Southwest Michigan - Dual (PACE)	8	20		1			H0390	1	0	2020	PACE of Southwest Michigan - Dual		2		2			2						www.seniorscript.com	theresesaggau@paceswmi.org										(855)243-8876		(269)408-4322		(855)243-8876		(269)408-4322										(855)243-8876		(269)408-4322		(855)243-8876		(269)408-4322																
H0390	2	0	1	20	8	H0390_002_0	1	1			05/24/2019	2020.01	05/24/2019 04:08:16 PM Eastern Daylight Time		05/24/2019 04:02:48 PM Eastern Daylight Time			05/24/2019 04:09:51 PM Eastern Daylight Time	"PACE OF SOUTHWEST MICHIGAN, INC."	PACE of Southwest Michigan	http://www.paceswmi.org/	PACE of Southwest Michigan - Medicare Only (PACE)	8	20		1			H0390	2	0	2020	PACE of Southwest Michigan - Medicare Only		2		2			2						www.seniorscript.com	theresesaggau@paceswmi.org										(855)243-8876		(269)408-4322		(855)243-8876		(269)408-4322										(855)243-8876		(269)408-4322		(855)243-8876		(269)408-4322																
H0422	1	0	1	2	1	H0422_001_0	5	1			08/05/2019	2020.01	08/05/2019 05:14:19 PM Central Daylight Time	08/06/2019 01:55:21 PM Central Daylight Time	07/31/2019 10:19:13 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	"UCARE HEALTH, INC."	UCare	www.ucare.org	Care Core: M Health Fairview & North Memorial (HMO-POS)	1	2		1			H0422	1	0	2020	Twin Cities Metropolitan Area: 8 Counties		2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(888)618-2595		(612)676-6520		(855)432-7029		(612)676-6545		(888)618-2595		(612)676-6520		(855)432-7029		(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	2			
H0422	2	0	1	2	1	H0422_002_0	6	1			08/05/2019	2020.01	08/05/2019 05:15:17 PM Central Daylight Time	08/06/2019 02:01:17 PM Central Daylight Time	07/31/2019 10:21:25 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	"UCARE HEALTH, INC."	UCare	www.ucare.org	Care Advantage: M Health Fairview & North Memorial (HMO-POS)	1	2		1			H0422	2	0	2020	Twin Cities Metropolitan Area: 8 Counties		2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(888)618-2595		(612)676-6520		(855)432-7029		(612)676-6545		(888)618-2595		(612)676-6520		(855)432-7029		(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	2			
H0423	1	0	1	1	1	H0423_001_0	10	1	2	1	08/05/2019	2020.01	08/05/2019 12:53:22 PM Eastern Daylight Time	08/05/2019 10:53:53 AM Eastern Daylight Time	08/05/2019 10:53:45 AM Eastern Daylight Time			08/05/2019 12:54:32 PM Eastern Daylight Time	"METROPLUS HEALTH PLAN, INC."	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus Advantage Plan (HMO D-SNP)	1	1		1			H0423	1	0	2020	NYC - All five boroughs		2	100556	2			1	3		2		2	www.caremark.com	https://www.metroplus.org/member-services/formularies	www.metroplusmedicare.org	(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	2			
H0423	4	0	1	1	1	H0423_004_0	6	1			05/29/2019	2020.01	05/29/2019 01:19:28 PM Eastern Daylight Time	08/05/2019 10:54:21 AM Eastern Daylight Time	08/05/2019 10:54:10 AM Eastern Daylight Time			08/05/2019 12:54:32 PM Eastern Daylight Time	"METROPLUS HEALTH PLAN, INC."	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus Platinum (HMO)	1	1		1			H0423	4	0	2020	NYC - All five boroughs		2	603	2			2						www.caremark.com	https://www.metroplus.org/member-services/formularies	www.metroplusmedicare.org	(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	2			
H0432	1	0	1	1	1	H0432_001_0	3	1			08/02/2019	2020.01	08/02/2019 11:31:06 AM Central Daylight Time	08/02/2019 11:10:08 AM Central Daylight Time	07/30/2019 05:17:47 PM Central Daylight Time			08/05/2019 05:52:59 PM Central Daylight Time	"UNITEDHEALTHCARE OF ALABAMA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H0432	1	0	2020	Northern Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	2	0	1	1	1	H0432_002_0	2	1			08/02/2019	2020.01	08/02/2019 11:03:21 AM Central Daylight Time	08/02/2019 11:10:38 AM Central Daylight Time	07/30/2019 05:18:23 PM Central Daylight Time			08/05/2019 05:52:59 PM Central Daylight Time	"UNITEDHEALTHCARE OF ALABAMA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H0432	2	0	2020	Northern Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	3	0	1	1	1	H0432_003_0	2	1			08/05/2019	2020.01	08/05/2019 11:38:49 AM Central Daylight Time	08/02/2019 11:11:07 AM Central Daylight Time	07/30/2019 05:18:57 PM Central Daylight Time			08/05/2019 05:52:59 PM Central Daylight Time	"UNITEDHEALTHCARE OF ALABAMA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H0432	3	0	2020	Southern Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	4	0	1	1	1	H0432_004_0	2	1			08/02/2019	2020.01	08/02/2019 11:04:44 AM Central Daylight Time	08/02/2019 11:11:36 AM Central Daylight Time	07/30/2019 05:19:30 PM Central Daylight Time			08/05/2019 05:52:59 PM Central Daylight Time	"UNITEDHEALTHCARE OF ALABAMA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H0432	4	0	2020	Southern Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	5	0	1	1	1	H0432_005_0	3	1			08/02/2019	2020.01	08/02/2019 11:05:28 AM Central Daylight Time	08/02/2019 11:12:06 AM Central Daylight Time	07/30/2019 05:20:05 PM Central Daylight Time			08/05/2019 05:52:59 PM Central Daylight Time	"UNITEDHEALTHCARE OF ALABAMA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H0432	5	0	2020	West Central Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	6	0	1	1	1	H0432_006_0	2	1			08/02/2019	2020.01	08/02/2019 11:06:21 AM Central Daylight Time	08/02/2019 11:12:35 AM Central Daylight Time	07/30/2019 05:20:38 PM Central Daylight Time			08/05/2019 05:52:59 PM Central Daylight Time	"UNITEDHEALTHCARE OF ALABAMA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H0432	6	0	2020	West Central Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	7	0	1	1	1	H0432_007_0	3	1			08/02/2019	2020.01	08/02/2019 11:07:02 AM Central Daylight Time	08/02/2019 11:13:05 AM Central Daylight Time	07/30/2019 05:21:14 PM Central Daylight Time			08/05/2019 05:52:59 PM Central Daylight Time	"UNITEDHEALTHCARE OF ALABAMA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H0432	7	0	2020	East Central Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	8	0	1	1	1	H0432_008_0	2	1			08/02/2019	2020.01	08/02/2019 11:07:45 AM Central Daylight Time	08/02/2019 11:13:34 AM Central Daylight Time	07/30/2019 05:21:49 PM Central Daylight Time			08/05/2019 05:52:59 PM Central Daylight Time	"UNITEDHEALTHCARE OF ALABAMA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H0432	8	0	2020	East Central Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	9	0	1	1	1	H0432_009_0	2	1	2	1	08/06/2019	2020.01	08/06/2019 10:14:16 AM Central Daylight Time	08/02/2019 11:14:04 AM Central Daylight Time	07/30/2019 05:22:23 PM Central Daylight Time			08/06/2019 10:16:24 AM Central Daylight Time	"UNITEDHEALTHCARE OF ALABAMA, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Plan 1 (HMO D-SNP)	1	1		1			H0432	9	0	2020	Select Counties in Alabama		2		2			1	3		2		2	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	10	0	1	1	1	H0432_010_0	2	1			08/02/2019	2020.01	08/02/2019 11:08:27 AM Central Daylight Time	08/02/2019 11:14:34 AM Central Daylight Time	07/30/2019 05:22:58 PM Central Daylight Time			08/05/2019 05:52:59 PM Central Daylight Time	"UNITEDHEALTHCARE OF ALABAMA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 1 (HMO)	1	1		1			H0432	10	0	2020	Select Counties in Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0432	11	0	1	1	1	H0432_011_0	2	1			08/02/2019	2020.01	08/02/2019 11:09:07 AM Central Daylight Time	08/02/2019 11:15:03 AM Central Daylight Time	07/30/2019 05:23:29 PM Central Daylight Time			08/05/2019 05:52:59 PM Central Daylight Time	"UNITEDHEALTHCARE OF ALABAMA, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Walgreens Plan 2 (HMO)	1	1		1			H0432	11	0	2020	Select Counties in Alabama		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	2	0	1	1	1	H0439_002_0	4	1	2	1	07/09/2019	2020.01	07/09/2019 10:22:35 AM Central Daylight Time	07/31/2019 04:37:25 PM Central Daylight Time	07/30/2019 04:08:50 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF GEORGIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H0439	2	0	2020	Georgia		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	3	1	1	1	1	H0439_003_1	5	1			07/08/2019	2020.01	07/08/2019 03:35:41 PM Central Daylight Time	07/31/2019 04:37:46 PM Central Daylight Time	07/30/2019 04:09:04 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF GEORGIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred GA (HMO)	1	1		1			H0439	3	1	2020	Georgia	Georgia Metro/Athens	2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	3	2	1	1	1	H0439_003_2	5	1			07/08/2019	2020.01	07/08/2019 03:35:53 PM Central Daylight Time	07/31/2019 04:38:08 PM Central Daylight Time	07/30/2019 04:09:18 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF GEORGIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred GA (HMO)	1	1		1			H0439	3	2	2020	Georgia	Georgia Gainesville/Rome	2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	6	0	1	2	1	H0439_006_0	4	1			07/09/2019	2020.01	07/09/2019 10:53:57 AM Central Daylight Time	07/31/2019 04:38:31 PM Central Daylight Time	07/30/2019 04:09:31 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF GEORGIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	1	2		1			H0439	6	0	2020	Georgia		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	7	0	1	1	1	H0439_007_0	4	1			07/08/2019	2020.01	07/08/2019 03:36:25 PM Central Daylight Time	07/31/2019 04:38:53 PM Central Daylight Time	07/30/2019 04:09:45 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF GEORGIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H0439	7	0	2020	Georgia		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	8	0	1	1	1	H0439_008_0	4	1			07/08/2019	2020.01	07/08/2019 03:37:48 PM Central Daylight Time	07/31/2019 04:39:14 PM Central Daylight Time	07/30/2019 04:09:59 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF GEORGIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H0439	8	0	2020	Georgia		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	9	0	1	1	1	H0439_009_0	4	1			07/08/2019	2020.01	07/08/2019 03:38:40 PM Central Daylight Time	07/31/2019 04:39:36 PM Central Daylight Time	07/30/2019 04:10:13 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF GEORGIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H0439	9	0	2020	Georgia		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	10	0	1	1	1	H0439_010_0	4	1			07/08/2019	2020.01	07/08/2019 03:39:28 PM Central Daylight Time	07/31/2019 04:39:58 PM Central Daylight Time	07/30/2019 04:10:26 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF GEORGIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H0439	10	0	2020	Georgia		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	11	0	1	1	1	H0439_011_0	4	1			07/08/2019	2020.01	07/08/2019 03:40:18 PM Central Daylight Time	07/31/2019 04:40:21 PM Central Daylight Time	07/30/2019 04:10:40 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF GEORGIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H0439	11	0	2020	Georgia		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(800)668-3813		(800)668-3813		(866)625-2494		(866)625-2494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0439	801	0	1	1	1	H0439_801_0	2	1			04/18/2019	2020.01	04/18/2019 12:13:25 PM Central Daylight Time					05/30/2019 04:35:04 PM Central Daylight Time	"CIGNA HEALTHCARE OF GEORGIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	1	1		1			H0439	801	0	2020	Georgia		1	1320	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(866)625-2494		(866)625-2494		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0473	1	0	1	4	1	H0473_001_0	3	1			08/01/2019	2020.01	08/01/2019 06:51:53 PM Eastern Daylight Time	08/04/2019 03:52:42 PM Eastern Daylight Time	08/02/2019 01:17:54 PM Eastern Daylight Time			08/05/2019 11:25:37 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF KENTUCKY	Humana	www.humana.com/medicare	HumanaChoice H0473-001 (PPO)	1	4		1			H0473	1	0	2020	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0473	3	0	1	4	1	H0473_003_0	3	1			07/15/2019	2020.01	07/15/2019 10:33:48 AM Eastern Daylight Time	08/04/2019 04:00:37 PM Eastern Daylight Time	08/02/2019 01:17:54 PM Eastern Daylight Time			08/05/2019 11:25:37 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF KENTUCKY	Humana	www.humana.com/medicare	HumanaChoice H0473-003 (PPO)	1	4		1			H0473	3	0	2020	"Hays, Travis and Williamson counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0477	1	0	1	20	8	H0477_001_0	1	1			05/30/2019	2020.01	05/30/2019 11:55:24 AM Eastern Daylight Time		05/30/2019 11:16:49 AM Eastern Daylight Time			05/30/2019 12:03:44 PM Eastern Daylight Time	"SERENITY CARE, INC."	Serenity Care PACE	http://www.serenitypace.org	Serenity PACE Dual (PACE)	8	20		1			H0477	1	0	2020	Serenity Pace Dual		2		2			2						www.omnicare.com	www.pharmastarpbm.com										(413)241-6265		(413)241-6265		(413)241-6265		(413)241-6265										(413)241-6265		(413)241-6265		(413)241-6265		(413)241-6265																
H0477	2	0	1	20	8	H0477_002_0	1	1			05/30/2019	2020.01	05/30/2019 11:56:20 AM Eastern Daylight Time		05/30/2019 12:02:05 PM Eastern Daylight Time			05/30/2019 12:03:44 PM Eastern Daylight Time	"SERENITY CARE, INC."	Serenity Care PACE	http://www.serenitypace.org	Serenity PACE Medicare only (PACE)	8	20		1			H0477	2	0	2020	Serenity PACE Medicare only		2		2			2						www.omnicare.com	www.pharmastarpbm.com										(413)241-6265		(413)241-6265		(413)304-3977		(413)304-3977										(413)241-6265		(413)241-6265		(413)304-3977		(413)304-3977																
H0480	1	0	1	48	5	H0480_001_0	8	1			08/12/2019	2020.01	08/12/2019 09:38:13 AM Eastern Daylight Time					08/12/2019 09:56:42 AM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	MeridianComplete	www.mhplan.com	MeridianComplete (Medicare-Medicaid Plan)	5	48		1			H0480	1	0	2020	Southwestern Michigan		2	70000	2			2						www.mhplan.com	www.mhplan.com	www.mhplan.com	(855)323-4578		(855)323-4578		(855)323-4578		(855)323-4578		(855)323-4578		(855)323-4578		(855)323-4578		(855)323-4578		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H0504	15	0	1	1	1	H0504_015_0	8	1			07/18/2019	2020.01	07/18/2019 04:23:07 PM Pacific Daylight Time	08/06/2019 09:48:13 AM Pacific Daylight Time	08/06/2019 09:45:14 AM Pacific Daylight Time			08/06/2019 01:31:37 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	1	1		1			H0504	15	0	2020	Los Angeles and Orange Counties		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	17	0	1	1	1	H0504_017_0	7	1			08/06/2019	2020.01	08/06/2019 09:43:08 AM Pacific Daylight Time	08/06/2019 09:49:39 AM Pacific Daylight Time	08/06/2019 09:45:19 AM Pacific Daylight Time			08/06/2019 01:31:37 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	1	1		1			H0504	17	0	2020	San Bernardino County		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	21	0	1	1	1	H0504_021_0	7	1			07/09/2019	2020.01	07/09/2019 09:21:19 AM Pacific Daylight Time	08/06/2019 09:48:25 AM Pacific Daylight Time	08/06/2019 09:45:24 AM Pacific Daylight Time			08/06/2019 01:31:37 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus Choice Plan (HMO)	1	1		1			H0504	21	0	2020	Los Angeles (Partial) and Orange Counties		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	26	0	1	1	1	H0504_026_0	7	1			07/09/2019	2020.01	07/09/2019 09:21:52 AM Pacific Daylight Time	08/06/2019 09:48:31 AM Pacific Daylight Time	08/06/2019 09:45:28 AM Pacific Daylight Time			08/06/2019 01:31:37 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	1	1		1			H0504	26	0	2020	Riverside County		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	28	0	1	1	1	H0504_028_0	7	1			08/05/2019	2020.01	08/05/2019 04:06:29 PM Pacific Daylight Time	08/06/2019 09:48:37 AM Pacific Daylight Time	08/06/2019 09:45:33 AM Pacific Daylight Time			08/06/2019 01:29:43 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	1	1		1			H0504	28	0	2020	San Diego County		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	29	0	1	1	1	H0504_029_0	7	1			07/09/2019	2020.01	07/09/2019 09:23:16 AM Pacific Daylight Time	08/06/2019 09:48:44 AM Pacific Daylight Time	08/06/2019 09:45:37 AM Pacific Daylight Time			08/06/2019 01:29:43 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	1	1		1			H0504	29	0	2020	Ventura County		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	31	0	1	1	1	H0504_031_0	8	1			07/09/2019	2020.01	07/09/2019 09:23:46 AM Pacific Daylight Time	08/06/2019 09:48:50 AM Pacific Daylight Time	08/06/2019 09:45:42 AM Pacific Daylight Time			08/06/2019 01:29:43 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	1	1		1			H0504	31	0	2020	Fresno County		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	37	0	1	1	1	H0504_037_0	7	1			07/09/2019	2020.01	07/09/2019 09:24:14 AM Pacific Daylight Time	08/06/2019 09:48:56 AM Pacific Daylight Time	08/06/2019 09:45:46 AM Pacific Daylight Time			08/06/2019 01:29:43 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield Trio Medicare (HMO)	1	1		1			H0504	37	0	2020	Sacramento County		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	38	0	1	1	1	H0504_038_0	7	1			07/09/2019	2020.01	07/09/2019 09:24:44 AM Pacific Daylight Time	08/06/2019 09:49:02 AM Pacific Daylight Time	08/06/2019 09:45:51 AM Pacific Daylight Time			08/06/2019 01:33:30 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	1	1		1			H0504	38	0	2020	Kern County		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7a;	
H0504	39	0	1	1	1	H0504_039_0	7	1			08/05/2019	2020.01	08/05/2019 03:09:31 PM Pacific Daylight Time	08/06/2019 09:49:09 AM Pacific Daylight Time	08/06/2019 09:45:56 AM Pacific Daylight Time			08/06/2019 01:33:30 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus (HMO)	1	1		1			H0504	39	0	2020	San Luis Obispo/Santa Barbara Counties (partial)		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	40	0	1	1	1	H0504_040_0	7	1			08/05/2019	2020.01	08/05/2019 03:13:17 PM Pacific Daylight Time	08/06/2019 09:49:15 AM Pacific Daylight Time	08/06/2019 09:46:00 AM Pacific Daylight Time			08/06/2019 01:33:30 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield 65 Plus Choice Plan (HMO)	1	1		1			H0504	40	0	2020	Riverside and San Bernardino Counties		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	41	0	1	1	1	H0504_041_0	6	1			08/05/2019	2020.01	08/05/2019 03:09:58 PM Pacific Daylight Time	08/06/2019 09:49:21 AM Pacific Daylight Time	08/06/2019 09:46:05 AM Pacific Daylight Time			08/06/2019 01:33:30 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield Inspire (HMO)	1	1		1			H0504	41	0	2020	Alameda County		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	42	0	1	1	1	H0504_042_0	6	1			08/05/2019	2020.01	08/05/2019 03:10:39 PM Pacific Daylight Time	08/06/2019 09:49:27 AM Pacific Daylight Time	08/06/2019 09:46:10 AM Pacific Daylight Time			08/06/2019 01:35:17 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield Inspire (HMO)	1	1		1			H0504	42	0	2020	San Mateo County		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	43	0	1	1	1	H0504_043_0	8	1			07/09/2019	2020.01	07/09/2019 09:27:45 AM Pacific Daylight Time	08/06/2019 09:49:33 AM Pacific Daylight Time	08/06/2019 09:46:14 AM Pacific Daylight Time			08/06/2019 01:35:17 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield Inspire (HMO)	1	1		1			H0504	43	0	2020	Los Angeles and Orange Counties		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	44	0	1	1	1	H0504_044_0	8	1			08/05/2019	2020.01	08/05/2019 03:11:22 PM Pacific Daylight Time	08/06/2019 09:49:40 AM Pacific Daylight Time	08/06/2019 09:46:19 AM Pacific Daylight Time			08/06/2019 01:35:17 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield Vital (HMO)	1	1		1			H0504	44	0	2020	Los Angeles and Orange Counties		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	45	0	1	1	1	H0504_045_0	7	1			08/05/2019	2020.01	08/05/2019 03:11:58 PM Pacific Daylight Time	08/06/2019 09:49:46 AM Pacific Daylight Time	08/06/2019 09:46:24 AM Pacific Daylight Time			08/06/2019 01:35:17 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield Vital (HMO)	1	1		1			H0504	45	0	2020	Riverside and San Bernardino Counties		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(800)776-4466		(800)776-4466		(888)534-4263		(888)534-4263		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0504	803	0	1	1	1	H0504_803_0	2	1			05/28/2019	2020.01	05/28/2019 03:44:22 PM Pacific Daylight Time					05/31/2019 01:30:53 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	1	1		1			H0504	803	0	2020	MA-PD Employer Group Plan		1	19424	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(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	3-1;3-2;3-3;3-4;6;7k;11a;11b;11c;12;14d;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	2					1				
H0504	804	0	1	1	1	H0504_804_0	2	1			05/28/2019	2020.01	05/28/2019 03:46:49 PM Pacific Daylight Time					05/31/2019 01:30:53 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	1	1		1			H0504	804	0	2020	MA-PD Employer Group Plan		1	3245	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(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	3-1;3-2;3-3;3-4;6;7k;11a;11b;11c;12;14d;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	2					1				
H0504	805	0	1	1	1	H0504_805_0	2	1			05/28/2019	2020.01	05/28/2019 08:27:01 PM Pacific Daylight Time					05/31/2019 01:30:53 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	1	1		1			H0504	805	0	2020	MA-Only Employer Group Plan		1	0	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466										(711)-		(711)-		(711)-		(711)-										1	1	3-1;3-2;3-3;3-4;6;7k;11a;11b;11c;12;14d;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;18a;	2					1				
H0523	2	0	1	1	1	H0523_002_0	3	1			07/31/2019	2020.01	07/31/2019 04:49:18 PM Eastern Daylight Time	08/01/2019 07:35:50 AM Pacific Daylight Time	07/30/2019 05:15:09 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	1	1		1			H0523	2	0	2020	Los Angeles and Orange Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	22	0	1	1	1	H0523_022_0	2	1			07/31/2019	2020.01	07/31/2019 04:50:34 PM Eastern Daylight Time	08/01/2019 07:37:41 AM Pacific Daylight Time	07/30/2019 05:16:20 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	1	1		1			H0523	22	0	2020	Riverside and San Bernardino Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	31	0	1	1	1	H0523_031_0	2	1			07/31/2019	2020.01	07/31/2019 04:50:51 PM Eastern Daylight Time	08/01/2019 07:39:07 AM Pacific Daylight Time	07/30/2019 05:17:31 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	1	1		1			H0523	31	0	2020	Kern County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	52	0	1	1	1	H0523_052_0	3	1			07/31/2019	2020.01	07/31/2019 04:51:14 PM Eastern Daylight Time	08/01/2019 12:30:09 PM Pacific Daylight Time	07/30/2019 05:18:42 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	1	1		1			H0523	52	0	2020	San Diego County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	61	0	1	1	1	H0523_061_0	2	1			07/31/2019	2020.01	07/31/2019 04:51:45 PM Eastern Daylight Time	08/01/2019 07:44:54 AM Pacific Daylight Time	07/30/2019 05:19:53 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	1	1		1			H0523	61	0	2020	Los Angeles and Orange Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	63	0	1	1	1	H0523_063_0	2	1			07/31/2019	2020.01	07/31/2019 04:52:00 PM Eastern Daylight Time	08/01/2019 07:46:13 AM Pacific Daylight Time	07/30/2019 05:21:04 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	1	1		1			H0523	63	0	2020	San Bernardino County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0523	801	0	1	1	1	H0523_801_0	3	1			05/24/2019	2020.01	05/24/2019 08:56:19 AM Eastern Daylight Time					05/30/2019 05:36:06 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H0523	801	0	2020	California		1	6090	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H0523	805	0	1	1	1	H0523_805_0	2	1			05/24/2019	2020.01	05/24/2019 09:33:35 AM Eastern Daylight Time					05/30/2019 05:36:06 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H0523	805	0	2020	California		1	7250	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H0523	807	0	1	1	1	H0523_807_0	2	1			05/24/2019	2020.01	05/24/2019 09:33:47 AM Eastern Daylight Time					05/30/2019 05:36:06 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H0523	807	0	2020	California		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H0524	2	0	2	1	1	H0524_002_0	9	1			05/31/2019	2020.01	05/31/2019 04:21:42 PM Pacific Daylight Time	07/31/2019 04:44:11 PM Pacific Daylight Time	07/31/2019 09:23:40 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage B Only South (HMO)	1	1		2	1		H0524	2	0	2020	Part B Only Southern California Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	3	0	1	1	1	H0524_003_0	9	1			05/31/2019	2020.01	05/31/2019 04:22:03 PM Pacific Daylight Time	07/31/2019 04:46:18 PM Pacific Daylight Time	07/31/2019 09:24:48 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	"Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)"	1	1		1			H0524	3	0	2020	Los Angeles and Orange Counties Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	8	0	1	1	1	H0524_008_0	9	1			05/31/2019	2020.01	05/31/2019 04:10:43 PM Pacific Daylight Time	07/31/2019 04:00:04 PM Pacific Daylight Time	07/31/2019 09:08:47 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Solano (HMO)	1	1		1			H0524	8	0	2020	Solano County Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	10	0	2	1	1	H0524_010_0	9	1			05/31/2019	2020.01	05/31/2019 04:11:19 PM Pacific Daylight Time	07/31/2019 04:03:13 PM Pacific Daylight Time	07/31/2019 09:09:47 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage B Only North (HMO)	1	1		2	1		H0524	10	0	2020	Part B Only Northern California Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	13	0	1	1	1	H0524_013_0	9	1			05/31/2019	2020.01	05/31/2019 04:11:53 PM Pacific Daylight Time	07/31/2019 04:06:30 PM Pacific Daylight Time	07/31/2019 09:10:58 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	"Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO)"	1	1		1			H0524	13	0	2020	Greater Sac and Sonoma County Plan - Enhanced		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	15	0	1	1	1	H0524_015_0	9	1			05/31/2019	2020.01	05/31/2019 04:22:29 PM Pacific Daylight Time	07/31/2019 04:48:21 PM Pacific Daylight Time	07/31/2019 09:25:45 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Inland Empire (HMO)	1	1		1			H0524	15	0	2020	Inland Empire Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	29	0	1	1	1	H0524_029_0	10	1	2	1	05/31/2019	2020.01	05/31/2019 04:22:57 PM Pacific Daylight Time	07/31/2019 05:00:34 PM Pacific Daylight Time	07/31/2019 09:31:52 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal Plan South (HMO D-SNP)	1	1		1			H0524	29	0	2020	Southern California Plan		2		2			1	3		2		2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	30	0	1	1	1	H0524_030_0	10	1	2	1	05/31/2019	2020.01	05/31/2019 04:13:00 PM Pacific Daylight Time	07/31/2019 04:58:33 PM Pacific Daylight Time	07/31/2019 09:30:44 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal Plan North (HMO D-SNP)	1	1		1			H0524	30	0	2020	Northern California Plan		2		2			1	3		2		2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	31	0	1	1	1	H0524_031_0	9	1			05/31/2019	2020.01	05/31/2019 04:13:31 PM Pacific Daylight Time	07/31/2019 04:09:36 PM Pacific Daylight Time	07/31/2019 09:12:04 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Marin San Mateo (HMO)	1	1		1			H0524	31	0	2020	Marin and San Mateo Counties Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	32	0	1	1	1	H0524_032_0	9	1			05/31/2019	2020.01	05/31/2019 04:14:05 PM Pacific Daylight Time	07/31/2019 04:13:13 PM Pacific Daylight Time	07/31/2019 09:13:07 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	"Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO)"	1	1		1			H0524	32	0	2020	"Alameda, Napa, and SF Counties Plan"		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	33	0	1	1	1	H0524_033_0	9	1			05/31/2019	2020.01	05/31/2019 04:14:46 PM Pacific Daylight Time	07/31/2019 04:17:15 PM Pacific Daylight Time	07/31/2019 09:14:06 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Contra Costa (HMO)	1	1		1			H0524	33	0	2020	Contra Costa County Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	34	0	1	1	1	H0524_034_0	9	1			05/31/2019	2020.01	05/31/2019 04:23:16 PM Pacific Daylight Time	07/31/2019 04:50:22 PM Pacific Daylight Time	07/31/2019 09:26:44 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Ventura (HMO)	1	1		1			H0524	34	0	2020	Ventura County Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	35	0	1	1	1	H0524_035_0	10	1			07/16/2019	2020.01	07/16/2019 08:50:53 PM Pacific Daylight Time	07/31/2019 04:52:20 PM Pacific Daylight Time	08/01/2019 10:11:38 AM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced Kern (HMO)	1	1		1			H0524	35	0	2020	Kern County Plan - Enhanced		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	36	0	1	1	1	H0524_036_0	10	1			07/16/2019	2020.01	07/16/2019 08:44:55 PM Pacific Daylight Time	07/31/2019 04:54:26 PM Pacific Daylight Time	07/31/2019 09:28:46 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic Kern (HMO)	1	1		1			H0524	36	0	2020	Kern County Plan - Basic		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	37	0	1	1	1	H0524_037_0	9	1			05/31/2019	2020.01	05/31/2019 04:24:28 PM Pacific Daylight Time	07/31/2019 04:56:37 PM Pacific Daylight Time	07/31/2019 09:29:42 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage San Diego (HMO)	1	1		1			H0524	37	0	2020	San Diego County Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	38	0	1	1	1	H0524_038_0	9	1			05/31/2019	2020.01	05/31/2019 04:15:19 PM Pacific Daylight Time	07/31/2019 04:20:50 PM Pacific Daylight Time	07/31/2019 09:15:09 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced Fresno (HMO)	1	1		1			H0524	38	0	2020	Greater Fresno Area Plan - Enhanced		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	39	0	1	1	1	H0524_039_0	9	1			05/31/2019	2020.01	05/31/2019 04:15:51 PM Pacific Daylight Time	07/31/2019 04:26:38 PM Pacific Daylight Time	07/31/2019 09:16:11 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Santa Clara (HMO)	1	1		1			H0524	39	0	2020	Santa Clara County Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	40	0	1	1	1	H0524_040_0	9	1			05/31/2019	2020.01	05/31/2019 04:16:37 PM Pacific Daylight Time	07/31/2019 04:31:29 PM Pacific Daylight Time	07/31/2019 09:17:24 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced Stanis (HMO)	1	1		1			H0524	40	0	2020	Stanislaus County Plan - Enhanced		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	41	0	1	1	1	H0524_041_0	9	1			05/31/2019	2020.01	05/31/2019 04:17:23 PM Pacific Daylight Time	07/31/2019 04:33:35 PM Pacific Daylight Time	07/31/2019 09:18:24 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic Stanis (HMO)	1	1		1			H0524	41	0	2020	Stanislaus County Plan - Basic		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	42	0	1	1	1	H0524_042_0	10	1			05/31/2019	2020.01	05/31/2019 04:18:00 PM Pacific Daylight Time	07/31/2019 04:35:45 PM Pacific Daylight Time	07/31/2019 09:19:23 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO)	1	1		1			H0524	42	0	2020	San Joaquin County Plan - Enhanced		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	43	0	1	1	1	H0524_043_0	9	1			05/31/2019	2020.01	05/31/2019 04:18:31 PM Pacific Daylight Time	07/31/2019 04:37:55 PM Pacific Daylight Time	07/31/2019 09:20:27 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic SnJoaq (HMO)	1	1		1			H0524	43	0	2020	San Joaquin County Plan - Basic		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	46	0	1	1	1	H0524_046_0	9	1			05/31/2019	2020.01	05/31/2019 04:20:31 PM Pacific Daylight Time	07/31/2019 04:39:58 PM Pacific Daylight Time	07/31/2019 09:21:33 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic Fresno (HMO)	1	1		1			H0524	46	0	2020	Greater Fresno Area Plan - Basic		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	51	0	1	1	1	H0524_051_0	10	1			05/31/2019	2020.01	05/31/2019 04:20:55 PM Pacific Daylight Time	07/31/2019 04:42:04 PM Pacific Daylight Time	07/31/2019 09:22:36 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	"Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO)"	1	1		1			H0524	51	0	2020	Greater Sac and Sonoma County Plan - Basic		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	54	0	1	1	1	H0524_054_0	9	1			05/31/2019	2020.01	05/31/2019 04:21:15 PM Pacific Daylight Time	07/31/2019 05:02:30 PM Pacific Daylight Time	07/31/2019 09:32:47 PM Pacific Daylight Time			08/02/2019 10:15:43 AM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Santa Cruz (HMO)	1	1		1			H0524	54	0	2020	Santa Cruz County Plan		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0524	801	0	1	1	1	H0524_801_0	1	1			05/28/2019	2020.01	05/28/2019 12:19:38 PM Pacific Daylight Time					05/30/2019 06:47:04 PM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	1	1		1			H0524	801	0	2020	Southern California Group Part A B		1	22529	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	802	0	1	1	1	H0524_802_0	1	1			05/28/2019	2020.01	05/28/2019 12:19:47 PM Pacific Daylight Time					05/30/2019 06:47:04 PM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	1	1		1			H0524	802	0	2020	Northern California Group Part A B		1	110353	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;7b;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	803	0	2	1	1	H0524_803_0	1	1			05/28/2019	2020.01	05/28/2019 12:19:25 PM Pacific Daylight Time					05/30/2019 06:47:04 PM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	1	1		2	1		H0524	803	0	2020	Southern California Group B Only		1	36	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	804	0	2	1	1	H0524_804_0	1	1			05/28/2019	2020.01	05/28/2019 12:21:17 PM Pacific Daylight Time					05/30/2019 06:47:04 PM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	1	1		2	1		H0524	804	0	2020	Northern California Group B Only		1	114	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;7b;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	805	0	1	1	1	H0524_805_0	1	1			05/28/2019	2020.01	05/28/2019 12:31:30 PM Pacific Daylight Time					05/30/2019 06:47:04 PM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	1	1		1			H0524	805	0	2020	Southern California Group Part A B Part D		1	2193515	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;2;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	806	0	1	1	1	H0524_806_0	1	1			05/28/2019	2020.01	05/28/2019 12:31:44 PM Pacific Daylight Time					05/30/2019 06:47:04 PM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	1	1		1			H0524	806	0	2020	Northern California Group Part A B Part D		1	2336898	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;2;7b;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	807	0	2	1	1	H0524_807_0	1	1			05/28/2019	2020.01	05/28/2019 12:32:03 PM Pacific Daylight Time					05/30/2019 06:47:04 PM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	1	1		2	1		H0524	807	0	2020	Southern California Group Part B only  Part D		1	29776	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;2;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	808	0	2	1	1	H0524_808_0	1	1			05/28/2019	2020.01	05/28/2019 12:32:20 PM Pacific Daylight Time					05/30/2019 06:47:04 PM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	1	1		2	1		H0524	808	0	2020	Northern California Group Part B only Part D		1	5084	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;2;7b;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	809	0	1	1	1	H0524_809_0	1	1			05/28/2019	2020.01	05/28/2019 12:32:28 PM Pacific Daylight Time					05/30/2019 06:47:04 PM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	FEHB Part AB with D (HMO)	1	1		1			H0524	809	0	2020	Southern California Plan		1	123700	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;2;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	810	0	1	1	1	H0524_810_0	1	1			05/28/2019	2020.01	05/28/2019 12:32:40 PM Pacific Daylight Time					05/30/2019 06:47:04 PM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	FEHB Part AB with D (HMO)	1	1		1			H0524	810	0	2020	Northern California Plan		1	132779	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;2;7b;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	811	0	2	1	1	H0524_811_0	1	1			05/28/2019	2020.01	05/28/2019 12:32:49 PM Pacific Daylight Time					05/30/2019 06:47:04 PM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	FEHB Part B Only with D (HMO)	1	1		2	1		H0524	811	0	2020	Southern California Plan		1	332	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;2;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0524	812	0	2	1	1	H0524_812_0	1	1			05/28/2019	2020.01	05/28/2019 12:35:44 PM Pacific Daylight Time					05/30/2019 06:47:04 PM Pacific Daylight Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	FEHB Part B Only with D (HMO)	1	1		2	1		H0524	812	0	2020	Northern California Plan		1	581	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;2;7b;7k;11a;11b;11c;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;14a;14d;14e3;16b;17a;18a;	1					2				
H0542	1	0	1	20	8	H0542_001_0	1	1			05/21/2019	2020.01	05/21/2019 12:19:20 PM Pacific Daylight Time		05/21/2019 11:54:36 AM Pacific Daylight Time			05/21/2019 12:22:02 PM Pacific Daylight Time	ALTAMED HEALTH SERVICES CORPORATION	AltaMed Health Services Corporation	www.altamed.org	AltaMed Health Services Corporation (PACE)	8	20		1			H0542	1	0	2020	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	2	0	1	20	8	H0542_002_0	1	1			05/21/2019	2020.01	05/21/2019 12:20:10 PM Pacific Daylight Time		05/21/2019 11:57:27 AM Pacific Daylight Time			05/21/2019 12:22:02 PM Pacific Daylight Time	ALTAMED HEALTH SERVICES CORPORATION	AltaMed Health Services Corporation	www.altamed.org	AltaMed Health Services Corporation (PACE)	8	20		1			H0542	2	0	2020	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	1	0	1	1	1	H0543_001_0	4	1			08/02/2019	2020.01	08/02/2019 09:03:54 AM Central Daylight Time	08/02/2019 12:59:57 PM Central Daylight Time	07/30/2019 05:24:03 PM Central Daylight Time			08/05/2019 06:14:39 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	1	1		1			H0543	1	0	2020	Los Angeles county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	13	0	1	1	1	H0543_013_0	4	1			08/02/2019	2020.01	08/02/2019 09:04:49 AM Central Daylight Time	08/02/2019 01:00:28 PM Central Daylight Time	07/30/2019 05:24:33 PM Central Daylight Time			08/05/2019 06:14:39 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Value (HMO)	1	1		1			H0543	13	0	2020	San Diego county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	19	0	1	1	1	H0543_019_0	4	1			08/02/2019	2020.01	08/02/2019 09:05:22 AM Central Daylight Time	08/02/2019 01:01:02 PM Central Daylight Time	07/30/2019 05:25:07 PM Central Daylight Time			08/05/2019 06:14:39 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	19	0	2020	Kern county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	22	0	1	1	1	H0543_022_0	4	1			08/02/2019	2020.01	08/02/2019 09:06:06 AM Central Daylight Time	08/02/2019 01:01:33 PM Central Daylight Time	07/30/2019 05:25:40 PM Central Daylight Time			08/05/2019 06:14:39 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	22	0	2020	Ventura county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	28	0	1	1	1	H0543_028_0	4	1			08/02/2019	2020.01	08/02/2019 09:22:21 AM Central Daylight Time	08/02/2019 01:02:11 PM Central Daylight Time	07/30/2019 05:26:14 PM Central Daylight Time			08/05/2019 06:14:39 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	1	1		1			H0543	28	0	2020	San Mateo county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	29	0	1	1	1	H0543_029_0	4	1			08/02/2019	2020.01	08/02/2019 09:22:04 AM Central Daylight Time	08/02/2019 01:02:48 PM Central Daylight Time	07/30/2019 05:26:51 PM Central Daylight Time			08/05/2019 06:24:10 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	29	0	2020	Santa Clara county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	32	0	1	1	1	H0543_032_0	4	1			08/02/2019	2020.01	08/02/2019 09:11:31 AM Central Daylight Time	08/02/2019 01:03:25 PM Central Daylight Time	07/30/2019 05:27:25 PM Central Daylight Time			08/05/2019 06:24:10 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	1	1		1			H0543	32	0	2020	Santa Barbara and San Luis Obispo counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	35	0	1	1	1	H0543_035_0	3	1			08/02/2019	2020.01	08/02/2019 09:21:41 AM Central Daylight Time	08/02/2019 01:04:04 PM Central Daylight Time	07/30/2019 05:28:01 PM Central Daylight Time			08/05/2019 06:24:10 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	35	0	2020	"Fresno, Kings and Madera counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	36	0	1	1	1	H0543_036_0	3	1			08/02/2019	2020.01	08/02/2019 09:21:25 AM Central Daylight Time	08/02/2019 01:04:43 PM Central Daylight Time	07/30/2019 05:28:32 PM Central Daylight Time			08/05/2019 06:24:10 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	1	1		1			H0543	36	0	2020	Stanislaus county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	60	0	1	1	1	H0543_060_0	3	1			08/02/2019	2020.01	08/02/2019 09:19:58 AM Central Daylight Time	08/02/2019 01:05:18 PM Central Daylight Time	07/30/2019 05:29:03 PM Central Daylight Time			08/05/2019 06:24:10 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Premier (HMO)	1	1		1			H0543	60	0	2020	San Diego county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	70	0	1	1	1	H0543_070_0	4	1			08/02/2019	2020.01	08/02/2019 09:21:02 AM Central Daylight Time	08/02/2019 12:59:01 PM Central Daylight Time	07/30/2019 05:29:36 PM Central Daylight Time			08/05/2019 07:00:24 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	1	1		1			H0543	70	0	2020	Alameda and Contra Costa counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	86	0	1	1	1	H0543_086_0	3	1			08/02/2019	2020.01	08/02/2019 09:22:58 AM Central Daylight Time	08/02/2019 01:00:53 PM Central Daylight Time	07/30/2019 05:30:10 PM Central Daylight Time			08/05/2019 07:00:24 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	86	0	2020	Nevada county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	89	0	1	1	1	H0543_089_0	3	1			08/02/2019	2020.01	08/02/2019 09:26:24 AM Central Daylight Time	08/02/2019 01:02:59 PM Central Daylight Time	07/30/2019 05:30:46 PM Central Daylight Time			08/05/2019 07:00:24 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	89	0	2020	"Placer, Sacramento, and Yolo counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	121	0	1	1	1	H0543_121_0	3	1			07/11/2019	2020.01	07/11/2019 03:47:44 PM Central Daylight Time	05/31/2019 01:11:00 PM Central Daylight Time				07/12/2019 01:34:16 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Essential (HMO)	1	1		1			H0543	121	0	2020	"Kern,LA,Orange,Riverside,San Bernardino,San Diego"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0543	138	0	1	1	1	H0543_138_0	4	1			08/02/2019	2020.01	08/02/2019 09:27:16 AM Central Daylight Time	08/02/2019 01:07:21 PM Central Daylight Time	07/30/2019 05:31:22 PM Central Daylight Time			08/05/2019 07:00:24 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	1	1		1			H0543	138	0	2020	Orange county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	140	0	1	1	1	H0543_140_0	3	1			08/02/2019	2020.01	08/02/2019 09:29:14 AM Central Daylight Time	08/02/2019 01:09:18 PM Central Daylight Time	07/30/2019 05:31:55 PM Central Daylight Time			08/05/2019 07:00:24 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	140	0	2020	"Amador, El Dorado, Mendocino, Merced, Tulare"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	144	0	1	1	1	H0543_144_0	4	1			08/02/2019	2020.01	08/02/2019 09:34:03 AM Central Daylight Time	08/02/2019 01:11:08 PM Central Daylight Time	07/30/2019 05:32:28 PM Central Daylight Time			08/06/2019 08:46:37 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	1	1		1			H0543	144	0	2020	Riverside and San Bernardino counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	145	0	1	1	1	H0543_145_0	4	1			08/02/2019	2020.01	08/02/2019 09:34:49 AM Central Daylight Time	08/02/2019 01:13:47 PM Central Daylight Time	07/30/2019 05:33:00 PM Central Daylight Time			08/06/2019 08:46:37 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	Sharp SecureHorizons Plan by UnitedHealthcare (HMO)	1	1		1			H0543	145	0	2020	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	2			
H0543	146	0	1	1	1	H0543_146_0	3	1			08/02/2019	2020.01	08/02/2019 09:35:38 AM Central Daylight Time	08/02/2019 01:15:43 PM Central Daylight Time	07/30/2019 05:33:34 PM Central Daylight Time			08/06/2019 08:46:37 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	1	1		1			H0543	146	0	2020	"Placer, Sacramento, and Yolo counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	147	0	1	1	1	H0543_147_0	3	1			08/02/2019	2020.01	08/02/2019 09:36:28 AM Central Daylight Time	08/02/2019 01:17:31 PM Central Daylight Time	07/30/2019 05:34:13 PM Central Daylight Time			08/06/2019 08:46:37 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	1	1		1			H0543	147	0	2020	Stanislaus county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	148	0	1	1	1	H0543_148_0	3	1			08/02/2019	2020.01	08/02/2019 09:42:11 AM Central Daylight Time	08/02/2019 01:30:06 PM Central Daylight Time	07/30/2019 05:34:51 PM Central Daylight Time			08/06/2019 08:46:37 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	148	0	2020	Sonoma county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	151	0	1	1	1	H0543_151_0	4	1			08/02/2019	2020.01	08/02/2019 09:42:55 AM Central Daylight Time	08/02/2019 01:47:35 PM Central Daylight Time	07/30/2019 05:35:22 PM Central Daylight Time			08/06/2019 08:46:37 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	1	1		1			H0543	151	0	2020	Los Angeles county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	152	0	1	1	1	H0543_152_0	4	1			08/02/2019	2020.01	08/02/2019 09:43:33 AM Central Daylight Time	08/02/2019 01:30:52 PM Central Daylight Time	07/30/2019 05:35:55 PM Central Daylight Time			08/06/2019 08:46:37 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 4 (HMO)	1	1		1			H0543	152	0	2020	San Diego county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	153	0	1	1	1	H0543_153_0	2	1			05/29/2019	2020.01	05/29/2019 09:54:59 AM Central Daylight Time	08/02/2019 01:31:23 PM Central Daylight Time	07/30/2019 05:36:28 PM Central Daylight Time			08/06/2019 08:46:37 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	153	0	2020	"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)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	2			
H0543	158	0	1	1	1	H0543_158_0	3	1			08/02/2019	2020.01	08/02/2019 09:45:16 AM Central Daylight Time	08/02/2019 01:31:53 PM Central Daylight Time	07/30/2019 05:37:01 PM Central Daylight Time			08/06/2019 08:46:37 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	1	1		1			H0543	158	0	2020	San Mateo County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	163	0	1	1	1	H0543_163_0	3	1			08/02/2019	2020.01	08/02/2019 09:46:24 AM Central Daylight Time	08/02/2019 01:32:26 PM Central Daylight Time	07/30/2019 05:37:35 PM Central Daylight Time			08/06/2019 08:46:37 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	1	1		1			H0543	163	0	2020	Contra Costa County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	164	0	1	1	1	H0543_164_0	3	1			07/11/2019	2020.01	07/11/2019 03:52:12 PM Central Daylight Time	08/02/2019 01:32:56 PM Central Daylight Time	07/30/2019 05:38:07 PM Central Daylight Time			08/06/2019 08:46:37 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Premier (HMO)	1	1		1			H0543	164	0	2020	Los Angeles County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	165	0	1	1	1	H0543_165_0	3	1			07/11/2019	2020.01	07/11/2019 03:52:33 PM Central Daylight Time	08/02/2019 01:33:27 PM Central Daylight Time	07/30/2019 05:38:40 PM Central Daylight Time			08/06/2019 08:46:37 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Premier (HMO)	1	1		1			H0543	165	0	2020	Orange County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	166	0	1	1	1	H0543_166_0	3	1			07/11/2019	2020.01	07/11/2019 03:52:56 PM Central Daylight Time	08/02/2019 01:33:57 PM Central Daylight Time	07/30/2019 05:39:14 PM Central Daylight Time			08/06/2019 08:46:37 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Premier (HMO)	1	1		1			H0543	166	0	2020	Riverside and San Bernardino Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	167	0	1	1	1	H0543_167_0	4	1			08/02/2019	2020.01	08/02/2019 09:49:32 AM Central Daylight Time	08/02/2019 01:34:28 PM Central Daylight Time	07/30/2019 05:39:48 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	1	1		1			H0543	167	0	2020	San Luis Obispo County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	168	0	1	1	1	H0543_168_0	4	1			08/02/2019	2020.01	08/02/2019 09:50:16 AM Central Daylight Time	08/02/2019 12:59:53 PM Central Daylight Time	07/30/2019 05:40:18 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	1	1		1			H0543	168	0	2020	Los Angeles County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	169	0	1	1	1	H0543_169_0	4	1			08/02/2019	2020.01	08/02/2019 09:51:08 AM Central Daylight Time	08/02/2019 01:00:27 PM Central Daylight Time	07/30/2019 05:40:51 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	1	1		1			H0543	169	0	2020	Orange County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	170	0	1	1	1	H0543_170_0	4	1			08/02/2019	2020.01	08/02/2019 09:55:19 AM Central Daylight Time	08/02/2019 01:01:00 PM Central Daylight Time	07/30/2019 05:41:26 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	1	1		1			H0543	170	0	2020	Riverside and San Bernardino County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	172	0	1	1	1	H0543_172_0	3	1			05/29/2019	2020.01	05/29/2019 09:55:40 AM Central Daylight Time	08/02/2019 01:01:33 PM Central Daylight Time	07/30/2019 05:42:04 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	172	0	2020	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	2			
H0543	173	0	1	1	1	H0543_173_0	3	1			05/29/2019	2020.01	05/29/2019 09:56:35 AM Central Daylight Time	08/02/2019 01:02:07 PM Central Daylight Time	07/30/2019 05:42:39 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	173	0	2020	Kern 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	2			
H0543	175	0	1	1	1	H0543_175_0	3	1			08/02/2019	2020.01	08/02/2019 09:56:01 AM Central Daylight Time	08/02/2019 01:02:41 PM Central Daylight Time	07/30/2019 05:43:13 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	175	0	2020	San Francisco County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	176	0	1	1	1	H0543_176_0	3	1			08/02/2019	2020.01	08/02/2019 09:56:34 AM Central Daylight Time	08/02/2019 01:03:14 PM Central Daylight Time	07/30/2019 05:43:47 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	176	0	2020	Marin County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	177	0	1	1	1	H0543_177_0	3	1			08/05/2019	2020.01	08/05/2019 10:21:14 AM Central Daylight Time	08/02/2019 01:03:49 PM Central Daylight Time	07/30/2019 05:44:17 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	177	0	2020	San Joaquin county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	178	0	1	1	1	H0543_178_0	3	1			08/02/2019	2020.01	08/02/2019 10:30:32 AM Central Daylight Time	08/02/2019 01:04:24 PM Central Daylight Time	07/30/2019 05:44:48 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	178	0	2020	Santa Cruz County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	179	0	1	1	1	H0543_179_0	4	1			08/02/2019	2020.01	08/02/2019 10:31:08 AM Central Daylight Time	08/02/2019 01:04:58 PM Central Daylight Time	07/30/2019 05:45:21 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	179	0	2020	Solano County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0543	180	0	1	1	1	H0543_180_0	2	1			05/31/2019	2020.01	05/31/2019 08:48:04 AM Central Daylight Time	08/02/2019 01:03:40 PM Central Daylight Time	07/30/2019 05:45:55 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	180	0	2020	Santa Clara 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	2			
H0543	181	0	1	1	1	H0543_181_0	3	1			07/17/2019	2020.01	07/17/2019 02:31:38 PM Central Daylight Time	08/02/2019 01:04:11 PM Central Daylight Time	07/30/2019 05:46:31 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	181	0	2020	"Fresno, Kings and Madera 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	2			
H0543	182	0	1	1	1	H0543_182_0	2	1			05/29/2019	2020.01	05/29/2019 09:57:54 AM Central Daylight Time	08/02/2019 01:04:41 PM Central Daylight Time	07/30/2019 05:47:08 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	182	0	2020	Stanislaus 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	2			
H0543	183	0	1	1	1	H0543_183_0	2	1			05/30/2019	2020.01	05/30/2019 11:20:12 AM Central Daylight Time	08/02/2019 01:05:12 PM Central Daylight Time	07/30/2019 05:47:43 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	183	0	2020	Alameda and Contra Costa counties		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	2			
H0543	184	0	1	1	1	H0543_184_0	2	1			05/29/2019	2020.01	05/29/2019 09:58:32 AM Central Daylight Time	08/02/2019 01:05:43 PM Central Daylight Time	07/30/2019 05:48:18 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	184	0	2020	Nevada 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	2			
H0543	185	0	1	1	1	H0543_185_0	2	1			05/29/2019	2020.01	05/29/2019 10:09:46 AM Central Daylight Time	08/02/2019 01:06:13 PM Central Daylight Time	07/30/2019 05:48:53 PM Central Daylight Time			08/06/2019 08:59:30 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	185	0	2020	Select counties in California		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	2			
H0543	186	0	1	1	1	H0543_186_0	2	1			05/31/2019	2020.01	05/31/2019 11:55:10 AM Central Daylight Time	08/02/2019 01:06:43 PM Central Daylight Time	07/30/2019 05:49:26 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	186	0	2020	San Francisco 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	2			
H0543	187	0	1	1	1	H0543_187_0	2	1			05/29/2019	2020.01	05/29/2019 10:16:54 AM Central Daylight Time	08/02/2019 01:07:14 PM Central Daylight Time	07/30/2019 05:49:59 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	187	0	2020	San Joaquin 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	2			
H0543	188	0	1	1	1	H0543_188_0	3	1			08/02/2019	2020.01	08/02/2019 10:31:52 AM Central Daylight Time	08/02/2019 01:07:45 PM Central Daylight Time	07/30/2019 05:50:31 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Canopy Health Medicare Advantage (HMO)	1	1		1			H0543	188	0	2020	Alameda 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	2			
H0543	189	0	1	1	1	H0543_189_0	3	1			08/02/2019	2020.01	08/02/2019 10:32:29 AM Central Daylight Time	08/02/2019 01:08:17 PM Central Daylight Time	07/30/2019 05:51:06 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Canopy Health Medicare Advantage (HMO)	1	1		1			H0543	189	0	2020	Contra Costa 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	2			
H0543	191	0	1	1	1	H0543_191_0	3	1			08/02/2019	2020.01	08/02/2019 10:36:05 AM Central Daylight Time	08/02/2019 01:00:06 PM Central Daylight Time	07/30/2019 05:51:34 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Canopy Health Medicare Advantage (HMO)	1	1		1			H0543	191	0	2020	San Francisco 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	2			
H0543	193	0	1	1	1	H0543_193_0	3	1			08/05/2019	2020.01	08/05/2019 10:21:49 AM Central Daylight Time	08/02/2019 01:00:51 PM Central Daylight Time	07/30/2019 05:52:06 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	1	1		1			H0543	193	0	2020	Santa Clara 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	2			
H0543	194	0	1	1	1	H0543_194_0	3	1			08/02/2019	2020.01	08/02/2019 10:37:48 AM Central Daylight Time	08/02/2019 01:01:38 PM Central Daylight Time	07/30/2019 05:52:39 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	194	0	2020	Napa 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	2			
H0543	195	0	1	1	1	H0543_195_0	4	1			08/02/2019	2020.01	08/02/2019 10:38:23 AM Central Daylight Time	08/02/2019 01:02:22 PM Central Daylight Time	07/30/2019 05:53:15 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H0543	195	0	2020	Shasta 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	2			
H0543	196	0	1	1	1	H0543_196_0	3	1			08/05/2019	2020.01	08/05/2019 10:22:31 AM Central Daylight Time	08/02/2019 01:03:12 PM Central Daylight Time	07/30/2019 05:53:47 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage SecureHorizons Focus (HMO)	1	1		1			H0543	196	0	2020	Stanislaus 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	2			
H0543	197	0	1	1	1	H0543_197_0	2	1			06/01/2019	2020.01	06/01/2019 05:31:54 PM Central Daylight Time	08/02/2019 01:03:58 PM Central Daylight Time	07/30/2019 05:54:19 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	197	0	2020	Sonoma 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	2			
H0543	198	0	1	1	1	H0543_198_0	2	1			05/29/2019	2020.01	05/29/2019 10:17:35 AM Central Daylight Time	08/02/2019 01:04:48 PM Central Daylight Time	07/30/2019 05:54:51 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	198	0	2020	Marin 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	2			
H0543	199	0	1	1	1	H0543_199_0	2	1			05/29/2019	2020.01	05/29/2019 10:17:53 AM Central Daylight Time	08/02/2019 01:05:33 PM Central Daylight Time	07/30/2019 05:55:25 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	199	0	2020	Solano 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	2			
H0543	200	0	1	1	1	H0543_200_0	2	1			05/29/2019	2020.01	05/29/2019 10:18:12 AM Central Daylight Time	08/02/2019 01:06:20 PM Central Daylight Time	07/30/2019 05:55:57 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	200	0	2020	Napa 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	2			
H0543	201	0	1	1	1	H0543_201_0	2	1			05/29/2019	2020.01	05/29/2019 03:05:57 PM Central Daylight Time	08/02/2019 01:07:14 PM Central Daylight Time	07/30/2019 05:56:33 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	201	0	2020	Shasta 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	2			
H0543	202	0	1	1	1	H0543_202_0	2	1			05/29/2019	2020.01	05/29/2019 10:31:45 AM Central Daylight Time	08/02/2019 01:07:59 PM Central Daylight Time	07/30/2019 05:57:06 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assure (HMO)	1	1		1			H0543	202	0	2020	Select counties in Northern California		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	2			
H0543	204	0	1	1	1	H0543_204_0	4	1			08/02/2019	2020.01	08/02/2019 10:39:48 AM Central Daylight Time	08/02/2019 01:08:47 PM Central Daylight Time	07/30/2019 05:57:37 PM Central Daylight Time			08/06/2019 09:09:24 AM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Walgreens (HMO)	1	1		1			H0543	204	0	2020	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	2			
H0543	802	0	1	1	1	H0543_802_0	1	1			05/11/2019	2020.01	05/11/2019 06:25:20 AM Central Daylight Time					06/02/2019 05:40:38 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0543	802	0	2020	CA Employer Sponsored Plan Service Area		1	79608	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0543	805	0	1	1	1	H0543_805_0	1	1			05/11/2019	2020.01	05/11/2019 06:25:33 AM Central Daylight Time					06/02/2019 05:40:38 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0543	805	0	2020	CA Employer Sponsored Plan Service Area		1	173880	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0543	806	0	1	1	1	H0543_806_0	1	1			05/11/2019	2020.01	05/11/2019 06:25:46 AM Central Daylight Time					06/02/2019 05:40:38 PM Central Daylight Time	UHC OF CALIFORNIA	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0543	806	0	2020	CA Employer Sponsored Plan Service Area		1	50964	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0544	2	0	1	1	1	H0544_002_0	10	1			08/01/2019	2020.01	08/01/2019 09:37:30 PM Pacific Daylight Time	08/05/2019 06:47:09 AM Pacific Daylight Time	07/30/2019 03:52:37 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Value Plus (HMO)	1	1		1			H0544	2	0	2020	Los Angeles and Orange Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	3	0	1	1	1	H0544_003_0	10	1	2	1	08/04/2019	2020.01	08/04/2019 08:14:55 PM Pacific Daylight Time	08/05/2019 06:47:19 AM Pacific Daylight Time	07/30/2019 03:53:15 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Connect (HMO D-SNP)	1	1		1			H0544	3	0	2020	Los Angeles and Santa Clara counties		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	4	0	1	1	1	H0544_004_0	10	1		1	08/04/2019	2020.01	08/04/2019 08:15:01 PM Pacific Daylight Time	08/05/2019 06:47:50 AM Pacific Daylight Time	07/30/2019 03:53:54 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Diabetes (HMO C-SNP)	1	1		1			H0544	4	0	2020	Los Angeles and Orange Counties		2		2			1	4			1E+13		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	5	0	1	1	1	H0544_005_0	10	1		1	08/04/2019	2020.01	08/04/2019 08:15:09 PM Pacific Daylight Time	08/05/2019 06:47:51 AM Pacific Daylight Time	07/30/2019 03:54:36 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Care On Site (HMO I-SNP)	1	1		1			H0544	5	0	2020	"Los Angeles, Orange, and San Bernardino counties"		2		2			1	1	3				https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	7	0	1	1	1	H0544_007_0	10	1			07/29/2019	2020.01	07/29/2019 09:34:08 PM Pacific Daylight Time	08/05/2019 06:47:51 AM Pacific Daylight Time	07/30/2019 03:55:18 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue StartSmart Plus (HMO)	1	1		1			H0544	7	0	2020	"Los Angeles, Orange, and San Bernardino Counties"		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	8	0	1	1	1	H0544_008_0	10	1			08/04/2019	2020.01	08/04/2019 08:15:19 PM Pacific Daylight Time	08/05/2019 06:47:51 AM Pacific Daylight Time	07/30/2019 03:55:57 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Value Plus (HMO)	1	1		1			H0544	8	0	2020	San Bernardino County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	10	0	1	1	1	H0544_010_0	10	1		1	08/04/2019	2020.01	08/04/2019 08:15:25 PM Pacific Daylight Time	08/05/2019 06:47:52 AM Pacific Daylight Time	07/30/2019 03:56:35 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Diabetes (HMO C-SNP)	1	1		1			H0544	10	0	2020	San Bernardino County		2		2			1	4			1E+13		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	12	0	1	1	1	H0544_012_0	9	1			08/01/2019	2020.01	08/01/2019 03:07:57 PM Pacific Daylight Time	08/05/2019 06:47:52 AM Pacific Daylight Time	07/30/2019 03:57:13 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Value Plus (HMO)	1	1		1			H0544	12	0	2020	Santa Clara and San Benito Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	13	0	1	1	1	H0544_013_0	10	1		1	08/01/2019	2020.01	08/01/2019 03:06:49 PM Pacific Daylight Time	08/05/2019 06:47:52 AM Pacific Daylight Time	07/30/2019 03:57:51 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Heart (HMO C-SNP)	1	1		1			H0544	13	0	2020	Los Angeles and Orange Counties		2		2			1	4			10000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	14	0	1	1	1	H0544_014_0	10	1		1	08/01/2019	2020.01	08/01/2019 03:09:00 PM Pacific Daylight Time	08/05/2019 06:47:53 AM Pacific Daylight Time	07/30/2019 03:58:29 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Breathe (HMO C-SNP)	1	1		1			H0544	14	0	2020	Los Angeles and Orange Counties		2		2			1	4			100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	15	0	1	1	1	H0544_015_0	9	1		1	08/01/2019	2020.01	08/01/2019 03:51:07 PM Pacific Daylight Time		07/30/2019 03:59:07 PM Pacific Daylight Time		08/05/2019 06:48:26 AM Pacific Daylight Time	08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue ESRD (HMO C-SNP)	1	1		1			H0544	15	0	2020	Los Angeles and Orange Counties		2		2			1	4			1E+11		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	19	0	1	1	1	H0544_019_0	10	1		1	08/04/2019	2020.01	08/04/2019 08:15:33 PM Pacific Daylight Time	08/05/2019 06:48:26 AM Pacific Daylight Time	07/30/2019 03:59:44 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Breathe (HMO C-SNP)	1	1		1			H0544	19	0	2020	San Bernardino County		2		2			1	4			100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	20	0	1	1	1	H0544_020_0	9	1		1	08/01/2019	2020.01	08/01/2019 03:53:02 PM Pacific Daylight Time		07/30/2019 04:00:22 PM Pacific Daylight Time		08/05/2019 06:48:26 AM Pacific Daylight Time	08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue ESRD (HMO C-SNP)	1	1		1			H0544	20	0	2020	San Bernardino County		2		2			1	4			1E+11		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	21	0	1	1	1	H0544_021_0	11	1			08/08/2019	2020.01	08/08/2019 09:41:04 AM Pacific Daylight Time	08/05/2019 06:48:25 AM Pacific Daylight Time	07/30/2019 04:00:59 PM Pacific Daylight Time			08/08/2019 09:43:22 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue StartSmart Plus (HMO)	1	1		1			H0544	21	0	2020	"Santa Clara, Stanislaus, and San Benito Counties"		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	24	0	1	1	1	H0544_024_0	9	1		1	08/01/2019	2020.01	08/01/2019 03:12:28 PM Pacific Daylight Time	08/05/2019 06:48:25 AM Pacific Daylight Time	07/30/2019 04:01:36 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Breathe (HMO C-SNP)	1	1		1			H0544	24	0	2020	Santa Clara and San Benito Counties		2		2			1	4			100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	25	0	1	1	1	H0544_025_0	10	1		1	08/01/2019	2020.01	08/01/2019 03:19:18 PM Pacific Daylight Time	08/05/2019 06:48:25 AM Pacific Daylight Time	07/30/2019 04:02:14 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Diabetes (HMO C-SNP)	1	1		1			H0544	25	0	2020	Santa Clara and San Benito Counties		2		2			1	4			1E+13		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	27	0	1	1	1	H0544_027_0	10	1			07/29/2019	2020.01	07/29/2019 09:50:12 PM Pacific Daylight Time	08/05/2019 06:49:04 AM Pacific Daylight Time	07/30/2019 04:02:52 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Value Plus (HMO)	1	1		1			H0544	27	0	2020	Stanislaus County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	31	0	1	1	1	H0544_031_0	11	1		1	08/04/2019	2020.01	08/04/2019 08:15:40 PM Pacific Daylight Time	08/05/2019 06:49:04 AM Pacific Daylight Time	07/30/2019 04:03:30 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Breathe (HMO C-SNP)	1	1		1			H0544	31	0	2020	Stanislaus County		2		2			1	4			100000000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	32	0	1	1	1	H0544_032_0	10	1		1	08/04/2019	2020.01	08/04/2019 08:15:46 PM Pacific Daylight Time	08/05/2019 06:49:01 AM Pacific Daylight Time	07/30/2019 04:04:10 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Diabetes (HMO C-SNP)	1	1		1			H0544	32	0	2020	Stanislaus County		2		2			1	4			1E+13		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	36	0	1	1	1	H0544_036_0	10	1		1	08/04/2019	2020.01	08/04/2019 08:15:51 PM Pacific Daylight Time	08/05/2019 06:49:02 AM Pacific Daylight Time	07/30/2019 04:04:47 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Heart (HMO C-SNP)	1	1		1			H0544	36	0	2020	Stanislaus County		2		2			1	4			10000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	37	0	1	1	1	H0544_037_0	9	1		1	08/01/2019	2020.01	08/01/2019 03:26:38 PM Pacific Daylight Time	08/05/2019 06:49:02 AM Pacific Daylight Time	07/30/2019 04:05:24 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Heart (HMO C-SNP)	1	1		1			H0544	37	0	2020	Santa Clara and San Benito Counties		2		2			1	4			10000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	38	0	1	1	1	H0544_038_0	11	1		1	08/04/2019	2020.01	08/04/2019 08:16:00 PM Pacific Daylight Time	08/05/2019 06:49:02 AM Pacific Daylight Time	07/30/2019 04:06:01 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Heart (HMO C-SNP)	1	1		1			H0544	38	0	2020	San Bernardino County		2		2			1	4			10000		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	49	0	1	1	1	H0544_049_0	13	1			07/29/2019	2020.01	07/29/2019 09:51:21 PM Pacific Daylight Time	08/05/2019 06:49:03 AM Pacific Daylight Time	07/30/2019 04:06:39 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Connect Plus (HMO)	1	1		1			H0544	49	0	2020	"Counties: LA, Orange, San Bern., SC, San Benito"		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	50	0	1	1	1	H0544_050_0	11	1		1	07/25/2019	2020.01	07/25/2019 10:16:53 AM Pacific Daylight Time	08/05/2019 06:49:03 AM Pacific Daylight Time	07/30/2019 04:07:16 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Care On Site (HMO I-SNP)	1	1		1			H0544	50	0	2020	Santa Clara County		2		2			1	1	3				https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	52	0	1	1	1	H0544_052_0	7	1	2	1	06/25/2019	2020.01	06/25/2019 09:04:45 PM Eastern Daylight Time	08/05/2019 06:50:24 AM Pacific Daylight Time	07/30/2019 04:07:53 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H0544	52	0	2020	"Fresno, Kings, Madera and Tulare Counties"		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(844)469-6831		(844)469-6831		(844)398-0642		(844)398-0642		(844)469-6831		(844)469-6831		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	53	0	1	1	1	H0544_053_0	7	1	2	1	06/25/2019	2020.01	06/25/2019 09:05:01 PM Eastern Daylight Time	08/05/2019 06:50:24 AM Pacific Daylight Time	07/30/2019 04:08:30 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H0544	53	0	2020	Kern County		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(844)469-6831		(844)469-6831		(844)398-0642		(844)398-0642		(844)469-6831		(844)469-6831		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	54	0	1	1	1	H0544_054_0	7	1	2	1	06/25/2019	2020.01	06/25/2019 09:05:26 PM Eastern Daylight Time	08/05/2019 06:50:25 AM Pacific Daylight Time	07/30/2019 04:09:08 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H0544	54	0	2020	San Francisco and Sacramento Counties		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(844)469-6831		(844)469-6831		(844)398-0642		(844)398-0642		(844)469-6831		(844)469-6831		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	55	0	1	1	1	H0544_055_0	7	1	2	1	06/25/2019	2020.01	06/25/2019 09:06:08 PM Eastern Daylight Time	08/05/2019 06:50:25 AM Pacific Daylight Time	07/30/2019 04:09:46 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H0544	55	0	2020	Ventura County		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(844)469-6831		(844)469-6831		(844)398-0642		(844)398-0642		(844)469-6831		(844)469-6831		(844)799-9866		(844)799-9866		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	56	0	1	1	1	H0544_056_0	8	1			07/31/2019	2020.01	07/31/2019 09:24:43 PM Pacific Daylight Time	08/05/2019 06:50:25 AM Pacific Daylight Time	07/30/2019 04:10:23 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	1	1		1			H0544	56	0	2020	"Fresno, Kings, Madera and Tulare Counties"		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	57	0	1	1	1	H0544_057_0	8	1			07/31/2019	2020.01	07/31/2019 09:27:45 PM Pacific Daylight Time	08/05/2019 06:50:26 AM Pacific Daylight Time	07/30/2019 04:11:01 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	1	1		1			H0544	57	0	2020	San Francisco County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	58	0	1	1	1	H0544_058_0	8	1			07/31/2019	2020.01	07/31/2019 09:29:02 PM Pacific Daylight Time	08/05/2019 06:50:26 AM Pacific Daylight Time	07/30/2019 04:11:39 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Select (HMO)	1	1		1			H0544	58	0	2020	Los Angeles County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	59	0	1	1	1	H0544_059_0	8	1			07/31/2019	2020.01	07/31/2019 09:33:31 PM Pacific Daylight Time	08/05/2019 06:50:26 AM Pacific Daylight Time	07/30/2019 04:12:17 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Select (HMO)	1	1		1			H0544	59	0	2020	Orange County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	60	3	1	1	1	H0544_060_3	8	1			08/02/2019	2020.01	08/02/2019 10:29:36 AM Pacific Daylight Time	08/05/2019 06:50:27 AM Pacific Daylight Time	07/30/2019 04:12:55 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	1	1		1			H0544	60	3	2020	Select County in Inland Empire	San Bernardino County	2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	60	4	1	1	1	H0544_060_4	8	1			07/31/2019	2020.01	07/31/2019 09:39:34 PM Pacific Daylight Time	08/05/2019 06:50:27 AM Pacific Daylight Time	07/30/2019 04:13:32 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	1	1		1			H0544	60	4	2020	Select County in Inland Empire	Riverside County	2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	61	0	1	1	1	H0544_061_0	8	1			07/31/2019	2020.01	07/31/2019 09:41:50 PM Pacific Daylight Time	08/05/2019 06:50:28 AM Pacific Daylight Time	07/30/2019 04:14:09 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	1	1		1			H0544	61	0	2020	Orange and Los Angeles Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	62	0	1	1	1	H0544_062_0	7	1			07/31/2019	2020.01	07/31/2019 09:46:04 PM Pacific Daylight Time	08/05/2019 06:50:28 AM Pacific Daylight Time	07/30/2019 04:14:47 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	1	1		1			H0544	62	0	2020	Kern County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	63	0	1	1	1	H0544_063_0	7	1			07/31/2019	2020.01	07/31/2019 09:50:34 PM Pacific Daylight Time	08/05/2019 06:50:28 AM Pacific Daylight Time	07/30/2019 04:15:24 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	1	1		1			H0544	63	0	2020	Ventura County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	64	0	1	1	1	H0544_064_0	7	1			07/31/2019	2020.01	07/31/2019 09:52:39 PM Pacific Daylight Time	08/05/2019 06:50:29 AM Pacific Daylight Time	07/30/2019 04:16:00 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	1	1		1			H0544	64	0	2020	Sacramento County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	65	0	1	1	1	H0544_065_0	8	1			07/31/2019	2020.01	07/31/2019 09:55:16 PM Pacific Daylight Time	08/05/2019 06:50:29 AM Pacific Daylight Time	07/30/2019 04:16:38 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	1	1		1			H0544	65	0	2020	San Diego County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	66	0	1	1	1	H0544_066_0	8	1			08/05/2019	2020.01	08/05/2019 02:00:00 PM Pacific Daylight Time	08/05/2019 06:50:23 AM Pacific Daylight Time	07/30/2019 04:17:15 PM Pacific Daylight Time			08/05/2019 02:03:41 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Select (HMO)	1	1		1			H0544	66	0	2020	San Bernardino County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	67	0	1	1	1	H0544_067_0	9	1			08/05/2019	2020.01	08/05/2019 02:00:13 PM Pacific Daylight Time	08/05/2019 06:50:23 AM Pacific Daylight Time	07/30/2019 04:17:51 PM Pacific Daylight Time			08/05/2019 02:03:41 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Select (HMO)	1	1		1			H0544	67	0	2020	Riverside County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	69	0	1	1	1	H0544_069_0	8	1			07/31/2019	2020.01	07/31/2019 10:05:39 PM Pacific Daylight Time	08/05/2019 06:50:23 AM Pacific Daylight Time	07/30/2019 04:18:28 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Select (HMO)	1	1		1			H0544	69	0	2020	San Francisco County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	70	0	1	1	1	H0544_070_0	8	1			06/25/2019	2020.01	06/25/2019 09:12:10 PM Eastern Daylight Time	08/05/2019 06:50:24 AM Pacific Daylight Time	07/30/2019 04:19:05 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Coordination Plus (HMO)	1	1		1			H0544	70	0	2020	San Diego County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)799-9862		(844)799-9862		(888)230-7338		(888)230-7338		(844)799-9863		(844)799-9863		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	71	0	1	1	1	H0544_071_0	8	1			06/25/2019	2020.01	06/25/2019 09:11:54 PM Eastern Daylight Time	08/05/2019 06:53:58 AM Pacific Daylight Time	07/30/2019 04:19:41 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Coordination Plus (HMO)	1	1		1			H0544	71	0	2020	Riverside and San Bernardino Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)799-9862		(844)799-9862		(888)230-7338		(888)230-7338		(844)799-9863		(844)799-9863		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	72	0	1	1	1	H0544_072_0	10	1			06/25/2019	2020.01	06/25/2019 09:11:37 PM Eastern Daylight Time	08/05/2019 06:53:58 AM Pacific Daylight Time	07/30/2019 04:20:18 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Coordination Plus (HMO)	1	1		1			H0544	72	0	2020	Los Angeles and Orange Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)799-9862		(844)799-9862		(888)230-7338		(888)230-7338		(844)799-9863		(844)799-9863		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	74	0	1	1	1	H0544_074_0	8	1			07/31/2019	2020.01	07/31/2019 10:21:34 PM Pacific Daylight Time	08/05/2019 06:53:59 AM Pacific Daylight Time	07/30/2019 04:20:54 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	1	1		1			H0544	74	0	2020	Yolo County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	81	0	1	1	1	H0544_081_0	8	1			06/25/2019	2020.01	06/25/2019 09:11:04 PM Eastern Daylight Time	08/05/2019 06:53:59 AM Pacific Daylight Time	07/30/2019 04:21:30 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Extra (HMO)	1	1		1			H0544	81	0	2020	"Counties: LA, Orange, San Bern., Riv, San Diego"		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(844)487-9286		(844)487-9286		(844)316-0357		(844)316-0357		(844)487-9286		(844)487-9286		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	87	0	1	1	1	H0544_087_0	8	1	2	1	06/25/2019	2020.01	06/25/2019 09:10:45 PM Eastern Daylight Time	08/05/2019 06:53:59 AM Pacific Daylight Time	07/30/2019 04:22:07 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Plus (HMO D-SNP)	1	1		1			H0544	87	0	2020	"Fresno, Kings, Madera, and Tulare Counties"		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(844)469-6831		(844)469-6831		(844)316-0357		(844)316-0357		(844)469-6831		(844)469-6831		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	88	0	1	1	1	H0544_088_0	8	1	2	1	06/25/2019	2020.01	06/25/2019 09:10:30 PM Eastern Daylight Time	08/05/2019 06:54:00 AM Pacific Daylight Time	07/30/2019 04:22:43 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Plus (HMO D-SNP)	1	1		1			H0544	88	0	2020	Kern County		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(844)469-6831		(844)469-6831		(844)316-0357		(844)316-0357		(844)469-6831		(844)469-6831		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	89	0	1	1	1	H0544_089_0	7	1	2	1	06/25/2019	2020.01	06/25/2019 09:10:13 PM Eastern Daylight Time	08/05/2019 06:54:00 AM Pacific Daylight Time	07/30/2019 04:23:19 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Plus (HMO D-SNP)	1	1		1			H0544	89	0	2020	San Francisco and Sacramento Counties		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(844)469-6831		(844)469-6831		(844)316-0357		(844)316-0357		(844)469-6831		(844)469-6831		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	90	0	1	1	1	H0544_090_0	8	1	2	1	06/25/2019	2020.01	06/25/2019 09:09:56 PM Eastern Daylight Time	08/05/2019 06:54:00 AM Pacific Daylight Time	07/30/2019 04:23:58 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Plus (HMO D-SNP)	1	1		1			H0544	90	0	2020	Ventura County		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(844)469-6831		(844)469-6831		(844)316-0357		(844)316-0357		(844)469-6831		(844)469-6831		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	91	0	1	1	1	H0544_091_0	8	1			07/31/2019	2020.01	07/31/2019 10:23:04 PM Pacific Daylight Time	08/05/2019 06:54:01 AM Pacific Daylight Time	07/30/2019 04:24:36 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Select (HMO)	1	1		1			H0544	91	0	2020	San Diego County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	93	0	1	1	1	H0544_093_0	9	1		1	07/31/2019	2020.01	07/31/2019 10:28:51 PM Pacific Daylight Time	08/05/2019 06:54:01 AM Pacific Daylight Time	07/30/2019 04:25:13 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Care On Site (HMO I-SNP)	1	1		1			H0544	93	0	2020	Sacramento County		2		2			1	1	3				https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	94	0	1	1	1	H0544_094_0	9	1		1	07/31/2019	2020.01	07/31/2019 10:31:45 PM Pacific Daylight Time	08/05/2019 06:54:01 AM Pacific Daylight Time	07/30/2019 04:25:50 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Diabetes (HMO C-SNP)	1	1		1			H0544	94	0	2020	Sacramento County		2		2			1	4			1E+13		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	95	0	1	1	1	H0544_095_0	9	1			07/31/2019	2020.01	07/31/2019 10:45:33 PM Pacific Daylight Time	08/05/2019 06:54:02 AM Pacific Daylight Time	07/30/2019 04:26:26 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	1	1		1			H0544	95	0	2020	San Joaquin County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	96	0	1	1	1	H0544_096_0	8	1			07/31/2019	2020.01	07/31/2019 10:47:13 PM Pacific Daylight Time	08/05/2019 06:54:02 AM Pacific Daylight Time	07/30/2019 04:27:05 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	1	1		1			H0544	96	0	2020	San Mateo County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	97	0	1	1	1	H0544_097_0	8	1			07/31/2019	2020.01	07/31/2019 10:49:54 PM Pacific Daylight Time	08/05/2019 06:54:03 AM Pacific Daylight Time	07/30/2019 04:27:43 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Plus (HMO)	1	1		1			H0544	97	0	2020	Alameda County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	98	0	1	1	1	H0544_098_0	8	1			07/31/2019	2020.01	07/31/2019 10:52:54 PM Pacific Daylight Time	08/05/2019 06:54:03 AM Pacific Daylight Time	07/30/2019 04:28:20 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Select (HMO)	1	1		1			H0544	98	0	2020	Alameda County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	99	0	1	1	1	H0544_099_0	8	1			06/25/2019	2020.01	06/25/2019 09:07:27 PM Eastern Daylight Time	08/05/2019 06:53:57 AM Pacific Daylight Time	07/30/2019 04:29:00 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Coordination Plus (HMO)	1	1		1			H0544	99	0	2020	Alameda and San Mateo Counties		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	100	0	1	1	1	H0544_100_0	7	1	2	1	07/31/2019	2020.01	07/31/2019 10:54:41 PM Pacific Daylight Time	08/05/2019 06:53:58 AM Pacific Daylight Time	07/30/2019 04:29:42 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H0544	100	0	2020	San Joaquin County		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(888)230-7338		(888)230-7338		(844)316-0357		(844)316-0357		(888)230-7338		(888)230-7338		(844)364-2108		(844)364-2108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0544	801	0	1	1	1	H0544_801_0	1	1			05/29/2019	2020.01	05/29/2019 08:04:48 PM Pacific Daylight Time					05/29/2019 08:53:45 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	caremore.com	Anthem EGWP (HMO)	1	1		1			H0544	801	0	2020	California		1	165	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;	1					1				
H0544	802	0	1	1	1	H0544_802_0	1	1			05/29/2019	2020.01	05/29/2019 08:02:13 PM Pacific Daylight Time					05/29/2019 08:53:45 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	caremore.com	Anthem EGWP MAPD (HMO)	1	1		1			H0544	802	0	2020	California		1	2083	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;	1					1				
H0544	804	0	1	1	1	H0544_804_0	1	1			05/29/2019	2020.01	05/29/2019 08:05:29 PM Pacific Daylight Time					05/29/2019 08:53:45 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	caremore.com	Anthem EGWP MAPD (HMO)	1	1		1			H0544	804	0	2020	California		1	65	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(800)499-2793		(800)499-2793		(844)309-6996		(844)309-6996		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;	1					1				
H0544	805	0	1	1	1	H0544_805_0	3	1			05/30/2019	2020.01	05/30/2019 06:28:11 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	1	1		1			H0544	805	0	2020	"California, select counties"		1	10625	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	806	0	1	1	1	H0544_806_0	3	1			05/17/2019	2020.01	05/17/2019 06:30:45 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	1	1		1			H0544	806	0	2020	"California, select counties"		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	807	0	1	1	1	H0544_807_0	3	1			05/17/2019	2020.01	05/17/2019 06:27:39 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	1	1		1			H0544	807	0	2020	"California, select counties"		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	808	0	2	1	1	H0544_808_0	3	1			05/30/2019	2020.01	05/30/2019 06:52:50 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	1	1		2	1		H0544	808	0	2020	Select counties in California		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	809	0	2	1	1	H0544_809_0	3	1			05/30/2019	2020.01	05/30/2019 06:53:07 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	1	1		2	1		H0544	809	0	2020	Select CA counties		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	810	0	1	1	1	H0544_810_0	3	1			05/17/2019	2020.01	05/17/2019 06:33:27 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	1	1		1			H0544	810	0	2020	Select CA Counties		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	811	0	2	1	1	H0544_811_0	3	1			05/30/2019	2020.01	05/30/2019 06:53:21 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	1	1		2	1		H0544	811	0	2020	Select CA Counties		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0544	812	0	2	1	1	H0544_812_0	3	1			05/30/2019	2020.01	05/30/2019 06:53:29 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	1	1		2	1		H0544	812	0	2020	Select CA counties		1	600	2			2						www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	1	6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;14d;14e1;14e2;14e3;14e4;14e5;14e6;18a;	1					1				
H0545	1	0	1	1	1	H0545_001_0	8	1			07/22/2019	2020.01	07/22/2019 12:49:00 PM Pacific Daylight Time	08/01/2019 11:00:00 AM Pacific Daylight Time	08/01/2019 11:35:00 AM Pacific Daylight Time			08/05/2019 04:19:29 PM Pacific Daylight Time	"INTER VALLEY HEALTH PLAN, INC."	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Service To Seniors (HMO)	1	1		1			H0545	1	0	2020	"Counties: LA, RV, OC and SB"		2	179046	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0545	12	0	1	1	1	H0545_012_0	4	1			05/31/2019	2020.01	05/31/2019 05:03:02 PM Pacific Daylight Time	08/05/2019 01:56:00 PM Pacific Daylight Time	08/01/2019 11:21:00 AM Pacific Daylight Time			08/05/2019 04:19:29 PM Pacific Daylight Time	"INTER VALLEY HEALTH PLAN, INC."	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Desert Preferred Choice (HMO)	1	1		1			H0545	12	0	2020	Riverside County		2	75600	2			2						http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(800)251-8191		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0545	15	0	1	1	1	H0545_015_0	4	1			05/29/2019	2020.01	05/29/2019 03:06:16 PM Pacific Daylight Time	08/05/2019 03:40:00 PM Pacific Daylight Time	08/05/2019 03:46:00 PM Pacific Daylight Time			08/05/2019 04:13:21 PM Pacific Daylight Time	"INTER VALLEY HEALTH PLAN, INC."	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Vitality Plus (HMO)	1	1		1			H0545	15	0	2020	"LA, San Bernardino, Riverside and Orange Counties"		2	5095	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0545	801	0	1	1	1	H0545_801_0	1	1			05/28/2019	2020.01	05/28/2019 04:36:01 PM Pacific Daylight Time					05/29/2019 02:52:10 PM Pacific Daylight Time	"INTER VALLEY HEALTH PLAN, INC."	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Active Plus I (HMO)	1	1		1			H0545	801	0	2020	"Counties: LA, OC, RV SB"		1	600	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;	2					1				
H0545	802	0	1	1	1	H0545_802_0	1	1			05/28/2019	2020.01	05/28/2019 04:37:49 PM Pacific Daylight Time					05/29/2019 02:52:10 PM Pacific Daylight Time	"INTER VALLEY HEALTH PLAN, INC."	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Active Plus II (HMO)	1	1		1			H0545	802	0	2020	"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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;	2					1				
H0562	9	0	1	1	1	H0562_009_0	4	1			08/01/2019	2020.01	08/01/2019 01:55:23 PM Pacific Daylight Time	08/05/2019 03:53:30 PM Central Daylight Time	08/05/2019 02:55:14 PM Central Daylight Time			08/05/2019 05:05:54 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	1	1		1			H0562	9	0	2020	San Francisco County		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	12	0	1	1	1	H0562_012_0	4	1			08/01/2019	2020.01	08/01/2019 01:57:42 PM Pacific Daylight Time	08/05/2019 03:53:33 PM Central Daylight Time	08/05/2019 02:58:02 PM Central Daylight Time			08/05/2019 05:05:54 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	1	1		1			H0562	12	0	2020	San Diego County		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	39	0	1	1	1	H0562_039_0	4	1			08/01/2019	2020.01	08/01/2019 01:57:36 PM Pacific Daylight Time	08/05/2019 03:53:37 PM Central Daylight Time	08/05/2019 02:56:51 PM Central Daylight Time			08/05/2019 05:05:54 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	1	1		1			H0562	39	0	2020	Yolo county		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/find-doctor	(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	2			
H0562	44	0	1	1	1	H0562_044_0	3	1			07/12/2019	2020.01	07/12/2019 08:22:14 AM US Mountain Standard Time	07/09/2019 03:30:38 PM Pacific Daylight Time				07/15/2019 03:14:41 PM Pacific Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Green (HMO)	1	1		1			H0562	44	0	2020	"L.A., Riverside, S.Bern. Counties"		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0562	45	0	1	1	1	H0562_045_0	2	1			07/12/2019	2020.01	07/12/2019 08:19:53 AM US Mountain Standard Time	07/09/2019 03:30:38 PM Pacific Daylight Time				07/15/2019 03:14:41 PM Pacific Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Green (HMO)	1	1		1			H0562	45	0	2020	"Ala, Pla, Sac, Sta Counties"		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0562	55	0	1	1	1	H0562_055_0	4	1	2	1	08/01/2019	2020.01	08/01/2019 01:56:40 PM Pacific Daylight Time	08/05/2019 03:53:40 PM Central Daylight Time	08/05/2019 03:02:17 PM Central Daylight Time			08/05/2019 05:05:54 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Amber I (HMO D-SNP)	1	1		1			H0562	55	0	2020	"L.A., Kern, Org, Riv, SB, Fresno, SD, SF, Tulare"		2		2			1	3		2		2	ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	68	0	1	1	1	H0562_068_0	4	1			08/01/2019	2020.01	08/01/2019 01:57:30 PM Pacific Daylight Time	08/05/2019 03:53:44 PM Central Daylight Time	08/05/2019 03:02:20 PM Central Daylight Time			08/05/2019 05:21:23 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	1	1		1			H0562	68	0	2020	Alameda and Stanislaus Counties		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	79	0	1	1	1	H0562_079_0	4	1			08/01/2019	2020.01	08/01/2019 01:58:23 PM Pacific Daylight Time	08/05/2019 03:53:48 PM Central Daylight Time	08/05/2019 03:02:22 PM Central Daylight Time			08/05/2019 05:21:23 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Ruby (HMO)	1	1		1			H0562	79	0	2020	Kern County		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	84	0	1	1	1	H0562_084_0	4	1			08/02/2019	2020.01	08/02/2019 01:11:57 PM Pacific Daylight Time	08/05/2019 03:53:51 PM Central Daylight Time	08/05/2019 03:02:26 PM Central Daylight Time			08/05/2019 05:21:23 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	1	1		1			H0562	84	0	2020	"Placer, Sacramento Counties"		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	90	0	1	1	1	H0562_090_0	4	1			08/01/2019	2020.01	08/01/2019 02:02:41 PM Pacific Daylight Time	08/05/2019 03:53:55 PM Central Daylight Time	08/05/2019 03:02:28 PM Central Daylight Time			08/05/2019 05:21:23 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	1	1		1			H0562	90	0	2020	Fresno County		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	92	0	1	1	1	H0562_092_0	4	1		1	08/01/2019	2020.01	08/01/2019 02:08:15 PM Pacific Daylight Time	08/05/2019 03:53:59 PM Central Daylight Time	08/05/2019 03:02:31 PM Central Daylight Time			08/05/2019 05:21:23 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Jade (HMO C-SNP)	1	1		1			H0562	92	0	2020	"Kern, L. A. and Orange Counties"		2		2			1	4			10		ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	97	0	1	1	1	H0562_097_0	5	1			08/01/2019	2020.01	08/01/2019 03:12:59 PM Pacific Daylight Time	08/05/2019 03:54:02 PM Central Daylight Time	08/05/2019 03:02:34 PM Central Daylight Time			08/05/2019 05:21:23 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Ruby Select (HMO)	1	1		1			H0562	97	0	2020	San Francisco		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	100	1	1	1	1	H0562_100_1	5	1			08/01/2019	2020.01	08/01/2019 03:13:06 PM Pacific Daylight Time	08/05/2019 03:54:06 PM Central Daylight Time	08/05/2019 03:03:32 PM Central Daylight Time			08/05/2019 05:21:23 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	1	1		1			H0562	100	1	2020	"LA, Orange, Riverside and San Bernardino Counties"	Los Angeles and Orange Counties	2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	100	2	1	1	1	H0562_100_2	4	1			08/02/2019	2020.01	08/02/2019 08:30:30 AM Pacific Daylight Time	08/05/2019 03:54:10 PM Central Daylight Time	08/05/2019 03:03:34 PM Central Daylight Time			08/05/2019 05:21:23 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	1	1		1			H0562	100	2	2020	"LA, Orange, Riverside and San Bernardino Counties"	Riverside and San Bernardino Counties	2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	101	1	1	1	1	H0562_101_1	4	1			08/01/2019	2020.01	08/01/2019 03:13:21 PM Pacific Daylight Time	08/05/2019 03:54:14 PM Central Daylight Time	08/05/2019 03:03:26 PM Central Daylight Time			08/05/2019 06:00:29 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Gold Select (HMO)	1	1		1			H0562	101	1	2020	"LA, Orange, Riverside and San Bernardino Counties"	Los Angeles and Orange Counties	2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	101	2	1	1	1	H0562_101_2	4	1			08/01/2019	2020.01	08/05/2019 05:57:07 PM Central Daylight Time	08/05/2019 03:54:18 PM Central Daylight Time	08/05/2019 03:03:29 PM Central Daylight Time			08/05/2019 06:00:29 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Gold Select (HMO)	1	1		1			H0562	101	2	2020	"LA, Orange, Riverside and San Bernardino Counties"	Riverside and San Bernardino Counties	2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	103	0	1	1	1	H0562_103_0	4	1			08/01/2019	2020.01	08/01/2019 03:14:08 PM Pacific Daylight Time	08/05/2019 03:54:25 PM Central Daylight Time	08/05/2019 03:05:18 PM Central Daylight Time			08/05/2019 05:37:50 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Ruby Select (HMO)	1	1		1			H0562	103	0	2020	Yolo County		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	112	0	1	1	1	H0562_112_0	4	1			08/01/2019	2020.01	08/01/2019 03:08:53 PM Pacific Daylight Time	08/05/2019 03:54:30 PM Central Daylight Time	08/05/2019 03:05:21 PM Central Daylight Time			08/05/2019 05:37:50 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Ruby Select (HMO)	1	1		1			H0562	112	0	2020	Fresno County		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	113	0	1	1	1	H0562_113_0	4	1			08/01/2019	2020.01	08/01/2019 03:09:20 PM Pacific Daylight Time	08/05/2019 03:54:35 PM Central Daylight Time	08/05/2019 03:05:25 PM Central Daylight Time			08/05/2019 05:37:50 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Ruby Select (HMO)	1	1		1			H0562	113	0	2020	Alameda County		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	114	0	1	1	1	H0562_114_0	4	1		1	08/01/2019	2020.01	08/01/2019 03:14:38 PM Pacific Daylight Time	08/05/2019 03:54:39 PM Central Daylight Time	08/05/2019 03:05:28 PM Central Daylight Time			08/05/2019 05:37:50 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Jade (HMO C-SNP)	1	1		1			H0562	114	0	2020	San Diego		2		2			1	4			10		ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	117	0	1	1	1	H0562_117_0	3	1		1	08/01/2019	2020.01	08/01/2019 03:10:11 PM Pacific Daylight Time	08/05/2019 03:54:42 PM Central Daylight Time	08/05/2019 03:05:32 PM Central Daylight Time			08/05/2019 05:37:50 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Jade (HMO C-SNP)	1	1		1			H0562	117	0	2020	San Francisco County		2		2			1	4			10		ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	118	0	1	1	1	H0562_118_0	4	1		1	08/02/2019	2020.01	08/02/2019 07:05:53 AM Pacific Daylight Time	08/05/2019 03:54:47 PM Central Daylight Time	08/05/2019 03:05:35 PM Central Daylight Time			08/05/2019 05:37:50 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Jade (HMO C-SNP)	1	1		1			H0562	118	0	2020	Fresno County		2		2			1	4			10		ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	119	0	1	1	1	H0562_119_0	3	1			08/01/2019	2020.01	08/01/2019 03:12:38 PM Pacific Daylight Time	08/05/2019 03:54:51 PM Central Daylight Time	08/05/2019 03:05:38 PM Central Daylight Time			08/05/2019 05:37:50 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	1	1		1			H0562	119	0	2020	Imperial County		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	120	0	1	1	1	H0562_120_0	3	1			08/01/2019	2020.01	08/01/2019 03:12:47 PM Pacific Daylight Time	08/05/2019 03:54:56 PM Central Daylight Time	08/05/2019 03:05:06 PM Central Daylight Time			08/05/2019 05:37:50 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Healthy Heart (HMO)	1	1		1			H0562	120	0	2020	Santa Clara and Stanislaus Counties		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	121	0	1	1	1	H0562_121_0	5	1	2	1	08/01/2019	2020.01	08/01/2019 03:15:42 PM Pacific Daylight Time	08/05/2019 03:55:00 PM Central Daylight Time	08/05/2019 03:05:10 PM Central Daylight Time			08/05/2019 05:37:50 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Amber II (HMO D-SNP)	1	1		1			H0562	121	0	2020	Parts of Southern and Northern California		2		2			1	3		2		2	ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	122	0	1	1	1	H0562_122_0	5	1			08/01/2019	2020.01	08/01/2019 03:15:21 PM Pacific Daylight Time	08/05/2019 03:55:04 PM Central Daylight Time	08/05/2019 03:05:14 PM Central Daylight Time			08/05/2019 05:37:50 PM Central Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	ca.healthnetadvantage.com	Health Net Seniority Plus Sapphire (HMO)	1	1		1			H0562	122	0	2020	Parts of Southern and Northern California		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H0562	801	0	1	1	1	H0562_801_0	2	1			05/13/2019	2020.01	05/13/2019 03:38:20 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	healthnet.com	Health Net Seniority Plus Employer (HMO)	1	1		1			H0562	801	0	2020	California		1	216000	2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;17b;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;9a1;9b;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					1				
H0562	803	0	1	1	1	H0562_803_0	2	1			05/13/2019	2020.01	05/13/2019 03:39:32 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	healthnet.com	Health Net Seniority Plus Employer (HMO)	1	1		1			H0562	803	0	2020	California		1	54000	2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;17b;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;9a1;9b;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					1				
H0562	804	0	1	1	1	H0562_804_0	2	1			05/13/2019	2020.01	05/13/2019 03:33:55 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"HEALTH NET OF CALIFORNIA,INC."	Health Net of California	healthnet.com	Health Net Seniority Plus Employer (HMO)	1	1		1			H0562	804	0	2020	California		1	21600	2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;17b;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;9a1;9b;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					1				
H0571	1	0	1	1	1	H0571_001_0	4	1			08/05/2019	2020.01	08/05/2019 02:27:21 PM Pacific Daylight Time	08/02/2019 09:18:06 AM Pacific Daylight Time	08/02/2019 09:21:24 AM Pacific Daylight Time			08/05/2019 02:29:16 PM Pacific Daylight Time	CHINESE COMMUNITY HEALTH PLAN	Chinese Community Health Plan	www.cchphealthplan.com/medicare	CCHP Senior Program (HMO)	1	1		1			H0571	1	0	2020	San Francisco and San Mateo Counties		2	25756	2			2						www.cchphealthplan.com/medicare-rx-benefit-information-including-part-d	www.cchphealthplan.com/medicare-rx-benefit-information-including-part-d		(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8831		(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8831		(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	1	1	9a1;	
H0571	5	0	1	1	1	H0571_005_0	4	1	2	1	08/05/2019	2020.01	08/05/2019 02:27:31 PM Pacific Daylight Time	08/02/2019 09:19:33 AM Pacific Daylight Time	08/02/2019 09:22:29 AM Pacific Daylight Time			08/05/2019 02:29:16 PM Pacific Daylight Time	CHINESE COMMUNITY HEALTH PLAN	Chinese Community Health Plan	www.cchphealthplan.com/medicare	CCHP Senior Select Program (HMO SNP)	1	1		1			H0571	5	0	2020	San Francisco County		2	33368	2			1	3		2		2	www.cchphealthplan.com/medicare-rx-benefit-information-including-part-d	www.cchphealthplan.com/medicare-rx-benefit-information-including-part-d		(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8831		(888)775-7888		(415)834-2118		(888)681-3888		(415)955-8831		(877)681-8898		(877)681-8898		(877)681-8898		(415)955-8801		(877)681-8898		(877)681-8898		(877)681-8898		(415)955-8801		2					2					2	2			
H0602	1	0	1	18	6	H0602_001_0	1	2			05/28/2019	2020.01	05/28/2019 10:11:43 AM Mountain Daylight Time					05/30/2019 08:51:49 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan (Cost)	6	18		1			H0602	1	0	2020	Colorado		2	71856	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	2			
H0602	3	0	1	18	6	H0602_003_0	1	2			05/28/2019	2020.01	05/28/2019 10:12:14 AM Mountain Daylight Time					05/30/2019 08:51:49 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Plus Plan (Cost)	6	18		1			H0602	3	0	2020	Colorado		2	5964	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	2			
H0602	26	0	1	18	6	H0602_026_0	1	2			05/22/2019	2020.01	05/22/2019 03:05:57 PM Mountain Daylight Time					05/30/2019 08:51:49 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Basic Plan (Cost)	6	18		1			H0602	26	0	2020	Colorado		2	16380	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	1a;5;7d;7e;7f;7g;7h;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;16b;17a;17b;20;	2		2					2				
H0602	27	0	1	18	6	H0602_027_0	1	2			05/28/2019	2020.01	05/28/2019 10:12:38 AM Mountain Daylight Time					05/30/2019 08:51:49 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Thrifty Plan (Cost)	6	18		1			H0602	27	0	2020	Colorado		2	21696	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	2			
H0602	40	0	2	18	6	H0602_040_0	1	2			05/22/2019	2020.01	05/22/2019 03:09:30 PM Mountain Daylight Time					05/30/2019 08:51:49 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain B Basic Plan (Cost)	6	18		2	2		H0602	40	0	2020	Colorado		2	4608	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	5;7d;7e;7f;7g;7h;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;16b;17a;17b;20;	2		2					2				
H0602	41	0	2	18	6	H0602_041_0	1	2			05/28/2019	2020.01	05/28/2019 10:13:23 AM Mountain Daylight Time					05/30/2019 08:51:49 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain B Standard Plan (Cost)	6	18		2	2		H0602	41	0	2020	Colorado		2	12	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	2			
H0602	42	0	1	18	6	H0602_042_0	1	2			05/22/2019	2020.01	05/22/2019 02:59:37 PM Mountain Daylight Time					05/30/2019 08:51:49 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Green Plan (Cost)	6	18		1			H0602	42	0	2020	Colorado		2	32124	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	2			
H0609	7	0	1	1	1	H0609_007_0	2	1			08/02/2019	2020.01	08/02/2019 11:14:11 AM Central Daylight Time	08/02/2019 10:42:39 AM Central Daylight Time	07/30/2019 05:58:10 PM Central Daylight Time			08/06/2019 08:51:16 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	1	1		1			H0609	7	0	2020	Denver Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0609	12	0	1	1	1	H0609_012_0	3	1			07/11/2019	2020.01	07/11/2019 03:26:32 PM Central Daylight Time	08/02/2019 10:43:35 AM Central Daylight Time	07/30/2019 05:58:44 PM Central Daylight Time			08/06/2019 08:51:16 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	1	1		1			H0609	12	0	2020	Denver Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0609	18	0	1	1	1	H0609_018_0	2	1			07/12/2019	2020.01	07/12/2019 08:14:33 AM Central Daylight Time	05/31/2019 12:25:42 PM Central Daylight Time				07/12/2019 08:35:00 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Essential (HMO)	1	1		1			H0609	18	0	2020	Denver Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0609	25	0	1	1	1	H0609_025_0	3	1			08/02/2019	2020.01	08/02/2019 11:21:50 AM Central Daylight Time	08/02/2019 10:45:15 AM Central Daylight Time	07/30/2019 05:59:18 PM Central Daylight Time			08/06/2019 08:51:16 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H0609	25	0	2020	Pima County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0609	26	0	1	1	1	H0609_026_0	3	1			07/11/2019	2020.01	07/11/2019 03:27:20 PM Central Daylight Time	08/02/2019 10:46:11 AM Central Daylight Time	07/30/2019 05:59:52 PM Central Daylight Time			08/06/2019 08:51:16 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H0609	26	0	2020	Maricopa and Pinal Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(877)370-2843		(877)370-2843		(800)555-5757		(800)555-5757		(877)370-2843		(877)370-2843		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	27	0	1	1	1	H0609_027_0	3	1			07/11/2019	2020.01	07/11/2019 03:27:35 PM Central Daylight Time	08/02/2019 10:47:03 AM Central Daylight Time	07/30/2019 06:00:25 PM Central Daylight Time			08/06/2019 08:51:16 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H0609	27	0	2020	Maricopa County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0609	28	0	1	1	1	H0609_028_0	3	1			08/05/2019	2020.01	08/05/2019 11:49:16 AM Central Daylight Time	08/02/2019 10:47:53 AM Central Daylight Time	07/30/2019 06:01:00 PM Central Daylight Time			08/06/2019 09:22:27 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H0609	28	0	2020	Clark and Nye counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0609	31	0	1	1	1	H0609_031_0	3	1			08/06/2019	2020.01	08/06/2019 09:17:43 AM Central Daylight Time	08/02/2019 10:48:46 AM Central Daylight Time	07/30/2019 06:01:33 PM Central Daylight Time			08/06/2019 09:22:27 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Premier (HMO)	1	1		1			H0609	31	0	2020	Clark and Nye counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0609	32	0	1	1	1	H0609_032_0	3	1			08/02/2019	2020.01	08/02/2019 10:48:36 AM Central Daylight Time	08/02/2019 10:49:37 AM Central Daylight Time	07/30/2019 06:02:05 PM Central Daylight Time			08/06/2019 09:22:27 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Focus (HMO)	1	1		1			H0609	32	0	2020	Clark and Nye counties		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)876-6176		(844)876-6176		(800)555-5757		(800)555-5757		(844)876-6176		(844)876-6176		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	33	0	1	1	1	H0609_033_0	3	1			08/02/2019	2020.01	08/02/2019 10:49:21 AM Central Daylight Time	08/02/2019 10:50:24 AM Central Daylight Time	07/30/2019 06:02:40 PM Central Daylight Time			08/06/2019 09:22:27 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H0609	33	0	2020	"Lyon, Mineral, and Washoe counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)876-6176		(844)876-6176		(800)555-5757		(800)555-5757		(844)876-6176		(844)876-6176		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0609	34	1	1	1	1	H0609_034_1	3	1			07/11/2019	2020.01	07/11/2019 03:27:48 PM Central Daylight Time	08/02/2019 10:51:13 AM Central Daylight Time	07/30/2019 06:03:13 PM Central Daylight Time			08/06/2019 08:51:16 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	1	1		1			H0609	34	1	2020	Select Counties in Colorado	Larimer and Weld counties	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0609	34	2	1	1	1	H0609_034_2	3	1			07/11/2019	2020.01	07/11/2019 03:28:03 PM Central Daylight Time	08/02/2019 10:52:01 AM Central Daylight Time	07/30/2019 06:03:47 PM Central Daylight Time			08/06/2019 08:51:16 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO)	1	1		1			H0609	34	2	2020	Select Counties in Colorado	"El Paso, Fremont, Pueblo, and Teller counties"	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0609	35	1	1	1	1	H0609_035_1	3	1			07/24/2019	2020.01	07/24/2019 12:02:42 PM Central Daylight Time	07/17/2019 10:18:59 AM Central Daylight Time				07/24/2019 12:05:08 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Essential (HMO)	1	1		1			H0609	35	1	2020	Colorado Springs Metro Area	Larimer and Weld counties	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0609	35	2	1	1	1	H0609_035_2	2	1			07/11/2019	2020.01	07/11/2019 03:28:34 PM Central Daylight Time	05/31/2019 12:33:13 PM Central Daylight Time				07/12/2019 08:35:00 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Essential (HMO)	1	1		1			H0609	35	2	2020	Colorado Springs Metro Area	"El Paso, Fremont, Pueblo, and Teller counties"	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0609	36	1	1	1	1	H0609_036_1	3	1			07/11/2019	2020.01	07/11/2019 03:28:48 PM Central Daylight Time	08/02/2019 10:54:44 AM Central Daylight Time	07/30/2019 06:04:22 PM Central Daylight Time			08/06/2019 08:51:16 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	1	1		1			H0609	36	1	2020	Colorado Springs Metro Area	Larimer and Weld counties	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0609	36	2	1	1	1	H0609_036_2	3	1			07/11/2019	2020.01	07/11/2019 03:29:01 PM Central Daylight Time	08/02/2019 10:55:30 AM Central Daylight Time	07/30/2019 06:04:53 PM Central Daylight Time			08/06/2019 08:51:16 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO)	1	1		1			H0609	36	2	2020	Colorado Springs Metro Area	"El Paso, Fremont, Pueblo, and Teller counties"	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H0609	37	0	1	1	1	H0609_037_0	4	1		1	08/02/2019	2020.01	08/02/2019 10:53:31 AM Central Daylight Time	08/02/2019 10:56:19 AM Central Daylight Time	07/30/2019 06:05:27 PM Central Daylight Time			08/06/2019 09:22:27 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assist (HMO C-SNP)	1	1		1			H0609	37	0	2020	Clark and Nye counties		2		2			1	4			10		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	2			
H0609	38	0	1	1	1	H0609_038_0	4	1			08/02/2019	2020.01	08/02/2019 10:54:31 AM Central Daylight Time	08/02/2019 10:57:11 AM Central Daylight Time	07/30/2019 06:05:58 PM Central Daylight Time			08/06/2019 09:22:27 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Walgreens Plan 1 (HMO)	1	1		1			H0609	38	0	2020	Clark and Nye counties		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	2			
H0609	39	0	1	1	1	H0609_039_0	4	1			08/02/2019	2020.01	08/02/2019 10:58:21 AM Central Daylight Time	08/02/2019 10:58:00 AM Central Daylight Time	07/30/2019 06:06:31 PM Central Daylight Time			08/06/2019 09:22:27 AM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Walgreens Plan 2 (HMO)	1	1		1			H0609	39	0	2020	Clark and Nye counties		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	2			
H0609	801	0	1	1	1	H0609_801_0	1	1			05/11/2019	2020.01	05/11/2019 06:26:26 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	801	0	2020	CO Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	804	0	1	1	1	H0609_804_0	1	1			05/11/2019	2020.01	05/11/2019 06:27:00 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	804	0	2020	CO Employer Sponsored Plan Service Area		1	7896	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	805	0	1	1	1	H0609_805_0	1	1			05/11/2019	2020.01	05/11/2019 06:27:38 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	805	0	2020	CO Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	806	0	2	1	1	H0609_806_0	1	1			05/11/2019	2020.01	05/11/2019 06:29:10 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		2	2		H0609	806	0	2020	CO Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	807	0	1	1	1	H0609_807_0	1	1			05/11/2019	2020.01	05/11/2019 06:29:26 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	807	0	2020	Arizona		1	1116	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	808	0	1	1	1	H0609_808_0	1	1			05/11/2019	2020.01	05/11/2019 06:30:15 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	808	0	2020	Arizona		1	273924	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	809	0	1	1	1	H0609_809_0	1	1			05/11/2019	2020.01	05/11/2019 06:31:02 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	809	0	2020	Arizona		1	84	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	810	0	1	1	1	H0609_810_0	1	1			05/11/2019	2020.01	05/11/2019 06:31:42 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	810	0	2020	Clark and Nye Counties		1	24	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	811	0	1	1	1	H0609_811_0	1	1			05/11/2019	2020.01	05/11/2019 06:32:22 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	811	0	2020	Clark and Nye counties		1	5892	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	812	0	1	1	1	H0609_812_0	1	1			05/11/2019	2020.01	05/11/2019 06:33:01 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	812	0	2020	Clark and Nye counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	813	0	1	1	1	H0609_813_0	1	1			05/11/2019	2020.01	05/11/2019 06:33:42 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	813	0	2020	NV Employer Sponsored Plan Service Area		1	9600	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	814	0	1	1	1	H0609_814_0	1	1			05/11/2019	2020.01	05/11/2019 06:34:14 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	814	0	2020	NV Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	815	0	1	1	1	H0609_815_0	1	1			05/11/2019	2020.01	05/11/2019 06:34:52 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	815	0	2020	NV Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	816	0	1	1	1	H0609_816_0	1	1			05/11/2019	2020.01	05/11/2019 06:35:28 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	816	0	2020	NV Employer Sponsored Plan Service Area		1	0	2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0609	817	0	1	1	1	H0609_817_0	1	1			05/11/2019	2020.01	05/11/2019 06:36:02 AM Central Daylight Time					06/02/2019 05:46:11 PM Central Daylight Time	"PACIFICARE OF COLORADO, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0609	817	0	2020	Arizona		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0613	1	0	1	20	8	H0613_001_0	1	1			05/16/2019	2020.01	05/16/2019 02:59:03 PM Mountain Daylight Time		05/16/2019 02:32:41 PM Mountain Daylight Time			05/16/2019 03:01:53 PM Mountain Daylight Time	"TOTAL LONGTERM CARE, INC."	InnovAge Colorado PACE	www.MyInnovAge.com	Total Longterm Care - Dual eligibles (PACE)	8	20		1			H0613	1	0	2020	"Metro Denver,Pueblo,Loveland,Fort Collins,Greeley"		2		2			2						http://www.granerx.com	http://www.totallongtermcare.org										(844)704-9613		(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613		(844)704-9613		(844)704-9613		(844)704-9613																
H0613	3	0	1	20	8	H0613_003_0	1	1			05/16/2019	2020.01	05/16/2019 02:59:52 PM Mountain Daylight Time		05/16/2019 02:32:43 PM Mountain Daylight Time			05/16/2019 03:01:53 PM Mountain Daylight Time	"TOTAL LONGTERM CARE, INC."	InnovAge Colorado PACE	www.MyInnovAge.com	Total Longterm Care - Medicare only (PACE)	8	20		1			H0613	3	0	2020	"Metro Denver,Pueblo,Loveland,Fort Collins,Greeley"		2		2			2						http://www.granerx.com	http://www.totallongtermcare.org										(844)704-9613	711	(844)704-9613		(877)277-6163		(303)869-4664										(844)704-9613	711	(844)704-9613	711	(877)277-6163		(303)869-4664																
H0624	1	0	1	1	1	H0624_001_0	4	1	2	1	07/11/2019	2020.01	07/11/2019 11:01:21 AM Central Daylight Time	08/02/2019 10:30:38 AM Central Daylight Time	07/30/2019 06:07:08 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H0624	1	0	2020	Denver and Colorado Springs metro areas		2		2			1	3		2		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	1	0	1	1	1	H0628_001_0	6	1			08/05/2019	2020.01	08/05/2019 03:01:59 PM Eastern Daylight Time	08/02/2019 10:38:19 AM Eastern Daylight Time	08/05/2019 09:20:10 AM Eastern Daylight Time			08/05/2019 03:05:06 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	1	1		1			H0628	1	0	2020	Toledo OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	3	0	1	1	1	H0628_003_0	5	1			08/01/2019	2020.01	08/01/2019 02:18:46 PM Eastern Daylight Time	08/02/2019 10:38:59 AM Eastern Daylight Time	08/05/2019 09:18:46 AM Eastern Daylight Time			08/05/2019 03:05:06 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	1	1		1			H0628	3	0	2020	Select South-Western OH Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	5	0	1	1	1	H0628_005_0	5	1			08/01/2019	2020.01	08/01/2019 02:19:14 PM Eastern Daylight Time	08/02/2019 10:39:39 AM Eastern Daylight Time	08/05/2019 09:23:46 AM Eastern Daylight Time			08/05/2019 03:05:06 PM Eastern Daylight Time	AETNA HEALTH OF OHIO INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	1	1		1			H0628	5	0	2020	Select Eastern-North East OH Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0628	801	0	1	1	1	H0628_801_0	2	1			05/31/2019	2020.01	05/31/2019 11:46:31 AM Eastern Daylight Time					05/31/2019 12:11:03 PM Eastern Daylight Time	AETNA BETTER HEALTH OF IOWA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H0628	801	0	2020	Ohio		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H0628	802	0	1	1	1	H0628_802_0	2	1			05/31/2019	2020.01	05/31/2019 11:46:42 AM Eastern Daylight Time					05/31/2019 12:11:03 PM Eastern Daylight Time	AETNA BETTER HEALTH OF IOWA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H0628	802	0	2020	Ohio		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H0628	803	0	1	1	1	H0628_803_0	2	1			05/24/2019	2020.01	05/24/2019 09:34:35 AM Eastern Daylight Time					05/31/2019 12:11:03 PM Eastern Daylight Time	AETNA BETTER HEALTH OF IOWA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H0628	803	0	2020	Ohio		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H0630	13	0	1	1	1	H0630_013_0	11	1			06/13/2019	2020.01	06/13/2019 08:48:53 AM Mountain Daylight Time	08/01/2019 10:29:37 AM Mountain Daylight Time	08/01/2019 09:56:24 AM Mountain Daylight Time			08/02/2019 02:55:12 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Core (HMO)	1	1		1			H0630	13	0	2020	Denver Metro Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0630	14	0	1	1	1	H0630_014_0	11	1	2	1	05/31/2019	2020.01	05/31/2019 05:02:04 PM Mountain Daylight Time	08/01/2019 10:31:15 AM Mountain Daylight Time	08/01/2019 09:58:24 AM Mountain Daylight Time			08/02/2019 02:55:12 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid (HMO D-SNP)	1	1		1			H0630	14	0	2020	Denver Metro Area		2		2			1	3		2		2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0630	15	0	1	1	1	H0630_015_0	11	1			05/31/2019	2020.01	05/31/2019 05:08:55 PM Mountain Daylight Time	08/01/2019 10:32:56 AM Mountain Daylight Time	08/01/2019 10:00:17 AM Mountain Daylight Time			08/02/2019 02:55:12 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Silver (HMO)	1	1		1			H0630	15	0	2020	Denver Metro Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0630	16	0	1	1	1	H0630_016_0	11	1			05/31/2019	2020.01	05/31/2019 05:08:26 PM Mountain Daylight Time	08/01/2019 10:34:37 AM Mountain Daylight Time	08/01/2019 10:02:10 AM Mountain Daylight Time			08/02/2019 02:55:12 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Gold (HMO)	1	1		1			H0630	16	0	2020	Denver Metro Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0630	17	0	1	1	1	H0630_017_0	13	1			05/31/2019	2020.01	05/31/2019 05:07:59 PM Mountain Daylight Time	08/01/2019 10:36:20 AM Mountain Daylight Time	08/01/2019 10:04:03 AM Mountain Daylight Time			08/02/2019 02:55:12 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Core (HMO)	1	1		1			H0630	17	0	2020	Southern Colorado		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1	1	7a;7g;14d;14e2;17a;	
H0630	20	0	1	1	1	H0630_020_0	11	1			06/03/2019	2020.01	06/03/2019 12:22:15 PM Mountain Daylight Time	08/01/2019 10:38:02 AM Mountain Daylight Time	08/01/2019 10:06:00 AM Mountain Daylight Time			08/02/2019 02:55:12 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Core (HMO)	1	1		1			H0630	20	0	2020	Northern Colorado		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0630	21	0	1	1	1	H0630_021_0	11	1			06/03/2019	2020.01	06/03/2019 01:57:09 PM Mountain Daylight Time	08/01/2019 10:39:45 AM Mountain Daylight Time	08/01/2019 10:07:54 AM Mountain Daylight Time			08/02/2019 02:55:12 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Silver (HMO)	1	1		1			H0630	21	0	2020	Northern Colorado		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H0630	805	0	2	1	1	H0630_805_0	9	1			05/14/2019	2020.01	05/14/2019 11:19:46 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA-PD_Part B only (HMO)	1	1		2	1		H0630	805	0	2020	Denver Metro Area		1	10396	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;5;6;7k;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7f;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	806	0	2	1	1	H0630_806_0	9	1			05/14/2019	2020.01	05/14/2019 11:23:16 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA only_Part B only (HMO)	1	1		2	1		H0630	806	0	2020	Denver Metro Area		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7k;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7f;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	807	0	1	1	1	H0630_807_0	9	1			05/14/2019	2020.01	05/14/2019 11:17:31 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA-PD (HMO)	1	1		1			H0630	807	0	2020	Denver Metro Area		1	270567	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;5;6;7k;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7f;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	808	0	1	1	1	H0630_808_0	9	1			05/14/2019	2020.01	05/14/2019 11:17:50 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Adv_Group_MA only (HMO)	1	1		1			H0630	808	0	2020	Denver Metro Area		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7k;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7f;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	809	0	2	1	1	H0630_809_0	9	1			05/14/2019	2020.01	05/14/2019 11:17:59 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB B only with D (HMO)	1	1		2	1		H0630	809	0	2020	Denver Metro Area		1	96	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;5;6;7k;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7f;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	810	0	1	1	1	H0630_810_0	9	1			05/14/2019	2020.01	05/14/2019 11:19:19 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	1	1		1			H0630	810	0	2020	Denver Metro Area		1	37151	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;5;6;7k;9a1;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7f;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	811	0	2	1	1	H0630_811_0	9	1			05/14/2019	2020.01	05/14/2019 11:23:41 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA-PD_Part B only (HMO)	1	1		2	1		H0630	811	0	2020	Southern Colorado		1	1795	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;5;6;7e;7h;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	812	0	2	1	1	H0630_812_0	9	1			05/14/2019	2020.01	05/14/2019 11:23:56 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA only_Part B only (HMO)	1	1		2	1		H0630	812	0	2020	Southern Colorado		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7e;7h;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	813	0	1	1	1	H0630_813_0	9	1			05/14/2019	2020.01	05/14/2019 11:24:06 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA-PD (HMO)	1	1		1			H0630	813	0	2020	Southern Colorado		1	30246	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;5;6;7e;7h;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	814	0	1	1	1	H0630_814_0	9	1			05/14/2019	2020.01	05/14/2019 11:24:23 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Adv Group_MA only (HMO)	1	1		1			H0630	814	0	2020	Southern Colorado		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7e;7h;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	815	0	2	1	1	H0630_815_0	9	1			05/14/2019	2020.01	05/14/2019 11:24:31 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB B only with D (HMO)	1	1		2	1		H0630	815	0	2020	Southern Colorado		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;5;6;7e;7h;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	816	0	1	1	1	H0630_816_0	9	1			05/14/2019	2020.01	05/14/2019 11:24:40 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	1	1		1			H0630	816	0	2020	Southern Colorado		1	4481	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;5;6;7e;7h;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	817	0	2	1	1	H0630_817_0	9	1			05/14/2019	2020.01	05/14/2019 11:24:52 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MAPD Part B Only (HMO)	1	1		2	1		H0630	817	0	2020	Northern Colorado		1	358	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;5;6;7e;7h;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	818	0	2	1	1	H0630_818_0	9	1			05/14/2019	2020.01	05/14/2019 11:28:16 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA Only Part B Only (HMO)	1	1		2	1		H0630	818	0	2020	Northern Colorado		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7e;7h;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	819	0	1	1	1	H0630_819_0	9	1			05/14/2019	2020.01	05/14/2019 11:28:29 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MAPD (HMO)	1	1		1			H0630	819	0	2020	Northern Colorado		1	11652	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;5;6;7e;7h;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	820	0	1	1	1	H0630_820_0	9	1			05/14/2019	2020.01	05/14/2019 11:28:46 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	Senior Advantage Group MA Only (HMO)	1	1		1			H0630	820	0	2020	Northern Colorado		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7e;7h;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	821	0	2	1	1	H0630_821_0	9	1			05/14/2019	2020.01	05/14/2019 11:29:00 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB B Only with D (HMO)	1	1		2	1		H0630	821	0	2020	Northern Colorado		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;5;6;7e;7h;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0630	822	0	1	1	1	H0630_822_0	9	1			05/14/2019	2020.01	05/14/2019 11:29:11 AM Mountain Daylight Time					06/03/2019 02:03:27 PM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	1	1		1			H0630	822	0	2020	Northern Colorado		1	1291	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;5;6;7e;7h;7k;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14e3;	1					2				
H0657	5	0	1	18	6	H0657_005_0	1	2			06/03/2019	2020.01	06/03/2019 12:34:12 PM Mountain Daylight Time					06/03/2019 03:01:11 PM Mountain Daylight Time	"FRIDAY HEALTH PLANS OF COLORADO, INC."	Friday Health Plans of Colorado	www.fridayhealthplans.com	Friday Health Plans Silver SV Plan (Cost)	6	18		1			H0657	5	0	2020	The 6 County San Luis Valley Area		2	4800	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	2			
H0657	6	0	1	18	6	H0657_006_0	1	2			06/03/2019	2020.01	06/03/2019 02:19:20 PM Mountain Daylight Time					06/03/2019 03:01:11 PM Mountain Daylight Time	"FRIDAY HEALTH PLANS OF COLORADO, INC."	Friday Health Plans of Colorado	www.fridayhealthplans.com	Friday Health Plans Gold SV Plan (Cost)	6	18		1			H0657	6	0	2020	The 6 County San Luis Valley Area		2	3500	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	2			
H0657	8	0	1	18	6	H0657_008_0	1	2			06/03/2019	2020.01	06/03/2019 02:24:23 PM Mountain Daylight Time					06/03/2019 03:01:11 PM Mountain Daylight Time	"FRIDAY HEALTH PLANS OF COLORADO, INC."	Friday Health Plans of Colorado	www.fridayhealthplans.com	Friday Health Plans Silver Plan (Cost)	6	18		1			H0657	8	0	2020	"BEN, CHA, CRO, CUS, FRE, HUE, LAS, OTE, PRO, YUM"		2	1920	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	2			
H0657	9	0	1	18	6	H0657_009_0	1	2			06/03/2019	2020.01	06/03/2019 02:36:32 PM Mountain Daylight Time					06/03/2019 03:01:11 PM Mountain Daylight Time	"FRIDAY HEALTH PLANS OF COLORADO, INC."	Friday Health Plans of Colorado	www.fridayhealthplans.com	Friday Health Plans Gold Plan (Cost)	6	18		1			H0657	9	0	2020	Colorado Counties other than San Luis Valley		2	2500	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	2			
H0672	1	0	1	1	1	H0672_001_0	5	1			07/08/2019	2020.01	07/08/2019 04:35:38 PM Central Daylight Time	07/31/2019 04:51:18 PM Central Daylight Time	07/30/2019 04:10:53 PM Central Daylight Time			08/02/2019 11:28:40 AM Central Daylight Time	"CIGNA HEALTHCARE OF COLORADO, INC."	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H0672	1	0	2020	Denver Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0672	2	0	1	1	1	H0672_002_0	5	1			07/08/2019	2020.01	07/08/2019 04:36:19 PM Central Daylight Time	07/31/2019 04:51:40 PM Central Daylight Time	07/30/2019 04:11:06 PM Central Daylight Time			08/02/2019 11:28:40 AM Central Daylight Time	"CIGNA HEALTHCARE OF COLORADO, INC."	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H0672	2	0	2020	Boulder Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0710	4	0	1	4	1	H0710_004_0	2	1		1	08/02/2019	2020.01	08/02/2019 12:36:32 PM Central Daylight Time	08/02/2019 10:45:33 AM Central Daylight Time	07/30/2019 06:07:44 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	4	0	2020	Select Counties in Alabama and Florida		2		2			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			
H0710	5	0	1	4	1	H0710_005_0	2	1		1	05/30/2019	2020.01	05/30/2019 05:06:41 PM Central Daylight Time	08/02/2019 10:46:15 AM Central Daylight Time	07/30/2019 06:08:18 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	5	0	2020	"Maricopa, Pima, Pinal, and Yavapai counties"		2		2			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			
H0710	7	0	1	4	1	H0710_007_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:27:12 AM Central Daylight Time	08/02/2019 10:46:58 AM Central Daylight Time	07/30/2019 06:08:56 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	7	0	2020	Denver and Colorado Springs metro areas		2		2			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			
H0710	8	0	1	4	1	H0710_008_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:27:24 AM Central Daylight Time	08/02/2019 10:47:39 AM Central Daylight Time	07/30/2019 06:09:29 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	1	4		1			H0710	8	0	2020	Denver and Colorado Springs metro areas		2		2			1	1	2				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			
H0710	9	0	1	4	1	H0710_009_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:27:34 AM Central Daylight Time	08/02/2019 10:48:23 AM Central Daylight Time	07/30/2019 06:10:02 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	1	4		1			H0710	9	0	2020	"Fairfield, Hartford, and New Haven counties"		2		2			1	1	2				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			
H0710	10	0	1	4	1	H0710_010_0	2	1		1	05/31/2019	2020.01	05/31/2019 03:35:17 PM Central Daylight Time	08/02/2019 10:49:07 AM Central Daylight Time	07/30/2019 06:10:31 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	10	0	2020	Select Counties in Florida		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)818-4270		(866)818-4270		(888)834-3721		(888)834-3721		(866)818-4270		(866)818-4270		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0710	12	0	1	4	1	H0710_012_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:28:00 AM Central Daylight Time	08/02/2019 10:49:51 AM Central Daylight Time	07/30/2019 06:11:03 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	1	4		1			H0710	12	0	2020	Select Counties in Florida		2		2			1	1	2				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			
H0710	13	0	1	4	1	H0710_013_0	2	1		1	05/31/2019	2020.01	05/31/2019 03:49:26 PM Central Daylight Time	08/02/2019 10:50:37 AM Central Daylight Time	07/30/2019 06:11:41 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	13	0	2020	Select Counties in Indiana		2		2			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			
H0710	15	0	1	4	1	H0710_015_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:37:40 AM Central Daylight Time	08/02/2019 10:51:20 AM Central Daylight Time	07/30/2019 06:12:15 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	15	0	2020	Select Counties in Maine and New Hampshire		2		2			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			
H0710	16	0	1	4	1	H0710_016_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:37:55 AM Central Daylight Time	08/02/2019 10:52:12 AM Central Daylight Time	07/30/2019 06:12:50 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	16	0	2020	St. Louis and Springfield Metro areas		2		2			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			
H0710	17	0	1	4	1	H0710_017_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:38:34 AM Central Daylight Time	08/02/2019 10:53:07 AM Central Daylight Time	07/30/2019 06:13:26 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	1	4		1			H0710	17	0	2020	"Select Counties in Pennsylvania, State of Delaware"		2		2			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			
H0710	20	0	1	4	1	H0710_020_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:38:44 AM Central Daylight Time	08/02/2019 10:53:50 AM Central Daylight Time	07/30/2019 06:14:03 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	20	0	2020	Select counties in Texas		2		2			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			
H0710	26	0	1	4	1	H0710_026_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:38:56 AM Central Daylight Time	08/02/2019 10:54:32 AM Central Daylight Time	07/30/2019 06:14:37 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	26	0	2020	Connecticut and Select counties in New Jersey		2		2			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			
H0710	27	0	1	4	1	H0710_027_0	2	1		1	08/02/2019	2020.01	08/02/2019 12:37:15 PM Central Daylight Time	08/02/2019 10:55:16 AM Central Daylight Time	07/30/2019 06:15:11 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	1	4		1			H0710	27	0	2020	Select Counties in Ohio		2		2			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			
H0710	30	0	1	4	1	H0710_030_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:39:20 AM Central Daylight Time	08/02/2019 10:56:01 AM Central Daylight Time	07/30/2019 06:15:46 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	1	4		1			H0710	30	0	2020	Select counties in Washington		2		2			1	1	2				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			
H0710	31	0	1	4	1	H0710_031_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:39:29 AM Central Daylight Time	08/02/2019 10:59:26 AM Central Daylight Time	07/30/2019 06:16:19 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	31	0	2020	Select counties in Washington		2		2			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			
H0710	32	0	1	4	1	H0710_032_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:39:40 AM Central Daylight Time	08/02/2019 11:00:11 AM Central Daylight Time	07/30/2019 06:16:52 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	1	4		1			H0710	32	0	2020	Select Counties in Maryland and Virginia		2		2			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			
H0710	33	0	1	4	1	H0710_033_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:39:51 AM Central Daylight Time	08/02/2019 11:00:58 AM Central Daylight Time	07/30/2019 06:17:26 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	1	4		1			H0710	33	0	2020	Select Counties in Georgia		2		2			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			
H0710	34	0	1	4	1	H0710_034_0	3	1		1	08/05/2019	2020.01	08/05/2019 09:02:54 AM Central Daylight Time	08/05/2019 10:49:29 AM Central Daylight Time	07/30/2019 06:18:03 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	34	0	2020	Select Counties in North Carolina		2		2			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			
H0710	35	0	1	4	1	H0710_035_0	2	1		1	08/05/2019	2020.01	08/05/2019 10:18:26 AM Central Daylight Time	08/02/2019 11:02:28 AM Central Daylight Time	07/30/2019 06:18:37 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	1	4		1			H0710	35	0	2020	State of Rhode Island		2		2			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			
H0710	36	0	1	4	1	H0710_036_0	3	1		1	08/05/2019	2020.01	08/05/2019 09:03:27 AM Central Daylight Time	08/05/2019 10:49:49 AM Central Daylight Time	07/30/2019 06:19:11 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	1	4		1			H0710	36	0	2020	Select Counties in Oregon		2		2			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			
H0710	37	0	1	4	1	H0710_037_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:40:32 AM Central Daylight Time	08/02/2019 11:03:58 AM Central Daylight Time	07/30/2019 06:19:45 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan 2 (PPO I-SNP)	1	4		1			H0710	37	0	2020	Select Counties in Oregon		2		2			1	1	2				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			
H0710	38	0	1	4	1	H0710_038_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:40:42 AM Central Daylight Time	08/02/2019 11:04:43 AM Central Daylight Time	07/30/2019 06:20:15 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	38	0	2020	Hillsborough County		2		2			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			
H0710	39	0	1	4	1	H0710_039_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:40:54 AM Central Daylight Time	08/02/2019 11:05:28 AM Central Daylight Time	07/30/2019 06:20:50 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	1	4		1			H0710	39	0	2020	Chicago Metro area		2		2			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			
H0710	41	0	1	4	1	H0710_041_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:41:04 AM Central Daylight Time	08/02/2019 11:06:13 AM Central Daylight Time	07/30/2019 06:21:23 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	41	0	2020	Select Counties in Twin Cities Metro Area		2		2			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			
H0710	42	0	1	4	1	H0710_042_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:41:17 AM Central Daylight Time	08/02/2019 11:06:58 AM Central Daylight Time	07/30/2019 06:21:56 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	1	4		1			H0710	42	0	2020	Select Counties in Wisconsin		2		2			1	1	2				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			
H0710	43	0	1	4	1	H0710_043_0	2	1		1	05/31/2019	2020.01	05/31/2019 12:25:01 PM Central Daylight Time	08/02/2019 11:07:45 AM Central Daylight Time	07/30/2019 06:22:28 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (PPO I-SNP)	1	4		1			H0710	43	0	2020	Select Counties in Wisconsin		2		2			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			
H0710	46	0	1	4	1	H0710_046_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:41:44 AM Central Daylight Time	08/02/2019 11:08:34 AM Central Daylight Time	07/30/2019 06:23:01 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	46	0	2020	Select Counties in Iowa		2		2			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			
H0710	47	0	1	4	1	H0710_047_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:41:55 AM Central Daylight Time	08/02/2019 11:09:22 AM Central Daylight Time	07/30/2019 06:23:32 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	1	4		1			H0710	47	0	2020	Select Counties in Minnesota		2		2			1	1	2				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			
H0710	49	0	1	4	1	H0710_049_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:42:05 AM Central Daylight Time	08/02/2019 11:10:07 AM Central Daylight Time	07/30/2019 06:24:03 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	1	4		1			H0710	49	0	2020	Select Counties in Maine and New Hampshire		2		2			1	1	2				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			
H0710	50	0	1	4	1	H0710_050_0	3	1		1	07/17/2019	2020.01	07/17/2019 09:58:02 AM Central Daylight Time	08/02/2019 11:10:50 AM Central Daylight Time	07/30/2019 06:24:39 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan 2 (PPO I-SNP)	1	4		1			H0710	50	0	2020	Select Counties in Rhode Island		2		2			1	1	2				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			
H0710	51	0	1	4	1	H0710_051_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:42:25 AM Central Daylight Time	08/02/2019 11:11:35 AM Central Daylight Time	07/30/2019 06:25:11 PM Central Daylight Time			08/05/2019 05:02:11 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO I-SNP)	1	4		1			H0710	51	0	2020	Select Counties in Utah		2		2			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			
H0710	801	0	1	4	1	H0710_801_0	2	1			05/11/2019	2020.01	05/11/2019 06:38:28 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	801	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	802	0	1	4	1	H0710_802_0	2	1			05/11/2019	2020.01	05/11/2019 06:39:20 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	802	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	803	0	1	4	1	H0710_803_0	2	1			05/11/2019	2020.01	05/11/2019 06:40:01 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	803	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	804	0	2	4	1	H0710_804_0	2	1			05/11/2019	2020.01	05/11/2019 06:40:39 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H0710	804	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	805	0	2	4	1	H0710_805_0	2	1			05/11/2019	2020.01	05/11/2019 06:41:18 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H0710	805	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	806	0	2	4	1	H0710_806_0	2	1			05/11/2019	2020.01	05/11/2019 06:42:04 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H0710	806	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	807	0	1	4	1	H0710_807_0	2	1			05/11/2019	2020.01	05/11/2019 07:01:07 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	807	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	808	0	1	4	1	H0710_808_0	2	1			05/11/2019	2020.01	05/11/2019 07:01:55 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	808	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	809	0	1	4	1	H0710_809_0	2	1			05/11/2019	2020.01	05/11/2019 07:02:37 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	809	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	810	0	1	4	1	H0710_810_0	2	1			05/11/2019	2020.01	05/11/2019 07:03:26 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	810	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	811	0	1	4	1	H0710_811_0	2	1			05/11/2019	2020.01	05/11/2019 07:04:05 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	811	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	812	0	2	4	1	H0710_812_0	2	1			05/11/2019	2020.01	05/11/2019 07:04:45 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H0710	812	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	813	0	2	4	1	H0710_813_0	2	1			05/11/2019	2020.01	05/11/2019 07:05:22 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H0710	813	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	814	0	2	4	1	H0710_814_0	2	1			05/11/2019	2020.01	05/11/2019 07:06:02 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H0710	814	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	815	0	1	4	1	H0710_815_0	2	1			05/11/2019	2020.01	05/11/2019 07:06:42 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	815	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	816	0	1	4	1	H0710_816_0	2	1			05/11/2019	2020.01	05/11/2019 07:07:19 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	816	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	817	0	1	4	1	H0710_817_0	2	1			05/11/2019	2020.01	05/11/2019 07:07:58 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	817	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	818	0	1	4	1	H0710_818_0	2	1			05/11/2019	2020.01	05/11/2019 07:08:35 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	818	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	819	0	1	4	1	H0710_819_0	2	1			05/11/2019	2020.01	05/11/2019 07:09:09 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	819	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	820	0	1	4	1	H0710_820_0	2	1			05/11/2019	2020.01	05/11/2019 07:09:44 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	820	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	821	0	1	4	1	H0710_821_0	2	1			05/11/2019	2020.01	05/11/2019 07:10:21 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	821	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	822	0	1	4	1	H0710_822_0	2	1			05/11/2019	2020.01	05/11/2019 07:10:56 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	822	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	823	0	1	4	1	H0710_823_0	2	1			05/11/2019	2020.01	05/11/2019 07:11:35 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	823	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	824	0	2	4	1	H0710_824_0	2	1			05/11/2019	2020.01	05/11/2019 07:12:21 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H0710	824	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	825	0	1	4	1	H0710_825_0	2	1			05/11/2019	2020.01	05/11/2019 07:12:56 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	825	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	826	0	1	4	1	H0710_826_0	2	1			05/11/2019	2020.01	05/11/2019 07:13:32 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	826	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	827	0	1	4	1	H0710_827_0	2	1			05/11/2019	2020.01	05/11/2019 07:14:10 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	827	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	829	0	1	4	1	H0710_829_0	2	1			05/11/2019	2020.01	05/11/2019 07:14:53 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	829	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	830	0	1	4	1	H0710_830_0	2	1			05/11/2019	2020.01	05/11/2019 07:15:38 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	830	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0710	831	0	1	4	1	H0710_831_0	2	1			05/11/2019	2020.01	05/11/2019 07:16:25 AM Central Daylight Time					06/02/2019 05:47:58 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H0710	831	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H0712	5	0	1	1	1	H0712_005_0	8	1	2	1	07/12/2019	2020.01	07/12/2019 11:05:05 AM Eastern Daylight Time	08/02/2019 02:33:28 AM Eastern Daylight Time	07/30/2019 09:09:49 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF CONNECTICUT, INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H0712	5	0	2020	Select counties in CT		2	30946	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	19	0	1	1	1	H0712_019_0	8	1			07/12/2019	2020.01	07/12/2019 11:05:39 AM Eastern Daylight Time	08/02/2019 02:35:04 AM Eastern Daylight Time	07/30/2019 09:10:23 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF CONNECTICUT, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H0712	19	0	2020	Select counties in CT		2	34986	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	20	0	1	2	1	H0712_020_0	8	1			07/12/2019	2020.01	07/12/2019 11:06:14 AM Eastern Daylight Time	08/02/2019 02:36:39 AM Eastern Daylight Time	07/30/2019 09:10:58 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF CONNECTICUT, INC."	WellCare	www.wellcare.com/medicare	WellCare Compass (HMO-POS)	1	2		1			H0712	20	0	2020	Select counties in CT		2	25737	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	22	0	1	1	1	H0712_022_0	8	1			07/11/2019	2020.01	07/11/2019 01:48:53 PM Eastern Daylight Time	08/02/2019 02:38:13 AM Eastern Daylight Time	07/30/2019 09:11:33 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF CONNECTICUT, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H0712	22	0	2020	Select counties in NC		2	3334	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	23	0	1	1	1	H0712_023_0	8	1			07/11/2019	2020.01	07/11/2019 01:49:48 PM Eastern Daylight Time	08/02/2019 02:39:49 AM Eastern Daylight Time	07/30/2019 09:12:10 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF CONNECTICUT, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H0712	23	0	2020	Select counties in NC		2	7419	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	25	0	1	1	1	H0712_025_0	8	1	2	1	07/12/2019	2020.01	07/12/2019 11:07:00 AM Eastern Daylight Time	08/02/2019 02:41:28 AM Eastern Daylight Time	07/30/2019 09:12:45 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF CONNECTICUT, INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H0712	25	0	2020	Select counties in NC		2	5473	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	28	0	1	1	1	H0712_028_0	8	1	2	1	07/12/2019	2020.01	07/12/2019 11:07:37 AM Eastern Daylight Time	08/02/2019 02:43:00 AM Eastern Daylight Time	07/30/2019 09:13:19 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF CONNECTICUT, INC."	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H0712	28	0	2020	Select counties in CT		2	9016	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	29	0	1	1	1	H0712_029_0	8	1	2	1	07/12/2019	2020.01	07/12/2019 11:08:15 AM Eastern Daylight Time	08/02/2019 02:44:35 AM Eastern Daylight Time	07/30/2019 09:13:54 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF CONNECTICUT, INC."	WellCare	www.wellcare.com/medicare	WellCare Freedom (HMO D-SNP)	1	1		1			H0712	29	0	2020	Select counties in CT		2	5181	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0712	30	0	1	1	1	H0712_030_0	9	1			07/12/2019	2020.01	07/12/2019 11:08:47 AM Eastern Daylight Time	08/02/2019 02:46:14 AM Eastern Daylight Time	07/30/2019 09:14:30 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF CONNECTICUT, INC."	WellCare	www.wellcare.com/medicare	WellCare Plus (HMO)	1	1		1			H0712	30	0	2020	Select counties in NC		2	58	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0724	1	0	1	1	1	H0724_001_0	4	1			08/01/2019	2020.01	08/01/2019 01:12:19 PM Eastern Daylight Time	08/05/2019 04:11:23 PM Central Daylight Time	08/05/2019 03:06:45 PM Central Daylight Time			08/05/2019 06:08:45 PM Central Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS	Allwell	allwell.buckeyehealthplan.com	Allwell Medicare (HMO)	1	1		1			H0724	1	0	2020	Select Counties Statewide		2		2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0724	5	0	1	1	1	H0724_005_0	2	1			07/11/2019	2020.01	07/11/2019 09:33:27 AM Eastern Daylight Time	07/09/2019 03:30:38 PM Pacific Daylight Time				07/15/2019 03:24:07 PM Pacific Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS	Allwell	allwell.buckeyehealthplan.com	Allwell Medicare Essentials (HMO)	1	1		1			H0724	5	0	2020	Select Counties Statewide		2		2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0724	801	0	1	1	1	H0724_801_0	2	1			05/13/2019	2020.01	05/13/2019 09:16:58 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS	Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	1	1		1			H0724	801	0	2020	Countywide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0724	802	0	1	1	1	H0724_802_0	2	1			05/03/2019	2020.01	05/03/2019 10:21:32 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS	Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	1	1		1			H0724	802	0	2020	Countywide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0724	803	0	1	1	1	H0724_803_0	2	1			05/03/2019	2020.01	05/03/2019 10:21:51 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS	Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	1	1		1			H0724	803	0	2020	Countywide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0755	30	0	1	1	1	H0755_030_0	7	1			08/05/2019	2020.01	08/05/2019 08:52:53 AM Central Daylight Time	08/02/2019 10:43:08 AM Central Daylight Time	07/30/2019 06:25:44 PM Central Daylight Time			08/05/2019 04:09:32 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Plan 1 (HMO)	1	1		1			H0755	30	0	2020	State of 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	2			
H0755	31	0	1	1	1	H0755_031_0	6	1			08/05/2019	2020.01	08/05/2019 08:33:02 AM Central Daylight Time	08/02/2019 10:43:44 AM Central Daylight Time	07/30/2019 06:26:17 PM Central Daylight Time			08/05/2019 04:09:32 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Plan 2 (HMO)	1	1		1			H0755	31	0	2020	State of 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	2			
H0755	32	0	1	1	1	H0755_032_0	2	1			07/11/2019	2020.01	07/11/2019 03:28:50 PM Central Daylight Time	06/02/2019 08:38:53 AM Central Daylight Time				07/12/2019 10:21:43 AM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Essential (HMO)	1	1		1			H0755	32	0	2020	State of 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	2			
H0755	33	0	1	1	1	H0755_033_0	6	1			08/02/2019	2020.01	08/02/2019 10:31:45 AM Central Daylight Time	08/02/2019 10:45:34 AM Central Daylight Time	07/30/2019 06:26:47 PM Central Daylight Time			08/05/2019 04:09:32 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Plan 3 (HMO)	1	1		1			H0755	33	0	2020	State of 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	2			
H0755	37	0	1	1	1	H0755_037_0	2	1			07/11/2019	2020.01	07/11/2019 11:46:53 AM Central Daylight Time	06/02/2019 08:41:58 AM Central Daylight Time				07/12/2019 10:09:03 AM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Essential (HMO)	1	1		1			H0755	37	0	2020	Select counties in New Jersey		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H0755	38	0	1	1	1	H0755_038_0	8	1			08/05/2019	2020.01	08/05/2019 11:40:29 AM Central Daylight Time	08/02/2019 10:46:42 AM Central Daylight Time	07/30/2019 06:27:20 PM Central Daylight Time			08/05/2019 06:02:49 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H0755	38	0	2020	Essex and Ocean Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	40	1	1	1	1	H0755_040_1	6	1			08/02/2019	2020.01	08/02/2019 11:12:12 AM Central Daylight Time	08/02/2019 10:47:12 AM Central Daylight Time	07/30/2019 06:27:58 PM Central Daylight Time			08/05/2019 06:02:49 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H0755	40	1	2020	Select Counties in New Jersey	Select Counties in New Jersey	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	40	2	1	1	1	H0755_040_2	6	1			08/02/2019	2020.01	08/02/2019 11:12:57 AM Central Daylight Time	08/02/2019 10:47:42 AM Central Daylight Time	07/30/2019 06:28:35 PM Central Daylight Time			08/05/2019 06:02:49 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H0755	40	2	2020	Select Counties in New Jersey	"Burlington, Hunterdon, and Mercer Counties"	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	41	1	1	1	1	H0755_041_1	6	1			08/02/2019	2020.01	08/02/2019 11:13:39 AM Central Daylight Time	08/02/2019 10:48:16 AM Central Daylight Time	07/30/2019 06:29:11 PM Central Daylight Time			08/05/2019 06:02:49 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	1	1		1			H0755	41	1	2020	Select counties in New Jersey	Select Counties in New Jersey	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	41	2	1	1	1	H0755_041_2	6	1			08/02/2019	2020.01	08/02/2019 11:14:29 AM Central Daylight Time	08/02/2019 10:48:46 AM Central Daylight Time	07/30/2019 06:29:44 PM Central Daylight Time			08/05/2019 06:02:49 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	1	1		1			H0755	41	2	2020	Select counties in New Jersey	"Burlington, Hunterdon, and Mercer Counties"	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	42	1	1	1	1	H0755_042_1	6	1			08/02/2019	2020.01	08/02/2019 11:15:09 AM Central Daylight Time	08/02/2019 10:49:22 AM Central Daylight Time	07/30/2019 06:30:18 PM Central Daylight Time			08/05/2019 06:02:49 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 4 (HMO)	1	1		1			H0755	42	1	2020	Select counties in New Jersey	Select Counties in New Jersey	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	42	2	1	1	1	H0755_042_2	6	1			08/02/2019	2020.01	08/02/2019 11:15:51 AM Central Daylight Time	08/02/2019 10:49:52 AM Central Daylight Time	07/30/2019 06:30:52 PM Central Daylight Time			08/05/2019 06:02:49 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 4 (HMO)	1	1		1			H0755	42	2	2020	Select counties in New Jersey	"Burlington, Hunterdon, and Mercer Counties"	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0755	810	0	1	1	1	H0755_810_0	1	1			06/01/2019	2020.01	06/01/2019 03:40:09 PM Central Daylight Time					06/02/2019 05:07:11 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0755	810	0	2020	Connecticut		1	3048	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H0755	811	0	1	1	1	H0755_811_0	1	1			05/24/2019	2020.01	05/24/2019 08:13:43 AM Central Daylight Time					06/02/2019 05:07:11 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0755	811	0	2020	Connecticut		1	0	2			2						9999	www.UHCMedicareSolutions.com	610097	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H0755	812	0	1	1	1	H0755_812_0	1	1			05/12/2019	2020.01	05/12/2019 04:05:52 PM Central Daylight Time					06/02/2019 05:07:11 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0755	812	0	2020	Connecticut		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H0755	813	0	1	1	1	H0755_813_0	1	1			05/12/2019	2020.01	05/12/2019 04:04:27 PM Central Daylight Time					06/02/2019 05:07:11 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0755	813	0	2020	NJ		1	2076	2			2						www.UHCRetiree.com	www.UHCRetiree.com	www.UHCRetiree.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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H0755	814	0	1	1	1	H0755_814_0	1	1			05/12/2019	2020.01	05/12/2019 04:11:00 PM Central Daylight Time					06/02/2019 05:07:11 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0755	814	0	2020	NJ		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H0755	815	0	1	1	1	H0755_815_0	1	1			05/12/2019	2020.01	05/12/2019 04:40:25 PM Central Daylight Time					06/02/2019 05:07:11 PM Central Daylight Time	"OXFORD HEALTH PLANS (CT), INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H0755	815	0	2020	NJ		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H0798	1	0	1	1	1	H0798_001_0	11	1			07/26/2019	2020.01	07/26/2019 02:47:59 PM Central Daylight Time	08/01/2019 09:44:51 AM Central Daylight Time	08/01/2019 09:47:47 AM Central Daylight Time			08/01/2019 11:39:37 AM Central Daylight Time	MEDICA HEALTH PLANS OF WISCONSIN	Medica	medica.com	Medica Advantage Solution with CHI Health (HMO)	1	1		1			H0798	1	0	2020	Select counties in IA and NE		2		2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)398-7374		(952)992-2134		(800)906-5432		(952)992-2345		(866)398-7374		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0809	1	0	1	20	8	H0809_001_0	1	1			05/21/2019	2020.01	05/21/2019 11:56:42 AM Eastern Daylight Time		05/21/2019 11:47:32 AM Eastern Daylight Time			05/21/2019 11:59:34 AM Eastern Daylight Time	"MERCY LIFE, INC."	Mercy LIFE	www.mymercylife.com	"Mercy LIFE, Inc. (PACE)"	8	20		1			H0809	1	0	2020	Mercy LIFE		2		2			2						www.mercycares.com	www.mercycares.com										(413)748-7223		(413)748-7223		(413)748-7223		(413)748-7223										(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370																
H0809	2	0	1	20	8	H0809_002_0	1	1			05/21/2019	2020.01	05/21/2019 11:57:00 AM Eastern Daylight Time		05/21/2019 11:46:51 AM Eastern Daylight Time			05/21/2019 11:59:34 AM Eastern Daylight Time	"MERCY LIFE, INC."	Mercy LIFE	www.mymercylife.com	"Mercy LIFE, Inc. (PACE)"	8	20		1			H0809	2	0	2020	Mercy LIFE		2		2			2						www.mercycares.com	www.mercycares.com										(413)748-7223		(413)748-7223		(413)748-7223		(413)748-7223										(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370																
H0819	1	0	1	20	8	H0819_001_0	1	1			05/20/2019	2020.01	05/20/2019 02:11:28 PM Eastern Daylight Time		05/20/2019 01:05:10 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"SENIOR LIFE YORK, INC."	"Senior LIFE York, Inc."	www.seniorlifepa.com	Senior LIFE York Dual Eligibile (PACE)	8	20		1			H0819	1	0	2020	York County		2		2			2						http://granerx.com/	www.seniorlifeyork.com										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H0819	2	0	1	20	8	H0819_002_0	1	1			05/20/2019	2020.01	05/20/2019 02:11:41 PM Eastern Daylight Time		05/20/2019 01:05:08 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"SENIOR LIFE YORK, INC."	"Senior LIFE York, Inc."	http://www.seniorlifeyork.com	Senior LIFE York Medicare Only (PACE)	8	20		1			H0819	2	0	2020	York County		2		2			2						http://granerx.com/	www.seniorlifeyork.com										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H0838	20	0	1	1	1	H0838_020_0	6	1		1	07/25/2019	2020.01	07/25/2019 09:34:47 AM Pacific Daylight Time	07/31/2019 01:47:13 PM Pacific Daylight Time	07/30/2019 01:43:42 PM Pacific Daylight Time			08/05/2019 03:24:31 PM Pacific Daylight Time	"UNIVERSAL CARE, INC."	Brand New Day	www.bndhmo.com	Brand New Day Harmony Choice Plan (HMO C-SNP)	1	1		1			H0838	20	0	2020	FRE IMP KER KIN LA ORA RIV SBD SCL SD SM TUL		2	40344	2			1	4			10000000		www.bndhmo.com	www.bndhmo.com	www.bndhmo.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	2			
H0838	24	0	1	1	1	H0838_024_0	7	1	2	1	07/25/2019	2020.01	07/25/2019 09:34:55 AM Pacific Daylight Time	07/31/2019 01:47:52 PM Pacific Daylight Time	07/30/2019 01:44:31 PM Pacific Daylight Time			08/05/2019 03:24:31 PM Pacific Daylight Time	"UNIVERSAL CARE, INC."	Brand New Day	www.bndhmo.com	Brand New Day Dual Access Plan (HMO D-SNP)	1	1		1			H0838	24	0	2020	FRE IMP KER KIN LA ORA RIV SBD TUL		2	28230	2			1	3		2		2	www.bndhmo.com	www.bndhmo.com	www.bndhmo.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	2			
H0838	25	0	1	1	1	H0838_025_0	8	1			07/25/2019	2020.01	07/25/2019 09:35:37 AM Pacific Daylight Time	07/31/2019 01:48:31 PM Pacific Daylight Time	07/30/2019 01:45:12 PM Pacific Daylight Time			08/05/2019 03:24:31 PM Pacific Daylight Time	"UNIVERSAL CARE, INC."	Brand New Day	www.bndhmo.com	Brand New Day Classic Care I Plan (HMO)	1	1		1			H0838	25	0	2020	Counties:  KER LA ORA RIV SBD SD		2	83160	2			2						www.bndhmo.com	www.bndhmo.com	www.bndhmo.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	2			
H0838	28	0	1	1	1	H0838_028_0	8	1		1	08/05/2019	2020.01	08/05/2019 08:23:37 AM Pacific Daylight Time	07/31/2019 01:49:10 PM Pacific Daylight Time	07/30/2019 01:45:52 PM Pacific Daylight Time			08/05/2019 03:24:31 PM Pacific Daylight Time	"UNIVERSAL CARE, INC."	Brand New Day	www.bndhmo.com	Brand New Day Bridges Care Plan (HMO C-SNP)	1	1		1			H0838	28	0	2020	FRE IMP KER KIN LA ORA RIV SBD SD  SM SCL TUL		2	5808	2			1	4			1E+14		www.bndhmo.com	www.bndhmo.com	www.bndhmo.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	2			
H0838	29	0	1	1	1	H0838_029_0	6	1		1	07/25/2019	2020.01	07/25/2019 09:36:10 AM Pacific Daylight Time	07/31/2019 01:49:49 PM Pacific Daylight Time	07/30/2019 01:46:34 PM Pacific Daylight Time			08/05/2019 03:24:31 PM Pacific Daylight Time	"UNIVERSAL CARE, INC."	Brand New Day	www.bndhmo.com	Brand New Day Bridges Choice Plan (HMO C-SNP)	1	1		1			H0838	29	0	2020	FRE IMP KER KIN  LA ORA RIV SBD SCL SD SM  TUL		2	4752	2			1	4			1E+14		www.bndhmo.com	www.bndhmo.com	www.bndhmo.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	2			
H0838	32	0	1	1	1	H0838_032_0	8	1		1	07/25/2019	2020.01	07/25/2019 09:36:22 AM Pacific Daylight Time	07/31/2019 01:50:28 PM Pacific Daylight Time	07/30/2019 01:47:21 PM Pacific Daylight Time			08/05/2019 03:24:31 PM Pacific Daylight Time	"UNIVERSAL CARE, INC."	Brand New Day	www.bndhmo.com	Brand New Day Harmony Care Plan (HMO C-SNP)	1	1		1			H0838	32	0	2020	FRE IMP KIN KER  LA ORA RIV SBD SCL SD SM TUL		2	5334	2			1	4			10000000		www.bndhmo.com	www.bndhmo.com	www.bndhmo.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	2			
H0838	33	0	1	1	1	H0838_033_0	7	1			07/25/2019	2020.01	07/25/2019 09:36:34 AM Pacific Daylight Time	07/31/2019 01:51:07 PM Pacific Daylight Time	07/30/2019 01:48:04 PM Pacific Daylight Time			08/05/2019 03:24:31 PM Pacific Daylight Time	"UNIVERSAL CARE, INC."	Brand New Day	www.bndhmo.com	Brand New Day Classic Choice Plan (HMO)	1	1		1			H0838	33	0	2020	FRE IMP KER KIN LA ORA RIV SBD SD SM SCL TUL		2	78576	2			2						www.bndhmo.com	www.bndhmo.com	www.bndhmo.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	2			
H0838	37	0	1	1	1	H0838_037_0	7	1			07/25/2019	2020.01	07/25/2019 09:37:03 AM Pacific Daylight Time	07/31/2019 01:51:46 PM Pacific Daylight Time	07/30/2019 01:48:59 PM Pacific Daylight Time			08/05/2019 03:24:31 PM Pacific Daylight Time	"UNIVERSAL CARE, INC."	Brand New Day	www.bndhmo.com	Brand New Day Classic Care II Plan (HMO)	1	1		1			H0838	37	0	2020	FRE IMP KER KIN LA ORA RIV SBD SCL SD SM TUL		2	100986	2			2						www.bndhmo.com	www.bndhmo.com	www.bndhmo.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	2			
H0838	39	1	1	1	1	H0838_039_1	8	1		1	07/25/2019	2020.01	07/25/2019 09:37:18 AM Pacific Daylight Time	07/31/2019 01:52:25 PM Pacific Daylight Time	07/30/2019 01:49:47 PM Pacific Daylight Time			08/05/2019 03:24:31 PM Pacific Daylight Time	"UNIVERSAL CARE, INC."	Brand New Day	www.bndhmo.com	Brand New Day Embrace Care Plan (HMO C-SNP)	1	1		1			H0838	39	1	2020	FRE IMP KER KIN LA ORA RIV SBD SCL SD  SM  TUL	KER LA ORA RIV SBD SD	2	68130	2			1	4			10		www.bndhmo.com	www.bndhmo.com	www.bndhmo.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	2			
H0838	39	2	1	1	1	H0838_039_2	8	1		1	07/25/2019	2020.01	07/25/2019 09:37:35 AM Pacific Daylight Time	07/31/2019 01:53:04 PM Pacific Daylight Time	07/30/2019 01:50:28 PM Pacific Daylight Time			08/05/2019 03:24:31 PM Pacific Daylight Time	"UNIVERSAL CARE, INC."	Brand New Day	www.bndhmo.com	Brand New Day Embrace Care Plan (HMO C-SNP)	1	1		1			H0838	39	2	2020	FRE IMP KER KIN LA ORA RIV SBD SCL SD  SM  TUL	FRE IMP KIN SM SCL TUL	2	65580	2			1	4			10		www.bndhmo.com	www.bndhmo.com	www.bndhmo.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	2			
H0838	40	1	1	1	1	H0838_040_1	7	1		1	07/25/2019	2020.01	07/25/2019 09:37:55 AM Pacific Daylight Time	07/31/2019 01:53:43 PM Pacific Daylight Time	07/30/2019 01:51:10 PM Pacific Daylight Time			08/05/2019 03:24:31 PM Pacific Daylight Time	"UNIVERSAL CARE, INC."	Brand New Day	www.bndhmo.com	Brand New Day Embrace Choice Plan (HMO C-SNP)	1	1		1			H0838	40	1	2020	FRE IMP KER KIN LA ORA RIV SBD SCL SD  SM TUL	KER LA ORA RIV SBD SD	2	51024	2			1	4			10		www.bndhmo.com	www.bndhmo.com	www.bndhmo.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	2			
H0838	40	2	1	1	1	H0838_040_2	7	1		1	07/25/2019	2020.01	07/25/2019 09:38:01 AM Pacific Daylight Time	07/31/2019 01:54:22 PM Pacific Daylight Time	07/30/2019 01:52:29 PM Pacific Daylight Time			08/05/2019 03:24:31 PM Pacific Daylight Time	"UNIVERSAL CARE, INC."	Brand New Day	www.bndhmo.com	Brand New Day Embrace Choice Plan (HMO C-SNP)	1	1		1			H0838	40	2	2020	FRE IMP KER KIN LA ORA RIV SBD SCL SD  SM TUL	FRE IMP KIN SM SCL TUL	2	19812	2			1	4			10		www.bndhmo.com	www.bndhmo.com	www.bndhmo.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	2			
H0838	41	0	1	1	1	H0838_041_0	6	1		1	07/25/2019	2020.01	07/25/2019 09:38:06 AM Pacific Daylight Time	07/31/2019 01:55:02 PM Pacific Daylight Time	07/30/2019 01:52:42 PM Pacific Daylight Time			08/05/2019 03:24:31 PM Pacific Daylight Time	"UNIVERSAL CARE, INC."	Brand New Day	www.bndhmo.com	Brand New Day Select Care Plan (HMO I-SNP)	1	1		1			H0838	41	0	2020	FRE IMP KER KIN LA ORA RIV SBD SCL SD SM TUL		2	13932	2			1	1	1				www.bndhmo.com	www.bndhmo.com	www.bndhmo.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	2			
H0839	1	0	1	20	8	H0839_001_0	2	1			05/23/2019	2020.01	05/23/2019 10:47:02 AM Eastern Daylight Time		05/24/2019 09:38:21 AM Eastern Daylight Time			05/24/2019 09:40:35 AM 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)	8	20		1			H0839	1	0	2020	"Wake Co, Durham Co, Granville Co."		2		2			2						www.seniorcommunitycarenc.org	www.seniorcommunitycarenc.org										(919)425-3000		(919)425-3000		(919)425-3000		(919)425-3000										(919)425-3000		(919)425-3000		(919)425-3000		(919)425-3000																
H0839	2	0	1	20	8	H0839_002_0	1	1			05/23/2019	2020.01	05/23/2019 10:48:02 AM Eastern Daylight Time		05/22/2019 01:37:26 PM Eastern Daylight Time			05/23/2019 11:00:45 AM 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)	8	20		1			H0839	2	0	2020	"Wake Co., Durham Co, Granville Co"		2		2			2						www.seniorcommunitycarenc.org	www.seniorcommunitycarenc.org										(919)425-3000		(919)425-3000		(919)425-3000		(919)425-3000										(919)425-3000		(919)425-3000		(919)425-3000		(919)425-3000																
H0908	1	0	1	1	1	H0908_001_0	5	1	2	1	08/01/2019	2020.01	08/01/2019 01:13:14 PM Eastern Daylight Time	08/05/2019 04:13:41 PM Central Daylight Time	08/05/2019 03:07:08 PM Central Daylight Time			08/05/2019 06:14:53 PM Central Daylight Time	"BUCKEYE COMMUNITY HEALTH PLAN, INC."	Allwell	allwell.buckeyehealthplan.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H0908	1	0	2020	Statewide		2		2			1	3		2		2	advantage.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	advantage.buckeyehealthplan.com/findadoctor	(866)389-7690		(866)389-7690		(877)826-5518		(877)826-5518		(866)389-7690		(866)389-7690		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0908	801	0	1	1	1	H0908_801_0	1	1			05/10/2019	2020.01	05/10/2019 04:27:18 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"BUCKEYE COMMUNITY HEALTH PLAN, INC."	Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	1	1		1			H0908	801	0	2020	Statewide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0908	802	0	1	1	1	H0908_802_0	1	1			05/03/2019	2020.01	05/03/2019 10:27:03 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"BUCKEYE COMMUNITY HEALTH PLAN, INC."	Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	1	1		1			H0908	802	0	2020	Statewide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0908	803	0	1	1	1	H0908_803_0	1	1			05/10/2019	2020.01	05/10/2019 12:35:37 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"BUCKEYE COMMUNITY HEALTH PLAN, INC."	Allwell	allwell.buckeyehealthplan.com	Allwell Group (HMO)	1	1		1			H0908	803	0	2020	Statewide		1	100	2			2						allwell.buckeyehealthplan.com/findadoctor	allwell.buckeyehealthplan.com/formulary	allwell.buckeyehealthplan.com/findadoctor	(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(855)766-1851		(855)766-1851		(877)826-5518		(877)826-5518		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H0913	2	0	1	2	1	H0913_002_0	5	1			07/11/2019	2020.01	07/11/2019 01:50:02 PM Eastern Daylight Time	08/02/2019 02:47:49 AM Eastern Daylight Time	07/30/2019 09:15:05 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH PLANS OF NEW JERSEY, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	1	2		1			H0913	2	0	2020	Select counties in NJ		2	44402	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0913	13	0	1	1	1	H0913_013_0	5	1	2	1	07/12/2019	2020.01	07/12/2019 12:31:39 PM Eastern Daylight Time	08/02/2019 02:49:25 AM Eastern Daylight Time	07/30/2019 09:15:40 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH PLANS OF NEW JERSEY, INC."	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H0913	13	0	2020	Select Counties in NJ		2	52735	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0913	15	0	1	1	1	H0913_015_0	5	1			07/12/2019	2020.01	07/12/2019 12:32:23 PM Eastern Daylight Time	08/02/2019 02:51:01 AM Eastern Daylight Time	07/30/2019 09:16:15 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH PLANS OF NEW JERSEY, INC."	WellCare	www.wellcare.com/medicare	WellCare Compass (HMO)	1	1		1			H0913	15	0	2020	Select Counties in NJ		2	20909	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0913	17	0	1	1	1	H0913_017_0	5	1			07/11/2019	2020.01	07/11/2019 02:01:00 PM Eastern Daylight Time	08/02/2019 02:52:36 AM Eastern Daylight Time	07/30/2019 09:16:49 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH PLANS OF NEW JERSEY, INC."	WellCare	www.wellcare.com/medicare	WellCare Focus (HMO)	1	1		1			H0913	17	0	2020	Select counties in NJ		2	6892	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	3-1;3-2;3-3;3-4;7a;7c;7d;7f;7g;7i;7k;8b2;8b3;9a1;9b;16b;17a;18a;	
H0927	1	0	1	48	5	H0927_001_0	5	1			08/05/2019	2020.01	08/05/2019 02:48:04 PM Central Daylight Time					08/05/2019 02:48:13 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Community MMAI	www.bcbsil.com/mmai	Blue Cross Community MMAI (Medicare-Medicaid Plan)	5	48		1			H0927	1	0	2020	"Cook, DuPage, Kane, Kankakee, Lake, and Will ctys"		2	216000	2			2						www.yourpartd.com	www.bcbsil.com/mmai/plan_details/drug_coverage.html		(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)-																
H0934	1	0	1	20	8	H0934_001_0	3	1			06/03/2019	2020.01	06/03/2019 09:44:28 AM Mountain Daylight Time		07/18/2019 09:52:34 AM Mountain Daylight Time			07/18/2019 09:55:26 AM Mountain Daylight Time	"PACIFIC PACE, LLC"	Pacific PACE	https://pacificpace.welbehealth.com	Pacific PACE (PACE)	8	20		1			H0934	1	0	2020	Parts of Los Angeles County		2		2			2						www.omnicare.com	NA												(800)851-0966				(800)851-0966												(800)735-2922				(800)735-2922																
H0934	2	0	1	20	8	H0934_002_0	3	1			06/03/2019	2020.01	06/03/2019 09:44:37 AM Mountain Daylight Time		07/18/2019 09:52:21 AM Mountain Daylight Time			07/18/2019 09:55:26 AM Mountain Daylight Time	"PACIFIC PACE, LLC"	Pacific PACE	https://pacificpace.welbehealth.com	Pacific PACE (PACE)	8	20		1			H0934	2	0	2020	Parts of Los Angeles County		2		2			2						www.omnicare.com	NA												(800)851-0966				(800)851-0966												(800)735-2922				(800)735-2922																
H0969	1	0	1	4	1	H0969_001_0	7	1			07/12/2019	2020.01	07/12/2019 11:22:23 AM Eastern Daylight Time	08/02/2019 02:54:09 AM Eastern Daylight Time	07/30/2019 09:17:24 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	wellcare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H0969	1	0	2020	Select counties in NH		2	1199	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0969	2	0	1	4	1	H0969_002_0	7	1			07/12/2019	2020.01	07/12/2019 11:23:02 AM Eastern Daylight Time	08/02/2019 02:55:44 AM Eastern Daylight Time	07/30/2019 09:17:58 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	wellcare	www.wellcare.com/medicare	WellCare Prime (PPO)	1	4		1			H0969	2	0	2020	Select counties in NH		2	15	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H0982	1	0	1	1	1	H0982_001_0	7	1			07/16/2019	2020.01	07/16/2019 12:52:30 PM Mountain Daylight Time	08/05/2019 05:59:53 PM Central Daylight Time	08/05/2019 01:05:01 PM Central Daylight Time			08/06/2019 02:47:50 PM Central Daylight Time	"SOLIS HEALTH PLANS, INC."	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 001 (HMO)	1	1		1			H0982	1	0	2020	Miami-Dade MAPD		2		2			2						https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	2	0	1	1	1	H0982_002_0	6	1	2	1	06/26/2019	2020.01	06/26/2019 09:11:46 AM Mountain Daylight Time	08/05/2019 06:03:45 PM Central Daylight Time	08/05/2019 01:06:47 PM Central Daylight Time			08/06/2019 02:47:50 PM Central Daylight Time	"SOLIS HEALTH PLANS, INC."	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 002 (HMO D-SNP)	1	1		1			H0982	2	0	2020	Miami-Dade D-SNP		2		2			1	3		2		1	https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	5	0	1	1	1	H0982_005_0	6	1			08/06/2019	2020.01	08/06/2019 10:13:45 AM Mountain Daylight Time	08/05/2019 06:05:51 PM Central Daylight Time	08/05/2019 01:08:26 PM Central Daylight Time			08/06/2019 02:47:50 PM Central Daylight Time	"SOLIS HEALTH PLANS, INC."	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 005 (HMO)	1	1		1			H0982	5	0	2020	Orange MAPD		2		2			2						https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	6	0	1	1	1	H0982_006_0	6	1	2	1	06/26/2019	2020.01	06/26/2019 09:13:42 AM Mountain Daylight Time	08/05/2019 06:10:27 PM Central Daylight Time	08/05/2019 01:11:36 PM Central Daylight Time			08/06/2019 02:47:50 PM Central Daylight Time	"SOLIS HEALTH PLANS, INC."	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 006 (HMO D-SNP)	1	1		1			H0982	6	0	2020	Orange D-SNP		2		2			1	3		2		1	https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	7	0	1	1	1	H0982_007_0	6	1			08/06/2019	2020.01	08/06/2019 10:14:24 AM Mountain Daylight Time	08/05/2019 06:12:27 PM Central Daylight Time	08/05/2019 01:13:31 PM Central Daylight Time			08/06/2019 02:47:50 PM Central Daylight Time	"SOLIS HEALTH PLANS, INC."	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 007 (HMO)	1	1		1			H0982	7	0	2020	Broward MAPD		2		2			2						https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	8	0	1	1	1	H0982_008_0	6	1			06/26/2019	2020.01	06/26/2019 09:15:34 AM Mountain Daylight Time	08/05/2019 06:15:03 PM Central Daylight Time	08/05/2019 01:15:11 PM Central Daylight Time			08/06/2019 02:47:50 PM Central Daylight Time	"SOLIS HEALTH PLANS, INC."	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 008 (HMO)	1	1		1			H0982	8	0	2020	Palm Beach MAPD		2		2			2						https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	9	0	1	1	1	H0982_009_0	6	1			08/06/2019	2020.01	08/06/2019 10:14:42 AM Mountain Daylight Time	08/05/2019 06:17:28 PM Central Daylight Time	08/05/2019 01:17:41 PM Central Daylight Time			08/06/2019 02:47:50 PM Central Daylight Time	"SOLIS HEALTH PLANS, INC."	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 009 (HMO)	1	1		1			H0982	9	0	2020	Hillsborough MAPD		2		2			2						https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H0982	10	0	1	1	1	H0982_010_0	6	1	2	1	06/26/2019	2020.01	06/26/2019 09:17:58 AM Mountain Daylight Time	08/05/2019 06:01:23 PM Central Daylight Time	08/05/2019 01:23:01 PM Central Daylight Time			08/06/2019 02:47:50 PM Central Daylight Time	"SOLIS HEALTH PLANS, INC."	Solis Health Plans	https://solishealthplans.com	SOLIS SPF 010 (HMO D-SNP)	1	1		1			H0982	10	0	2020	Hillsborough D-SNP		2		2			1	3		2		1	https://solishealthplans.com	https://solishealthplans.com	https://solishealthplans.com	(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(844)447-6547		(305)420-3079		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1016	1	0	1	1	1	H1016_001_0	10	1			08/05/2019	2020.01	08/05/2019 02:22:59 PM Eastern Daylight Time	08/06/2019 05:12:50 PM Eastern Daylight Time	08/06/2019 05:14:08 PM Eastern Daylight Time			08/06/2019 06:01:32 PM Eastern Daylight Time	"AVMED, INC."	AvMed Medicare	www.avmed.org	AvMed Medicare Choice (HMO)	1	1		1			H1016	1	0	2020	Miami-Dade County		2		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	1	1	7d;	
H1016	21	0	1	1	1	H1016_021_0	12	1			08/05/2019	2020.01	08/05/2019 02:24:03 PM Eastern Daylight Time	08/06/2019 05:13:08 PM Eastern Daylight Time	08/06/2019 05:14:23 PM Eastern Daylight Time			08/06/2019 06:01:32 PM Eastern Daylight Time	"AVMED, INC."	AvMed Medicare	www.avmed.org	AvMed Medicare Choice (HMO)	1	1		1			H1016	21	0	2020	Broward County		2		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	1	1	7d;	
H1016	23	0	1	1	1	H1016_023_0	9	1			08/05/2019	2020.01	08/05/2019 02:53:58 PM Eastern Daylight Time	08/06/2019 05:13:34 PM Eastern Daylight Time	08/06/2019 05:14:36 PM Eastern Daylight Time			08/06/2019 06:01:32 PM Eastern Daylight Time	"AVMED, INC."	AvMed Medicare	www.avmed.org	AvMed Medicare Circle (HMO)	1	1		1			H1016	23	0	2020	Miami-Dade County		2		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	2			
H1016	24	0	1	1	1	H1016_024_0	9	1			08/05/2019	2020.01	08/05/2019 02:54:34 PM Eastern Daylight Time	08/06/2019 05:13:51 PM Eastern Daylight Time	08/06/2019 05:14:57 PM Eastern Daylight Time			08/06/2019 06:01:32 PM Eastern Daylight Time	"AVMED, INC."	AvMed Medicare	www.avmed.org	AvMed Medicare Circle (HMO)	1	1		1			H1016	24	0	2020	Broward County		2		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	2			
H1016	801	0	1	1	1	H1016_801_0	6	1			05/24/2019	2020.01	05/24/2019 03:43:53 PM Eastern Daylight Time					06/03/2019 05:33:25 PM Eastern Daylight Time	"AVMED, INC."	AvMed Medicare	www.avmed.org	AvMed Employer Group MAPD Plan (HMO)	1	1		1			H1016	801	0	2020	AvMed Florida Employer Group Plan		1	10	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	1	1	H1016_802_0	6	1			05/24/2019	2020.01	05/24/2019 03:49:13 PM Eastern Daylight Time					06/03/2019 05:33:25 PM Eastern Daylight Time	"AVMED, INC."	AvMed Medicare	www.avmed.org	AvMed Employer Group MA Only Plan (HMO)	1	1		1			H1016	802	0	2020	AvMed Florida Employer Group Plan		1	10	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	1	1	H1016_803_0	6	1			05/24/2019	2020.01	05/24/2019 03:50:39 PM Eastern Daylight Time					06/03/2019 05:33:25 PM Eastern Daylight Time	"AVMED, INC."	AvMed Medicare	www.avmed.org	AvMed Employer Group MAPD Non-CY Plan (HMO)	1	1		1			H1016	803	0	2020	AvMed Florida  Employer Group Plan		1	10	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	1	1	H1016_804_0	6	1			05/24/2019	2020.01	05/24/2019 03:54:43 PM Eastern Daylight Time					06/03/2019 05:33:25 PM Eastern Daylight Time	"AVMED, INC."	AvMed Medicare	www.avmed.org	AvMed Employer Group MA Only Non-CY Plan (HMO)	1	1		1			H1016	804	0	2020	AvMed Florida Employer Group Plan		1	10	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	805	0	1	1	1	H1016_805_0	7	1			07/02/2019	2020.01	07/02/2019 05:32:55 PM Eastern Daylight Time					07/03/2019 10:17:38 AM Eastern Daylight Time	"AVMED, INC."	AvMed Medicare	www.avmed.org	AvMed Medicare State of Florida High Option (HMO)	1	1		1			H1016	805	0	2020	Broward and Miami-Dade Counties		1	1650	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	1	1	7d;	
H1016	806	0	1	1	1	H1016_806_0	7	1			07/02/2019	2020.01	07/02/2019 05:33:47 PM Eastern Daylight Time					07/03/2019 10:17:38 AM Eastern Daylight Time	"AVMED, INC."	AvMed Medicare	www.avmed.org	AvMed Medicare State of Florida Dividend (HMO)	1	1		1			H1016	806	0	2020	Broward and Miami-Dade Counties		1	1259	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	1	1	7d;	
H1019	1	0	1	1	1	H1019_001_0	2	1			08/02/2019	2020.01	08/02/2019 05:06:55 PM Eastern Daylight Time	08/04/2019 04:23:48 PM Eastern Daylight Time	08/02/2019 01:17:54 PM Eastern Daylight Time			08/05/2019 10:37:15 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareOne (HMO)	1	1		1			H1019	1	0	2020	Broward County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	6	0	1	1	1	H1019_006_0	3	1			08/02/2019	2020.01	08/02/2019 03:19:31 PM Eastern Daylight Time	08/04/2019 03:56:46 PM Eastern Daylight Time	08/02/2019 01:17:54 PM Eastern Daylight Time			08/05/2019 10:37:15 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareOne PLUS (HMO)	1	1		1			H1019	6	0	2020	Miami-Dade County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	23	0	1	1	1	H1019_023_0	3	1	2	1	07/15/2019	2020.01	07/15/2019 10:32:40 AM Eastern Daylight Time	08/04/2019 03:38:19 PM Eastern Daylight Time	08/02/2019 01:17:55 PM Eastern Daylight Time			08/05/2019 10:51:21 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds PLUS (HMO D-SNP)	1	1		1			H1019	23	0	2020	Broward and Palm Beach counties		2		2			1	3		1		1	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	24	0	1	1	1	H1019_024_0	3	1	2	1	07/15/2019	2020.01	07/15/2019 10:33:48 AM Eastern Daylight Time	08/04/2019 03:42:14 PM Eastern Daylight Time	08/02/2019 01:17:55 PM Eastern Daylight Time			08/05/2019 10:51:21 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds PLUS (HMO D-SNP)	1	1		1			H1019	24	0	2020	Miami-Dade County		2		2			1	3		1		1	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	26	0	1	1	1	H1019_026_0	4	1	2	1	05/28/2019	2020.01	05/28/2019 04:19:02 PM Eastern Daylight Time	08/04/2019 03:45:55 PM Eastern Daylight Time	08/02/2019 01:17:55 PM Eastern Daylight Time			08/05/2019 12:19:16 PM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds PLUS (HMO D-SNP)	1	1		1			H1019	26	0	2020	"Hillsborough, Pasco, Pinellas, and Polk Counties"		2		2			1	3		1		1	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	28	0	1	1	1	H1019_028_0	3	1	2	1	05/22/2019	2020.01	05/22/2019 05:11:40 PM Eastern Daylight Time	08/04/2019 03:49:29 PM Eastern Daylight Time	08/02/2019 01:17:55 PM Eastern Daylight Time			08/05/2019 11:29:55 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds PLUS (HMO D-SNP)	1	1		1			H1019	28	0	2020	Orlando Area		2		2			1	3		1		1	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	43	0	1	1	1	H1019_043_0	2	1			08/02/2019	2020.01	08/02/2019 03:30:49 PM Eastern Daylight Time	08/04/2019 03:28:47 PM Eastern Daylight Time	08/02/2019 01:17:55 PM Eastern Daylight Time			08/05/2019 10:37:15 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareOne (HMO)	1	1		1			H1019	43	0	2020	Brevard and Indian River counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	57	0	1	1	1	H1019_057_0	2	1			08/01/2019	2020.01	08/01/2019 05:37:33 PM Eastern Daylight Time	08/04/2019 03:30:37 PM Eastern Daylight Time	08/02/2019 01:17:55 PM Eastern Daylight Time			08/05/2019 10:48:50 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareOne PLUS (HMO)	1	1		1			H1019	57	0	2020	Orlando Area		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	65	0	1	1	1	H1019_065_0	2	1			08/01/2019	2020.01	08/01/2019 05:42:44 PM Eastern Daylight Time	08/04/2019 03:32:34 PM Eastern Daylight Time	08/02/2019 01:17:55 PM Eastern Daylight Time			08/05/2019 10:37:15 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareFree (HMO)	1	1		1			H1019	65	0	2020	Broward and Palm Beach counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	69	0	1	1	1	H1019_069_0	2	1			08/02/2019	2020.01	08/02/2019 03:32:31 PM Eastern Daylight Time	08/04/2019 03:34:33 PM Eastern Daylight Time	08/02/2019 01:17:55 PM Eastern Daylight Time			08/05/2019 10:37:15 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareOne (HMO)	1	1		1			H1019	69	0	2020	Clay and Duval Counties		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	73	0	1	1	1	H1019_073_0	3	1	2	1	07/12/2019	2020.01	07/12/2019 02:44:55 PM Eastern Daylight Time	08/04/2019 03:53:10 PM Eastern Daylight Time	08/02/2019 01:17:55 PM Eastern Daylight Time			08/05/2019 10:51:21 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds PLUS (HMO D-SNP)	1	1		1			H1019	73	0	2020	Clay and Duval Counties		2		2			1	3		1		1	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	76	0	1	1	1	H1019_076_0	2	1			08/02/2019	2020.01	08/02/2019 03:37:20 PM Eastern Daylight Time	08/04/2019 03:36:30 PM Eastern Daylight Time	08/02/2019 01:17:56 PM Eastern Daylight Time			08/05/2019 10:37:15 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareFree PLUS (HMO)	1	1		1			H1019	76	0	2020	Miami-Dade County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	77	0	1	1	1	H1019_077_0	3	1	2	1	05/22/2019	2020.01	05/22/2019 05:12:00 PM Eastern Daylight Time	08/04/2019 03:51:15 PM Eastern Daylight Time	08/02/2019 01:17:56 PM Eastern Daylight Time			08/05/2019 11:29:55 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds (HMO D-SNP)	1	1		1			H1019	77	0	2020	Orlando Area		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	79	0	1	1	1	H1019_079_0	3	1	2	1	05/28/2019	2020.01	05/28/2019 04:23:02 PM Eastern Daylight Time	08/04/2019 03:47:43 PM Eastern Daylight Time	08/02/2019 01:17:56 PM Eastern Daylight Time			08/05/2019 11:29:55 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds (HMO D-SNP)	1	1		1			H1019	79	0	2020	"Hillsborough, Pasco, Pinellas, and Polk Counties"		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	81	0	1	1	1	H1019_081_0	3	1	2	1	07/15/2019	2020.01	07/15/2019 10:34:23 AM Eastern Daylight Time	08/04/2019 03:40:07 PM Eastern Daylight Time	08/02/2019 01:17:56 PM Eastern Daylight Time			08/05/2019 10:51:21 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds (HMO D-SNP)	1	1		1			H1019	81	0	2020	Broward and Palm Beach counties		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	83	0	1	1	1	H1019_083_0	3	1	2	1	07/15/2019	2020.01	07/15/2019 10:35:13 AM Eastern Daylight Time	08/04/2019 03:44:08 PM Eastern Daylight Time	08/02/2019 01:17:56 PM Eastern Daylight Time			08/05/2019 10:51:21 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds (HMO D-SNP)	1	1		1			H1019	83	0	2020	Miami-Dade County		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	85	0	1	1	1	H1019_085_0	2	1	2	1	05/28/2019	2020.01	05/28/2019 04:26:02 PM Eastern Daylight Time	08/04/2019 03:54:59 PM Eastern Daylight Time	08/02/2019 01:17:56 PM Eastern Daylight Time			08/05/2019 10:51:21 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds (HMO D-SNP)	1	1		1			H1019	85	0	2020	Clay and Duval Counties		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	89	0	1	1	1	H1019_089_0	5	1			07/16/2019	2020.01	07/16/2019 04:26:33 PM Eastern Daylight Time	08/04/2019 03:58:32 PM Eastern Daylight Time	08/02/2019 01:17:56 PM Eastern Daylight Time			08/05/2019 10:51:21 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareExtra (HMO)	1	1		1			H1019	89	0	2020	Miami-Dade County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	90	0	1	1	1	H1019_090_0	2	1	2	1	05/22/2019	2020.01	05/22/2019 05:48:27 PM Eastern Daylight Time	08/04/2019 04:00:20 PM Eastern Daylight Time	08/02/2019 01:17:56 PM Eastern Daylight Time			08/05/2019 10:51:21 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds PLUS (HMO D-SNP)	1	1		1			H1019	90	0	2020	Brevard and Indian River counties		2		2			1	3		1		1	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	91	0	1	1	1	H1019_091_0	2	1	2	1	05/22/2019	2020.01	05/22/2019 05:50:23 PM Eastern Daylight Time	08/04/2019 04:02:12 PM Eastern Daylight Time	08/02/2019 01:17:57 PM Eastern Daylight Time			08/05/2019 10:51:21 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds (HMO D-SNP)	1	1		1			H1019	91	0	2020	Brevard and Indian River counties		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	92	0	1	1	1	H1019_092_0	2	1			08/01/2019	2020.01	08/01/2019 05:38:10 PM Eastern Daylight Time	08/04/2019 04:03:59 PM Eastern Daylight Time	08/02/2019 01:17:57 PM Eastern Daylight Time			08/05/2019 10:48:50 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareFree (HMO)	1	1		1			H1019	92	0	2020	Orlando Area		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	94	0	1	1	1	H1019_094_0	3	1			08/02/2019	2020.01	08/02/2019 04:18:36 PM Eastern Daylight Time	08/04/2019 04:05:44 PM Eastern Daylight Time	08/02/2019 01:17:57 PM Eastern Daylight Time			08/05/2019 10:37:15 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareFree (HMO)	1	1		1			H1019	94	0	2020	Duval County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	98	0	1	1	1	H1019_098_0	2	1			08/01/2019	2020.01	08/01/2019 05:38:51 PM Eastern Daylight Time	08/04/2019 04:07:30 PM Eastern Daylight Time	08/02/2019 01:17:57 PM Eastern Daylight Time			08/05/2019 10:48:50 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareOne PLUS (HMO)	1	1		1			H1019	98	0	2020	Volusia County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	99	0	1	1	1	H1019_099_0	2	1			08/01/2019	2020.01	08/01/2019 05:39:33 PM Eastern Daylight Time	08/04/2019 04:12:51 PM Eastern Daylight Time	08/02/2019 01:17:57 PM Eastern Daylight Time			08/05/2019 10:48:50 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareFree (HMO)	1	1		1			H1019	99	0	2020	Volusia County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	100	0	1	1	1	H1019_100_0	3	1	2	1	05/28/2019	2020.01	05/28/2019 04:23:49 PM Eastern Daylight Time	08/04/2019 04:09:16 PM Eastern Daylight Time	08/02/2019 01:17:57 PM Eastern Daylight Time			08/05/2019 11:29:55 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds PLUS (HMO D-SNP)	1	1		1			H1019	100	0	2020	Volusia County		2		2			1	3		1		1	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	101	0	1	1	1	H1019_101_0	2	1	2	1	05/28/2019	2020.01	05/28/2019 04:23:55 PM Eastern Daylight Time	08/04/2019 04:11:01 PM Eastern Daylight Time	08/02/2019 01:17:57 PM Eastern Daylight Time			08/05/2019 11:02:39 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareNeeds (HMO D-SNP)	1	1		1			H1019	101	0	2020	Volusia County		2		2			1	3		2		2	www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	102	0	1	1	1	H1019_102_0	2	1			08/01/2019	2020.01	08/01/2019 05:40:08 PM Eastern Daylight Time	08/04/2019 04:14:37 PM Eastern Daylight Time	08/02/2019 01:17:58 PM Eastern Daylight Time			08/05/2019 10:48:50 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareOne (HMO)	1	1		1			H1019	102	0	2020	Palm Beach County		2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	103	1	1	1	1	H1019_103_1	2	1			08/01/2019	2020.01	08/01/2019 05:41:18 PM Eastern Daylight Time	08/04/2019 04:20:04 PM Eastern Daylight Time	08/02/2019 01:17:58 PM Eastern Daylight Time			08/05/2019 11:00:06 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareOne PLUS (HMO)	1	1		1			H1019	103	1	2020	Tampa Area	Polk County	2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	103	2	1	1	1	H1019_103_2	2	1			08/01/2019	2020.01	08/01/2019 05:42:00 PM Eastern Daylight Time	08/04/2019 04:21:56 PM Eastern Daylight Time	08/02/2019 01:17:58 PM Eastern Daylight Time			08/05/2019 11:00:06 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareOne PLUS (HMO)	1	1		1			H1019	103	2	2020	Tampa Area	"Hillsborough, Pasco and Pinellas Counties"	2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	104	1	1	1	1	H1019_104_1	2	1			08/01/2019	2020.01	08/01/2019 05:42:26 PM Eastern Daylight Time	08/04/2019 04:16:25 PM Eastern Daylight Time	08/02/2019 01:17:58 PM Eastern Daylight Time			08/05/2019 11:00:06 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareFree (HMO)	1	1		1			H1019	104	1	2020	Tampa Area	Polk County	2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1019	104	2	1	1	1	H1019_104_2	2	1			08/01/2019	2020.01	08/01/2019 05:42:55 PM Eastern Daylight Time	08/04/2019 04:18:13 PM Eastern Daylight Time	08/02/2019 01:17:58 PM Eastern Daylight Time			08/05/2019 11:00:06 AM Eastern Daylight Time	"CAREPLUS HEALTH PLANS, INC."	"CarePlus Health Plans, Inc."	www.careplushealthplans.com	CareFree (HMO)	1	1		1			H1019	104	2	2020	Tampa Area	"Hillsborough, Pasco and Pinellas Counties"	2		2			2						www.careplushealthplans.com/pharmacy-finder	www.careplushealthplans.com/medicare-plans/2019-prescription-drug-guides	www.careplushealthplans.com/physician-finder	(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	2			
H1032	32	0	1	1	1	H1032_032_0	5	1			05/29/2019	2020.01	05/29/2019 10:32:48 AM Eastern Daylight Time	08/02/2019 01:57:18 AM Central Daylight Time	07/30/2019 08:18:33 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1032	32	0	2020	Select Counties in FL		2	12089	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	40	0	1	1	1	H1032_040_0	5	1			05/29/2019	2020.01	05/29/2019 10:56:46 AM Eastern Daylight Time	08/02/2019 01:58:50 AM Central Daylight Time	07/30/2019 08:19:09 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1032	40	0	2020	Select Counties in FL		2	71603	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	61	0	1	1	1	H1032_061_0	4	1	2	1	07/12/2019	2020.01	07/12/2019 12:13:01 PM Eastern Daylight Time	08/02/2019 02:00:27 AM Central Daylight Time	07/30/2019 08:19:44 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Select (HMO D-SNP)	1	1		1			H1032	61	0	2020	Select Counties in FL		2	20198	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	73	0	1	1	1	H1032_073_0	5	1			05/29/2019	2020.01	05/29/2019 11:20:10 AM Eastern Daylight Time	08/02/2019 02:02:02 AM Central Daylight Time	07/30/2019 08:20:19 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H1032	73	0	2020	Select Counties in FL		2	10214	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	124	0	1	1	1	H1032_124_0	4	1	2	1	07/12/2019	2020.01	07/12/2019 12:14:18 PM Eastern Daylight Time	08/02/2019 02:03:53 AM Central Daylight Time	07/30/2019 08:20:54 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H1032	124	0	2020	Select Counties in FL		2	206937	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	133	0	1	2	1	H1032_133_0	5	1			07/12/2019	2020.01	07/12/2019 01:28:52 PM Eastern Daylight Time	08/02/2019 02:05:27 AM Central Daylight Time	07/30/2019 08:21:29 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	1	2		1			H1032	133	0	2020	Select Counties in FL		2	5255	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	170	0	1	1	1	H1032_170_0	5	1	2	1	07/12/2019	2020.01	07/12/2019 12:15:11 PM Eastern Daylight Time	08/02/2019 02:07:00 AM Central Daylight Time	07/30/2019 08:22:04 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H1032	170	0	2020	Select Counties in FL		2	3107	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	174	0	1	2	1	H1032_174_0	5	1			05/29/2019	2020.01	05/29/2019 01:07:49 PM Eastern Daylight Time	08/02/2019 02:08:33 AM Central Daylight Time	07/30/2019 08:22:38 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H1032	174	0	2020	Select Counties in FL		2	25509	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	175	0	1	1	1	H1032_175_0	4	1	2	1	07/12/2019	2020.01	07/12/2019 12:16:36 PM Eastern Daylight Time	08/02/2019 02:10:24 AM Central Daylight Time	07/30/2019 08:23:13 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H1032	175	0	2020	Select Counties in FL		2	208009	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	176	0	1	1	1	H1032_176_0	5	1	2	1	07/12/2019	2020.01	07/12/2019 12:17:07 PM Eastern Daylight Time	08/02/2019 02:11:58 AM Central Daylight Time	07/30/2019 08:23:48 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H1032	176	0	2020	Select Counties in FL		2	4183	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	182	0	1	1	1	H1032_182_0	4	1	2	1	07/12/2019	2020.01	07/12/2019 12:17:57 PM Eastern Daylight Time	08/02/2019 02:13:43 AM Central Daylight Time	07/30/2019 08:24:23 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Select (HMO D-SNP)	1	1		1			H1032	182	0	2020	Select Counties in FL		2	25670	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	184	0	1	1	1	H1032_184_0	5	1		1	07/11/2019	2020.01	07/11/2019 01:14:36 PM Eastern Daylight Time	08/02/2019 02:15:17 AM Central Daylight Time	07/30/2019 08:24:58 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Guardian (HMO C-SNP)	1	1		1			H1032	184	0	2020	Select Counties in FL		2	1531	2			1	4			10		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	186	0	1	1	1	H1032_186_0	5	1		1	07/11/2019	2020.01	07/11/2019 01:24:22 PM Eastern Daylight Time	08/02/2019 02:16:50 AM Central Daylight Time	07/30/2019 08:25:32 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Guardian (HMO C-SNP)	1	1		1			H1032	186	0	2020	Select Counties in FL		2	831	2			1	4			10		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	189	0	1	1	1	H1032_189_0	5	1			07/15/2019	2020.01	07/15/2019 01:07:26 PM Eastern Daylight Time	08/02/2019 02:18:23 AM Central Daylight Time	07/30/2019 08:26:07 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	1	1		1			H1032	189	0	2020	Select Counties in FL		2	3637	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	190	0	1	1	1	H1032_190_0	4	1			07/11/2019	2020.01	07/11/2019 03:04:57 PM Eastern Daylight Time	08/02/2019 02:19:57 AM Central Daylight Time	07/30/2019 08:26:42 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H1032	190	0	2020	Select Counties in FL		2	4628	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	191	0	1	1	1	H1032_191_0	4	1			07/11/2019	2020.01	07/11/2019 03:15:57 PM Eastern Daylight Time	08/02/2019 02:21:34 AM Central Daylight Time	07/30/2019 08:27:17 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	1	1		1			H1032	191	0	2020	Select Counties in FL		2	7450	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	192	0	1	1	1	H1032_192_0	4	1			07/11/2019	2020.01	07/11/2019 03:16:45 PM Eastern Daylight Time	08/02/2019 02:23:11 AM Central Daylight Time	07/30/2019 08:27:52 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H1032	192	0	2020	Select Counties in FL		2	20823	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	193	0	1	1	1	H1032_193_0	4	1			07/11/2019	2020.01	07/11/2019 03:17:33 PM Eastern Daylight Time	08/02/2019 02:24:47 AM Central Daylight Time	07/30/2019 08:28:28 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	1	1		1			H1032	193	0	2020	Select Counties in FL		2	37531	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	194	0	1	1	1	H1032_194_0	4	1			07/11/2019	2020.01	07/11/2019 03:18:20 PM Eastern Daylight Time	08/02/2019 02:26:23 AM Central Daylight Time	07/30/2019 08:29:03 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H1032	194	0	2020	Select Counties in FL		2	14683	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	195	0	1	1	1	H1032_195_0	4	1			07/11/2019	2020.01	07/11/2019 03:21:59 PM Eastern Daylight Time	08/02/2019 02:27:56 AM Central Daylight Time	07/30/2019 08:29:41 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	1	1		1			H1032	195	0	2020	Select Counties in FL		2	9915	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	196	0	1	1	1	H1032_196_0	4	1			07/11/2019	2020.01	07/11/2019 03:23:22 PM Eastern Daylight Time	08/02/2019 02:29:29 AM Central Daylight Time	07/30/2019 08:30:18 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H1032	196	0	2020	Select Counties in FL		2	1322	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	197	0	1	1	1	H1032_197_0	4	1	2	1	07/12/2019	2020.01	07/12/2019 12:18:38 PM Eastern Daylight Time	08/02/2019 02:31:05 AM Central Daylight Time	07/30/2019 08:30:55 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Reserve (HMO D-SNP)	1	1		1			H1032	197	0	2020	Select Counties in FL		2	715	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	198	0	1	1	1	H1032_198_0	4	1			07/11/2019	2020.01	07/11/2019 03:29:56 PM Eastern Daylight Time	08/02/2019 02:32:41 AM Central Daylight Time	07/30/2019 08:31:31 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	1	1		1			H1032	198	0	2020	Select Counties in FL		2	10584	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	199	0	1	1	1	H1032_199_0	4	1			07/11/2019	2020.01	07/11/2019 03:41:08 PM Eastern Daylight Time	08/02/2019 02:34:17 AM Central Daylight Time	07/30/2019 08:32:07 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H1032	199	0	2020	Select Counties in FL		2	5063	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	200	0	1	1	1	H1032_200_0	4	1			05/29/2019	2020.01	05/29/2019 04:01:45 PM Eastern Daylight Time	08/02/2019 02:35:52 AM Central Daylight Time	07/30/2019 08:32:43 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	1	1		1			H1032	200	0	2020	Select Counties in FL		2	94471	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	201	0	1	1	1	H1032_201_0	4	1			07/11/2019	2020.01	07/11/2019 03:41:56 PM Eastern Daylight Time	08/02/2019 02:37:26 AM Central Daylight Time	07/30/2019 08:33:19 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H1032	201	0	2020	Select Counties in FL		2	74598	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	202	0	1	1	1	H1032_202_0	4	1	2	1	07/12/2019	2020.01	07/12/2019 12:21:08 PM Eastern Daylight Time	08/02/2019 02:38:59 AM Central Daylight Time	07/30/2019 08:33:55 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Reserve (HMO D-SNP)	1	1		1			H1032	202	0	2020	Select Counties in FL		2	17939	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	203	0	1	1	1	H1032_203_0	4	1		1	07/12/2019	2020.01	07/12/2019 12:20:17 PM Eastern Daylight Time	08/02/2019 02:40:32 AM Central Daylight Time	07/30/2019 08:34:30 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Champion (HMO C-SNP)	1	1		1			H1032	203	0	2020	Select Counties in FL		2	2793	2			1	4			10		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	204	0	1	1	1	H1032_204_0	4	1			07/11/2019	2020.01	07/11/2019 04:06:50 PM Eastern Daylight Time	08/02/2019 02:42:05 AM Central Daylight Time	07/30/2019 08:35:06 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	1	1		1			H1032	204	0	2020	Select Counties in FL		2	16992	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	205	0	1	1	1	H1032_205_0	4	1			07/11/2019	2020.01	07/11/2019 04:16:21 PM Eastern Daylight Time	08/02/2019 02:43:37 AM Central Daylight Time	07/30/2019 08:35:43 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H1032	205	0	2020	Select Counties in FL		2	42230	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	206	0	1	1	1	H1032_206_0	4	1	2	1	07/12/2019	2020.01	07/12/2019 12:24:37 PM Eastern Daylight Time	08/02/2019 02:45:11 AM Central Daylight Time	07/30/2019 08:36:18 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Reserve (HMO D-SNP)	1	1		1			H1032	206	0	2020	Select Counties in FL		2	330	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	209	0	1	1	1	H1032_209_0	4	1			07/11/2019	2020.01	07/11/2019 04:18:30 PM Eastern Daylight Time	08/02/2019 02:46:47 AM Central Daylight Time	07/30/2019 08:36:54 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	1	1		1			H1032	209	0	2020	Select Counties in FL		2	5526	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	210	0	1	1	1	H1032_210_0	4	1			07/11/2019	2020.01	07/11/2019 04:21:23 PM Eastern Daylight Time	08/02/2019 02:48:21 AM Central Daylight Time	07/30/2019 08:37:31 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	1	1		1			H1032	210	0	2020	Select Counties in FL		2	14045	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	211	0	1	1	1	H1032_211_0	4	1			07/11/2019	2020.01	07/11/2019 04:24:28 PM Eastern Daylight Time	08/02/2019 02:49:56 AM Central Daylight Time	07/30/2019 08:38:07 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H1032	211	0	2020	Select Counties in FL		2	14306	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	212	0	1	1	1	H1032_212_0	4	1			07/11/2019	2020.01	07/11/2019 04:25:13 PM Eastern Daylight Time	08/02/2019 02:51:31 AM Central Daylight Time	07/30/2019 08:38:43 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	1	1		1			H1032	212	0	2020	Select Counties in FL		2	96432	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	213	0	1	1	1	H1032_213_0	4	1			07/11/2019	2020.01	07/11/2019 04:26:40 PM Eastern Daylight Time	08/02/2019 02:53:05 AM Central Daylight Time	07/30/2019 08:39:19 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H1032	213	0	2020	Select Counties in FL		2	103505	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	214	0	1	1	1	H1032_214_0	4	1	2	1	07/12/2019	2020.01	07/12/2019 12:25:12 PM Eastern Daylight Time	08/02/2019 01:53:53 PM Central Daylight Time	07/30/2019 08:39:56 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Reserve (HMO D-SNP)	1	1		1			H1032	214	0	2020	Select Counties in FL		2	16848	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	215	0	1	1	1	H1032_215_0	4	1			07/11/2019	2020.01	07/11/2019 04:28:25 PM Eastern Daylight Time	08/02/2019 02:56:14 AM Central Daylight Time	07/30/2019 08:40:32 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend Prime (HMO)	1	1		1			H1032	215	0	2020	Select Counties in FL		2	10178	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	216	0	1	1	1	H1032_216_0	4	1			07/11/2019	2020.01	07/11/2019 04:29:07 PM Eastern Daylight Time	08/02/2019 02:57:49 AM Central Daylight Time	07/30/2019 08:41:08 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H1032	216	0	2020	Select Counties in FL		2	1829	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	217	0	1	1	1	H1032_217_0	4	1	2	1	07/12/2019	2020.01	07/12/2019 12:25:57 PM Eastern Daylight Time	08/02/2019 02:59:25 AM Central Daylight Time	07/30/2019 08:41:44 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Reserve (HMO D-SNP)	1	1		1			H1032	217	0	2020	Select Counties in FL		2	1413	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	218	0	1	1	1	H1032_218_0	4	1			07/11/2019	2020.01	07/11/2019 04:31:34 PM Eastern Daylight Time	08/02/2019 03:01:02 AM Central Daylight Time	07/30/2019 08:42:22 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H1032	218	0	2020	Select Counties in FL		2	3014	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	219	0	1	1	1	H1032_219_0	4	1			05/29/2019	2020.01	05/29/2019 07:18:46 PM Eastern Daylight Time	08/02/2019 03:02:41 AM Central Daylight Time	07/30/2019 08:42:58 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1032	219	0	2020	Select Counties in FL		2	11050	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	220	0	1	1	1	H1032_220_0	4	1			05/29/2019	2020.01	05/29/2019 08:46:52 PM Eastern Daylight Time	08/02/2019 03:04:21 AM Central Daylight Time	07/30/2019 08:43:35 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1032	220	0	2020	Select Counties in FL		2	4815	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	221	0	1	1	1	H1032_221_0	4	1			05/29/2019	2020.01	05/29/2019 09:01:44 PM Eastern Daylight Time	08/02/2019 03:05:57 AM Central Daylight Time	07/30/2019 08:44:11 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1032	221	0	2020	Select Counties in FL		2	2890	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	222	1	1	2	1	H1032_222_1	4	1			05/29/2019	2020.01	05/29/2019 09:08:01 PM Eastern Daylight Time	08/02/2019 03:07:33 AM Central Daylight Time	07/30/2019 08:44:47 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H1032	222	1	2020	Select Counties in FL	Segment 001	2	29704	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	222	2	1	2	1	H1032_222_2	4	1			05/29/2019	2020.01	05/29/2019 09:21:09 PM Eastern Daylight Time	08/02/2019 03:09:06 AM Central Daylight Time	07/30/2019 08:45:23 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H1032	222	2	2020	Select Counties in FL	Segment 002	2	8139	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	222	3	1	2	1	H1032_222_3	4	1			05/30/2019	2020.01	05/30/2019 11:43:25 AM Eastern Daylight Time	08/02/2019 03:10:39 AM Central Daylight Time	07/30/2019 08:45:59 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H1032	222	3	2020	Select Counties in FL	Segment 003	2	4400	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	222	4	1	2	1	H1032_222_4	4	1			05/29/2019	2020.01	05/29/2019 09:52:16 PM Eastern Daylight Time	08/02/2019 03:12:13 AM Central Daylight Time	07/30/2019 08:46:35 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H1032	222	4	2020	Select Counties in FL	Segment 004	2	2427	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	223	1	1	1	1	H1032_223_1	4	1			05/29/2019	2020.01	05/29/2019 10:06:13 PM Eastern Daylight Time	08/02/2019 03:13:47 AM Central Daylight Time	07/30/2019 08:47:11 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1032	223	1	2020	Select counties in FL	Segment 001	2	7171	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	223	2	1	1	1	H1032_223_2	4	1			05/29/2019	2020.01	05/29/2019 10:21:31 PM Eastern Daylight Time	08/02/2019 03:15:22 AM Central Daylight Time	07/30/2019 08:47:48 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1032	223	2	2020	Select counties in FL	Segment 002	2	14189	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	223	3	1	1	1	H1032_223_3	4	1			05/29/2019	2020.01	05/29/2019 10:36:49 PM Eastern Daylight Time	08/02/2019 03:16:56 AM Central Daylight Time	07/30/2019 08:48:24 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1032	223	3	2020	Select counties in FL	Segment 003	2	1589	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	223	4	1	1	1	H1032_223_4	4	1			05/29/2019	2020.01	05/29/2019 10:52:40 PM Eastern Daylight Time	08/02/2019 03:18:30 AM Central Daylight Time	07/30/2019 08:49:00 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1032	223	4	2020	Select counties in FL	Segment 004	2	841	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	223	5	1	1	1	H1032_223_5	5	1			05/29/2019	2020.01	05/29/2019 11:06:29 PM Eastern Daylight Time	08/02/2019 03:20:03 AM Central Daylight Time	07/30/2019 08:49:36 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1032	223	5	2020	Select counties in FL	Segment 005	2	2996	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	224	0	1	1	1	H1032_224_0	4	1		1	07/11/2019	2020.01	07/11/2019 04:32:47 PM Eastern Daylight Time	08/02/2019 03:21:37 AM Central Daylight Time	07/30/2019 08:50:11 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Guardian (HMO C-SNP)	1	1		1			H1032	224	0	2020	Select Counties in FL		2	727	2			1	4			1E+13		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	225	0	1	1	1	H1032_225_0	4	1		1	05/29/2019	2020.01	05/29/2019 12:38:24 PM Eastern Daylight Time	08/02/2019 03:23:11 AM Central Daylight Time	07/30/2019 08:50:46 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Guardian (HMO C-SNP)	1	1		1			H1032	225	0	2020	Select Counties in FL		2	727	2			1	4			1E+13		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	226	0	1	1	1	H1032_226_0	4	1		1	07/11/2019	2020.01	07/11/2019 04:33:39 PM Eastern Daylight Time	08/02/2019 03:24:45 AM Central Daylight Time	07/30/2019 08:51:22 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Guardian (HMO C-SNP)	1	1		1			H1032	226	0	2020	Select Counties in FL		2	727	2			1	4			1E+13		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	227	0	1	1	1	H1032_227_0	4	1		1	07/12/2019	2020.01	07/12/2019 12:27:07 PM Eastern Daylight Time	08/02/2019 03:26:19 AM Central Daylight Time	07/30/2019 08:51:57 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Champion (HMO C-SNP)	1	1		1			H1032	227	0	2020	Select Counties in FL		2	727	2			1	4			1E+13		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1032	228	0	1	1	1	H1032_228_0	4	1		1	07/12/2019	2020.01	07/12/2019 12:27:41 PM Eastern Daylight Time	08/02/2019 03:27:53 AM Central Daylight Time	07/30/2019 08:52:33 PM Central Daylight Time			08/05/2019 02:31:20 PM Central Daylight Time	"WELLCARE OF FLORIDA, INC."	WellCare	www.wellcare.com/medicare	WellCare Champion (HMO C-SNP)	1	1		1			H1032	228	0	2020	Select Counties in FL		2	727	2			1	4			1E+13		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1035	2	0	1	2	1	H1035_002_0	4	1			08/02/2019	2020.01	08/02/2019 12:58:16 PM Eastern Daylight Time	08/01/2019 03:08:08 PM Eastern Daylight Time	08/01/2019 03:16:11 PM Eastern Daylight Time			08/02/2019 03:53:29 PM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	www.FHCPMedicare.com	FHCP Medicare Rx Plus (HMO-POS)	1	2		1			H1035	2	0	2020	"Flagler and Volusia Counties, FL"		2	89460	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(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	2			
H1035	6	0	1	1	1	H1035_006_0	4	1			08/02/2019	2020.01	08/02/2019 12:58:55 PM Eastern Daylight Time	08/01/2019 03:11:00 PM Eastern Daylight Time	08/01/2019 03:16:42 PM Eastern Daylight Time			08/02/2019 03:53:29 PM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	www.FHCPMedicare.com	FHCP Medicare Rx (HMO)	1	1		1			H1035	6	0	2020	"Flagler and Volusia Counties, FL"		2	65882	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(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	2			
H1035	11	0	1	1	1	H1035_011_0	6	1			08/02/2019	2020.01	08/02/2019 12:59:43 PM Eastern Daylight Time	08/01/2019 03:12:01 PM Eastern Daylight Time	08/01/2019 03:18:36 PM Eastern Daylight Time			08/02/2019 03:53:29 PM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	www.FHCPMedicare.com	FHCP Medicare Premier Plus (HMO)	1	1		1			H1035	11	0	2020	"Brevard and Seminole Counties, FL"		2	20227	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(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	2			
H1035	14	0	1	1	1	H1035_014_0	5	1			08/02/2019	2020.01	08/02/2019 01:04:24 PM Eastern Daylight Time	08/01/2019 03:12:44 PM Eastern Daylight Time	08/01/2019 03:19:15 PM Eastern Daylight Time			08/02/2019 03:53:29 PM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	www.FHCPMedicare.com	FHCP Medicare Rx Savings (HMO)	1	1		1			H1035	14	0	2020	"Volusia and Flagler Counties, FL"		2	11871	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(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	2			
H1035	16	0	1	1	1	H1035_016_0	4	1			08/02/2019	2020.01	08/02/2019 01:05:08 PM Eastern Daylight Time	08/01/2019 03:13:25 PM Eastern Daylight Time	08/01/2019 03:19:47 PM Eastern Daylight Time			08/02/2019 03:53:29 PM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	www.FHCPMedicare.com	FHCP Medicare Flagler Advantage (HMO)	1	1		1			H1035	16	0	2020	St. Johns County		2	7123	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(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	2			
H1035	17	0	1	1	1	H1035_017_0	6	1			05/31/2019	2020.01	05/31/2019 02:01:04 PM Eastern Daylight Time	08/01/2019 02:14:19 PM Eastern Daylight Time	07/30/2019 05:10:58 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	1	1		1			H1035	17	0	2020	Miami-Dade County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	18	0	1	1	1	H1035_018_0	10	1			07/17/2019	2020.01	07/17/2019 02:52:45 PM Eastern Daylight Time	08/01/2019 02:15:26 PM Eastern Daylight Time	07/30/2019 05:11:48 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	1	1		1			H1035	18	0	2020	Palm Beach County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	19	0	1	1	1	H1035_019_0	6	1			05/31/2019	2020.01	05/31/2019 02:03:11 PM Eastern Daylight Time	08/01/2019 02:16:39 PM Eastern Daylight Time	07/30/2019 05:12:37 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	1	1		1			H1035	19	0	2020	"South, Central and NE counties"		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	20	0	1	1	1	H1035_020_0	6	1			05/31/2019	2020.01	05/31/2019 02:05:52 PM Eastern Daylight Time	08/01/2019 02:17:47 PM Eastern Daylight Time	07/30/2019 05:13:27 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	1	1		1			H1035	20	0	2020	"Orange, Osceola & Seminole counties"		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	21	0	1	1	1	H1035_021_0	6	1			05/31/2019	2020.01	05/31/2019 02:06:52 PM Eastern Daylight Time	08/01/2019 02:18:56 PM Eastern Daylight Time	07/30/2019 05:14:17 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic (HMO)	1	1		1			H1035	21	0	2020	"Hillsborough, Hernando, Pasco, & Polk counties"		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	22	0	1	1	1	H1035_022_0	9	1			07/17/2019	2020.01	07/17/2019 02:46:15 PM Eastern Daylight Time	08/01/2019 02:20:03 PM Eastern Daylight Time	07/30/2019 05:15:06 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic Plus (HMO)	1	1		1			H1035	22	0	2020	Palm Beach County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	23	0	1	1	1	H1035_023_0	8	1			07/17/2019	2020.01	07/17/2019 02:46:43 PM Eastern Daylight Time	08/01/2019 02:21:12 PM Eastern Daylight Time	07/30/2019 05:15:55 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Classic Plus (HMO)	1	1		1			H1035	23	0	2020	Hillsborough and Polk counties		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	24	0	1	1	1	H1035_024_0	8	1			07/17/2019	2020.01	07/17/2019 02:47:15 PM Eastern Daylight Time	08/01/2019 02:22:21 PM Eastern Daylight Time	07/30/2019 05:16:45 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	1	1		1			H1035	24	0	2020	Miami-Dade County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	25	0	1	1	1	H1035_025_0	8	1			07/17/2019	2020.01	07/17/2019 02:47:50 PM Eastern Daylight Time	08/01/2019 02:23:36 PM Eastern Daylight Time	07/30/2019 05:17:34 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	1	1		1			H1035	25	0	2020	Broward County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	26	0	1	1	1	H1035_026_0	8	1			07/17/2019	2020.01	07/17/2019 02:48:17 PM Eastern Daylight Time	08/01/2019 02:24:43 PM Eastern Daylight Time	07/30/2019 05:18:23 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	1	1		1			H1035	26	0	2020	Orange & Osceola Counties		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	27	0	1	1	1	H1035_027_0	9	1	2	1	07/15/2019	2020.01	07/15/2019 11:25:42 AM Eastern Daylight Time	08/01/2019 02:25:51 PM Eastern Daylight Time	07/30/2019 05:19:12 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO D-SNP)	1	1		1			H1035	27	0	2020	Miami-Dade County		2		2			1	3		1		1	FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	28	0	1	1	1	H1035_028_0	8	1	2	1	07/15/2019	2020.01	07/15/2019 11:25:17 AM Eastern Daylight Time	08/01/2019 02:26:58 PM Eastern Daylight Time	07/30/2019 05:20:01 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO D-SNP)	1	1		1			H1035	28	0	2020	Broward and Palm Beach counties		2		2			1	3		1		1	FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	29	0	1	1	1	H1035_029_0	8	1	2	1	07/15/2019	2020.01	07/15/2019 11:27:00 AM Eastern Daylight Time	08/01/2019 02:28:07 PM Eastern Daylight Time	07/30/2019 05:20:50 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO D-SNP)	1	1		1			H1035	29	0	2020	Orange & Osceola Counties		2		2			1	3		1		1	FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	30	0	1	1	1	H1035_030_0	8	1	2	1	07/15/2019	2020.01	07/15/2019 11:28:32 AM Eastern Daylight Time	08/01/2019 02:29:15 PM Eastern Daylight Time	07/30/2019 05:21:39 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO D-SNP)	1	1		1			H1035	30	0	2020	Hillsborough and Polk counties		2		2			1	3		1		1	FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	31	0	1	1	1	H1035_031_0	8	1	2	1	07/15/2019	2020.01	07/15/2019 11:33:29 AM Eastern Daylight Time	08/01/2019 02:30:20 PM Eastern Daylight Time	07/30/2019 05:22:28 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO D-SNP)	1	1		1			H1035	31	0	2020	Clay & Duval Counties		2		2			1	3		1		1	FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	32	0	1	1	1	H1035_032_0	8	1	2	1	07/15/2019	2020.01	07/15/2019 11:34:26 AM Eastern Daylight Time	08/01/2019 02:31:27 PM Eastern Daylight Time	07/30/2019 05:23:17 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Complete (HMO D-SNP)	1	1		1			H1035	32	0	2020	Pinellas County		2		2			1	3		1		1	FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	33	0	1	1	1	H1035_033_0	8	1			07/17/2019	2020.01	07/17/2019 02:48:44 PM Eastern Daylight Time	08/01/2019 02:32:33 PM Eastern Daylight Time	07/30/2019 05:24:14 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	1	1		1			H1035	33	0	2020	Clay & Duval Counties		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	34	0	1	1	1	H1035_034_0	8	1			08/02/2019	2020.01	08/02/2019 08:49:27 AM Eastern Daylight Time	08/01/2019 02:33:39 PM Eastern Daylight Time	07/30/2019 05:25:05 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Premier (HMO)	1	1		1			H1035	34	0	2020	Pinellas County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	35	0	1	1	1	H1035_035_0	7	1			05/31/2019	2020.01	05/31/2019 03:32:53 PM Eastern Daylight Time	08/01/2019 02:34:49 PM Eastern Daylight Time	07/30/2019 05:25:58 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Saver (HMO)	1	1		1			H1035	35	0	2020	Broward County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	37	0	1	1	1	H1035_037_0	7	1			05/31/2019	2020.01	05/31/2019 03:33:39 PM Eastern Daylight Time	08/01/2019 02:35:56 PM Eastern Daylight Time	07/30/2019 05:26:51 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Saver (HMO)	1	1		1			H1035	37	0	2020	"Hillsborough, Pinellas & Polk Counties"		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	38	0	1	1	1	H1035_038_0	6	1			05/31/2019	2020.01	05/31/2019 03:34:30 PM Eastern Daylight Time	08/01/2019 02:37:01 PM Eastern Daylight Time	07/30/2019 05:27:44 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Saver (HMO)	1	1		1			H1035	38	0	2020	Orange & Osceola Counties		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	2			
H1035	39	0	1	1	1	H1035_039_0	7	1			06/05/2019	2020.01	06/05/2019 01:13:26 PM Eastern Daylight Time	08/01/2019 02:38:07 PM Eastern Daylight Time	07/30/2019 05:28:38 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	FloridaBlue.com/medicare	BlueMedicare Saver (HMO)	1	1		1			H1035	39	0	2020	Miami-Dade		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	1	1	7a;7d;	
H1035	40	0	1	1	1	H1035_040_0	4	1			08/02/2019	2020.01	08/02/2019 01:05:49 PM Eastern Daylight Time	08/01/2019 03:14:02 PM Eastern Daylight Time	08/01/2019 03:20:32 PM Eastern Daylight Time			08/02/2019 03:53:29 PM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	www.fhcpmedicare.com	FHCP Medicare Premier Advantage (HMO)	1	1		1			H1035	40	0	2020	Brevard and Seminole		2	3569	2			2						www.fhcpmedicare.com	www.fhcpmedicare.com	www.fhcpmedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(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	2			
H1035	801	0	1	1	1	H1035_801_0	1	1			05/17/2019	2020.01	05/17/2019 04:41:02 PM Eastern Daylight Time					05/24/2019 05:27:03 PM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	www.FHCPMedicare.com	GRPMED (HMO)	1	1		1			H1035	801	0	2020	Florida		1	500	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;11a;11b;11c;12;16b;	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;12;16b;	1					2				
H1035	802	0	1	1	1	H1035_802_0	1	1			05/17/2019	2020.01	05/17/2019 04:41:31 PM Eastern Daylight Time					05/24/2019 05:27:03 PM Eastern Daylight Time	"HEALTH OPTIONS, INC."	Florida Blue HMO	www.FHCPMedicare.com	GRPMED+ (HMO)	1	1		1			H1035	802	0	2020	Florida		1	500	2			2						www.FHCPMedicare.com	www.FHCPMedicare.com	www.FHCPMedicare.com	(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(833)866-6559		(386)615-5051		(855)462-3427		(386)676-7110		(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;11a;11b;11c;12;16b;	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;12;16b;	1					2				
H1036	25	0	1	1	1	H1036_025_0	3	1			08/01/2019	2020.01	08/01/2019 02:40:50 PM Eastern Daylight Time	08/04/2019 04:48:53 PM Eastern Daylight Time	08/02/2019 01:17:58 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-025 (HMO)	1	1		1			H1036	25	0	2020	Tampa Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	44	0	1	1	1	H1036_044_0	4	1			08/01/2019	2020.01	08/01/2019 03:53:49 PM Eastern Daylight Time	08/04/2019 05:02:11 PM Eastern Daylight Time	08/02/2019 01:17:58 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-044 (HMO)	1	1		1			H1036	44	0	2020	Flagler and Volusia counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	54	0	1	1	1	H1036_054_0	3	1			08/01/2019	2020.01	08/01/2019 05:39:15 PM Eastern Daylight Time	08/04/2019 03:42:18 PM Eastern Daylight Time	08/02/2019 01:17:58 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-054C (HMO)	1	1		1			H1036	54	0	2020	Miami-Dade County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	56	0	1	1	1	H1036_056_0	2	1			07/15/2019	2020.01	07/15/2019 04:11:47 PM Eastern Daylight Time	05/31/2019 02:26:48 PM Eastern Daylight Time				07/16/2019 06:32:45 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-056 (HMO)	1	1		1			H1036	56	0	2020	Flagler and Volusia counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1036	62	0	1	1	1	H1036_062_0	4	1			08/01/2019	2020.01	08/01/2019 05:40:01 PM Eastern Daylight Time	08/04/2019 04:13:29 PM Eastern Daylight Time	08/02/2019 01:17:58 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-062C (HMO)	1	1		1			H1036	62	0	2020	Palm Beach County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	65	0	1	1	1	H1036_065_0	4	1			08/01/2019	2020.01	08/01/2019 05:40:29 PM Eastern Daylight Time	08/04/2019 04:11:47 PM Eastern Daylight Time	08/02/2019 01:17:59 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-065C (HMO)	1	1		1			H1036	65	0	2020	Broward County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	68	0	1	1	1	H1036_068_0	4	1			08/01/2019	2020.01	08/01/2019 03:55:13 PM Eastern Daylight Time	08/04/2019 04:03:06 PM Eastern Daylight Time	08/02/2019 01:17:59 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-068 (HMO)	1	1		1			H1036	68	0	2020	Jacksonville Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	74	0	1	1	1	H1036_074_0	3	1			08/01/2019	2020.01	08/01/2019 02:41:29 PM Eastern Daylight Time	08/04/2019 04:01:51 PM Eastern Daylight Time	08/02/2019 01:17:59 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-074 (HMO)	1	1		1			H1036	74	0	2020	Manatee County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	77	0	1	1	1	H1036_077_0	3	1	2	1	07/15/2019	2020.01	07/15/2019 03:20:58 PM Eastern Daylight Time	08/04/2019 03:56:10 PM Eastern Daylight Time	08/02/2019 01:17:59 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP)	1	1		1			H1036	77	0	2020	Miami-Dade County		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	81	0	1	1	1	H1036_081_0	4	1			08/01/2019	2020.01	08/01/2019 05:42:58 PM Eastern Daylight Time	08/04/2019 05:00:43 PM Eastern Daylight Time	08/02/2019 01:17:59 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-081D (HMO)	1	1		1			H1036	81	0	2020	"Baker, Duval and Nassau counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	102	0	1	1	1	H1036_102_0	6	1	2	1	07/19/2019	2020.01	07/19/2019 03:12:26 PM Eastern Daylight Time	08/04/2019 04:17:01 PM Eastern Daylight Time	08/02/2019 01:17:59 PM Eastern Daylight Time			08/05/2019 11:15:13 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP)	1	1		1			H1036	102	0	2020	Tampa Metro Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	103	0	1	1	1	H1036_103_0	3	1	2	1	07/15/2019	2020.01	07/15/2019 03:21:33 PM Eastern Daylight Time	08/04/2019 03:52:41 PM Eastern Daylight Time	08/02/2019 01:17:59 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-103A (HMO D-SNP)	1	1		1			H1036	103	0	2020	Broward County		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	104	0	1	1	1	H1036_104_0	3	1	2	1	07/15/2019	2020.01	07/15/2019 03:22:09 PM Eastern Daylight Time	08/04/2019 03:59:41 PM Eastern Daylight Time	08/02/2019 01:18:00 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-104A (HMO D-SNP)	1	1		1			H1036	104	0	2020	Palm Beach County		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	119	0	1	1	1	H1036_119_0	2	1			07/15/2019	2020.01	07/15/2019 03:40:57 PM Eastern Daylight Time	05/31/2019 02:26:16 PM Eastern Daylight Time				07/16/2019 05:23:41 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-119 (HMO)	1	1		1			H1036	119	0	2020	Tampa Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1036	121	0	1	1	1	H1036_121_0	3	1		1	08/02/2019	2020.01	08/02/2019 03:11:31 PM Eastern Daylight Time	08/04/2019 03:38:46 PM Eastern Daylight Time	08/02/2019 01:18:00 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes (HMO C-SNP)	1	1		1			H1036	121	0	2020	Broward County		2		2			1	4			1E+13		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	130	0	1	1	1	H1036_130_0	3	1		1	08/01/2019	2020.01	08/01/2019 05:41:29 PM Eastern Daylight Time	08/04/2019 03:40:33 PM Eastern Daylight Time	08/02/2019 01:18:00 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes (HMO C-SNP)	1	1		1			H1036	130	0	2020	Palm Beach County		2		2			1	4			1E+13		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	137	0	1	1	1	H1036_137_0	3	1			07/31/2019	2020.01	07/31/2019 11:44:38 AM Eastern Daylight Time	08/04/2019 04:37:22 PM Eastern Daylight Time	08/02/2019 01:18:00 PM Eastern Daylight Time			08/05/2019 11:28:04 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-137 (HMO)	1	1		1			H1036	137	0	2020	Charlotte Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	140	0	1	1	1	H1036_140_0	4	1			08/01/2019	2020.01	08/01/2019 02:45:19 PM Eastern Daylight Time	08/04/2019 04:04:17 PM Eastern Daylight Time	08/02/2019 01:18:00 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-140 (HMO)	1	1		1			H1036	140	0	2020	Citrus County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	143	0	1	1	1	H1036_143_0	4	1			08/01/2019	2020.01	08/01/2019 02:55:20 PM Eastern Daylight Time	08/04/2019 04:05:31 PM Eastern Daylight Time	08/02/2019 01:18:00 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-143 (HMO)	1	1		1			H1036	143	0	2020	Select counties of Panhandle East		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	146	0	1	1	1	H1036_146_0	4	1			08/01/2019	2020.01	08/01/2019 03:11:53 PM Eastern Daylight Time	08/04/2019 04:06:45 PM Eastern Daylight Time	08/02/2019 01:18:00 PM Eastern Daylight Time			08/05/2019 11:15:13 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-146 (HMO)	1	1		1			H1036	146	0	2020	"Orange, Osceola and Seminole counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	151	0	1	1	1	H1036_151_0	5	1			07/15/2019	2020.01	07/15/2019 04:00:08 PM Eastern Daylight Time	08/03/2019 10:37:01 AM Eastern Daylight Time	08/02/2019 01:18:01 PM Eastern Daylight Time			08/05/2019 12:14:58 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-151 (HMO)	1	1		1			H1036	151	0	2020	Jackson Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	153	0	1	1	1	H1036_153_0	5	1			08/01/2019	2020.01	08/01/2019 07:07:40 PM Eastern Daylight Time	08/04/2019 04:42:22 PM Eastern Daylight Time	08/02/2019 01:18:01 PM Eastern Daylight Time			08/05/2019 11:31:18 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-153 (HMO)	1	1		1			H1036	153	0	2020	"Clackamas, Multnomah and Washington counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	156	0	1	1	1	H1036_156_0	4	1		1	08/01/2019	2020.01	08/01/2019 03:56:56 PM Eastern Daylight Time	08/04/2019 04:08:02 PM Eastern Daylight Time	08/02/2019 01:18:01 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes (HMO C-SNP)	1	1		1			H1036	156	0	2020	Flagler and Volusia counties		2		2			1	4			1E+13		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	157	0	1	1	1	H1036_157_0	3	1			08/01/2019	2020.01	08/01/2019 03:57:59 PM Eastern Daylight Time	08/04/2019 04:10:39 PM Eastern Daylight Time	08/02/2019 01:18:01 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-157 (HMO)	1	1		1			H1036	157	0	2020	Flagler and Volusia counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	160	0	1	1	1	H1036_160_0	3	1		1	08/01/2019	2020.01	08/01/2019 03:13:48 PM Eastern Daylight Time	08/04/2019 04:09:23 PM Eastern Daylight Time	08/02/2019 01:18:01 PM Eastern Daylight Time			08/05/2019 11:15:13 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes (HMO C-SNP)	1	1		1			H1036	160	0	2020	Tampa Metro Area		2		2			1	4			1E+13		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	167	0	1	1	1	H1036_167_0	7	1	2	1	07/19/2019	2020.01	07/19/2019 03:09:47 PM Eastern Daylight Time	08/04/2019 04:29:15 PM Eastern Daylight Time	08/02/2019 01:18:01 PM Eastern Daylight Time			08/05/2019 11:28:04 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)	1	1		1			H1036	167	0	2020	Charlotte Metro Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	168	0	1	1	1	H1036_168_0	2	1	2	1	05/30/2019	2020.01	05/30/2019 04:46:44 PM Eastern Daylight Time	08/04/2019 04:30:03 PM Eastern Daylight Time	08/02/2019 01:18:01 PM Eastern Daylight Time			08/05/2019 11:28:04 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-168 (HMO D-SNP)	1	1		1			H1036	168	0	2020	Greensboro / Winston-Salem Metro Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	171	0	1	1	1	H1036_171_0	5	1			07/15/2019	2020.01	07/15/2019 04:01:32 PM Eastern Daylight Time	08/03/2019 10:56:07 AM Eastern Daylight Time	08/02/2019 01:18:02 PM Eastern Daylight Time			08/05/2019 12:14:58 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-171 (HMO)	1	1		1			H1036	171	0	2020	Gulf Coast Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	175	0	1	1	1	H1036_175_0	4	1		1	08/01/2019	2020.01	08/01/2019 05:50:34 PM Eastern Daylight Time	08/04/2019 04:11:57 PM Eastern Daylight Time	08/02/2019 01:18:02 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes (HMO C-SNP)	1	1		1			H1036	175	0	2020	Jacksonville Area		2		2			1	4			1E+13		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	199	0	1	1	1	H1036_199_0	5	1			08/01/2019	2020.01	08/01/2019 05:41:48 PM Eastern Daylight Time	08/04/2019 03:45:45 PM Eastern Daylight Time	08/02/2019 01:18:02 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-199 (HMO)	1	1		1			H1036	199	0	2020	Palm Beach County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	209	0	1	1	1	H1036_209_0	2	1	2	1	05/25/2019	2020.01	05/25/2019 12:07:24 PM Eastern Daylight Time	08/04/2019 04:27:16 PM Eastern Daylight Time	08/02/2019 01:18:02 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP)	1	1		1			H1036	209	0	2020	Flagler and Volusia counties		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	210	0	1	1	1	H1036_210_0	2	1	2	1	05/25/2019	2020.01	05/25/2019 12:08:29 PM Eastern Daylight Time	08/04/2019 04:31:17 PM Eastern Daylight Time	08/02/2019 01:18:02 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP)	1	1		1			H1036	210	0	2020	Jacksonville Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	213	0	1	1	1	H1036_213_0	2	1	2	1	05/22/2019	2020.01	05/22/2019 02:20:07 PM Eastern Daylight Time	08/04/2019 04:23:18 PM Eastern Daylight Time	08/02/2019 01:18:02 PM Eastern Daylight Time			08/05/2019 11:15:13 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP)	1	1		1			H1036	213	0	2020	Greater Orlando		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	214	0	1	1	1	H1036_214_0	2	1	2	1	05/25/2019	2020.01	05/25/2019 11:40:44 AM Eastern Daylight Time	08/04/2019 04:35:16 PM Eastern Daylight Time	08/02/2019 01:18:02 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP)	1	1		1			H1036	214	0	2020	"Bay, Escambia, Santa Rosa and Walton counties"		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	215	0	1	1	1	H1036_215_0	4	1			08/01/2019	2020.01	08/01/2019 02:56:45 PM Eastern Daylight Time	08/04/2019 04:13:13 PM Eastern Daylight Time	08/02/2019 01:18:03 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-215 (HMO)	1	1		1			H1036	215	0	2020	Sarasota County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	217	0	1	1	1	H1036_217_0	4	1			08/01/2019	2020.01	08/01/2019 02:58:01 PM Eastern Daylight Time	08/04/2019 04:51:25 PM Eastern Daylight Time	08/02/2019 01:18:03 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-217 (HMO)	1	1		1			H1036	217	0	2020	"Charlotte, Collier and Lee counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	219	0	1	1	1	H1036_219_0	4	1			07/15/2019	2020.01	07/15/2019 03:26:40 PM Eastern Daylight Time	08/04/2019 04:46:53 PM Eastern Daylight Time	08/02/2019 01:18:03 PM Eastern Daylight Time			08/05/2019 12:13:05 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-219 (HMO)	1	1		1			H1036	219	0	2020	Deschutes and Jefferson counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	222	0	1	1	1	H1036_222_0	5	1	2	1	08/01/2019	2020.01	08/01/2019 12:18:48 PM Eastern Daylight Time	08/03/2019 11:09:38 AM Eastern Daylight Time	08/02/2019 01:18:03 PM Eastern Daylight Time			08/05/2019 12:14:58 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-222 (HMO D-SNP)	1	1		1			H1036	222	0	2020	Select Counties in Mississippi		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	223	0	1	1	1	H1036_223_0	5	1			07/15/2019	2020.01	07/15/2019 04:02:51 PM Eastern Daylight Time	08/03/2019 10:58:09 AM Eastern Daylight Time	08/02/2019 01:18:03 PM Eastern Daylight Time			08/05/2019 12:14:58 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-223 (HMO)	1	1		1			H1036	223	0	2020	DeSoto County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	226	0	1	1	1	H1036_226_0	2	1	2	1	05/31/2019	2020.01	05/31/2019 04:03:22 PM Eastern Daylight Time	08/04/2019 04:03:14 PM Eastern Daylight Time	08/02/2019 01:18:03 PM Eastern Daylight Time			08/05/2019 11:10:23 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP)	1	1		1			H1036	226	0	2020	"Glades, Martin, Okeechobee and St. Lucie counties"		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	229	0	1	1	1	H1036_229_0	4	1			08/01/2019	2020.01	08/01/2019 06:50:08 PM Eastern Daylight Time	08/04/2019 03:47:29 PM Eastern Daylight Time	08/02/2019 01:18:03 PM Eastern Daylight Time			08/05/2019 11:10:23 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-229 (HMO)	1	1		1			H1036	229	0	2020	"Glades, Martin, Okeechobee and St. Lucie counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	230	0	1	1	1	H1036_230_0	4	1			08/01/2019	2020.01	08/01/2019 03:00:03 PM Eastern Daylight Time	08/04/2019 04:14:29 PM Eastern Daylight Time	08/02/2019 01:18:03 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-230 (HMO)	1	1		1			H1036	230	0	2020	"Hardee, Highlands and Polk counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	231	0	1	1	1	H1036_231_0	6	1	2	1	07/19/2019	2020.01	07/19/2019 03:07:55 PM Eastern Daylight Time	08/04/2019 04:19:33 PM Eastern Daylight Time	08/02/2019 01:18:04 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-231 (HMO D-SNP)	1	1		1			H1036	231	0	2020	"Hardee, Highlands and Polk counties"		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	233	0	1	1	1	H1036_233_0	3	1			08/01/2019	2020.01	08/01/2019 06:42:34 PM Eastern Daylight Time	08/04/2019 04:38:11 PM Eastern Daylight Time	08/02/2019 01:18:04 PM Eastern Daylight Time			08/05/2019 11:28:04 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-233 (HMO)	1	1		1			H1036	233	0	2020	Raleigh Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	234	0	1	1	1	H1036_234_0	3	1		1	08/01/2019	2020.01	08/01/2019 07:26:35 PM Eastern Daylight Time	08/04/2019 06:45:39 PM Eastern Daylight Time	08/02/2019 01:18:04 PM Eastern Daylight Time			08/05/2019 11:11:35 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Community HMO Diabetes and Heart (HMO C-SNP)	1	1		1			H1036	234	0	2020	Jefferson County		2		2			1	4			10		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	235	0	1	1	1	H1036_235_0	7	1	2	1	07/19/2019	2020.01	07/19/2019 03:09:43 PM Eastern Daylight Time	08/04/2019 06:47:33 PM Eastern Daylight Time	08/02/2019 01:18:04 PM Eastern Daylight Time			08/05/2019 11:11:35 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Community HMO SNP-DE (HMO D-SNP)	1	1		1			H1036	235	0	2020	Jefferson County		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	236	0	1	1	1	H1036_236_0	3	1			08/01/2019	2020.01	08/01/2019 07:29:35 PM Eastern Daylight Time	08/04/2019 06:43:36 PM Eastern Daylight Time	08/02/2019 01:18:04 PM Eastern Daylight Time			08/05/2019 11:11:35 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Community (HMO)	1	1		1			H1036	236	0	2020	Jefferson County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	237	1	1	1	1	H1036_237_1	4	1			08/01/2019	2020.01	08/01/2019 05:42:10 PM Eastern Daylight Time	08/04/2019 03:49:11 PM Eastern Daylight Time	08/02/2019 01:18:04 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-237 (HMO)	1	1		1			H1036	237	1	2020	South Florida: Broward or Miami-Dade	South Florida- Broward	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	237	2	1	1	1	H1036_237_2	4	1			08/02/2019	2020.01	08/02/2019 03:22:03 PM Eastern Daylight Time	08/04/2019 03:44:01 PM Eastern Daylight Time	08/02/2019 01:18:04 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-237 (HMO)	1	1		1			H1036	237	2	2020	South Florida: Broward or Miami-Dade	South Florida- Miami-Dade	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	241	0	1	1	1	H1036_241_0	2	1	2	1	05/25/2019	2020.01	05/25/2019 12:11:25 PM Eastern Daylight Time	08/04/2019 04:25:17 PM Eastern Daylight Time	08/02/2019 01:18:04 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-241 (HMO D-SNP)	1	1		1			H1036	241	0	2020	Flagler and Volusia counties		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	243	0	1	1	1	H1036_243_0	2	1	2	1	05/25/2019	2020.01	05/25/2019 12:12:33 PM Eastern Daylight Time	08/04/2019 04:29:16 PM Eastern Daylight Time	08/02/2019 01:18:05 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-243 (HMO D-SNP)	1	1		1			H1036	243	0	2020	Jacksonville Area		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	245	0	1	1	1	H1036_245_0	3	1	2	1	07/15/2019	2020.01	07/15/2019 03:55:02 PM Eastern Daylight Time	08/04/2019 04:33:15 PM Eastern Daylight Time	08/02/2019 01:18:05 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-245 (HMO D-SNP)	1	1		1			H1036	245	0	2020	"Bay, Escambia, Santa Rosa and Walton counties"		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	247	0	1	1	1	H1036_247_0	2	1	2	1	05/24/2019	2020.01	05/24/2019 01:41:00 PM Eastern Daylight Time	08/04/2019 04:21:20 PM Eastern Daylight Time	08/02/2019 01:18:05 PM Eastern Daylight Time			08/05/2019 11:15:13 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-247 (HMO D-SNP)	1	1		1			H1036	247	0	2020	Greater Orlando		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	249	0	1	1	1	H1036_249_0	2	1	2	1	05/25/2019	2020.01	05/25/2019 11:07:00 AM Eastern Daylight Time	08/04/2019 04:01:28 PM Eastern Daylight Time	08/02/2019 01:18:05 PM Eastern Daylight Time			08/05/2019 11:10:23 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-249 (HMO D-SNP)	1	1		1			H1036	249	0	2020	"Glades, Martin, Okeechobee and St. Lucie counties"		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	251	0	1	1	1	H1036_251_0	2	1	2	1	05/22/2019	2020.01	05/22/2019 02:25:30 PM Eastern Daylight Time	08/04/2019 04:15:45 PM Eastern Daylight Time	08/02/2019 01:18:05 PM Eastern Daylight Time			08/05/2019 11:15:13 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-251 (HMO D-SNP)	1	1		1			H1036	251	0	2020	Tampa Metro Area		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	253	0	1	1	1	H1036_253_0	6	1	2	1	07/19/2019	2020.01	07/19/2019 03:11:18 PM Eastern Daylight Time	08/04/2019 04:18:17 PM Eastern Daylight Time	08/02/2019 01:18:05 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-253 (HMO D-SNP)	1	1		1			H1036	253	0	2020	"Hardee, Highlands and Polk counties"		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	255	0	1	1	1	H1036_255_0	3	1	2	1	07/15/2019	2020.01	07/15/2019 03:23:16 PM Eastern Daylight Time	08/04/2019 03:50:56 PM Eastern Daylight Time	08/02/2019 01:18:05 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-255 (HMO D-SNP)	1	1		1			H1036	255	0	2020	Broward County		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	257	0	1	1	1	H1036_257_0	3	1	2	1	07/15/2019	2020.01	07/15/2019 03:24:04 PM Eastern Daylight Time	08/04/2019 03:54:26 PM Eastern Daylight Time	08/02/2019 01:18:05 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-257 (HMO D-SNP)	1	1		1			H1036	257	0	2020	Miami-Dade County		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	259	0	1	1	1	H1036_259_0	2	1	2	1	05/25/2019	2020.01	05/25/2019 03:24:04 PM Eastern Daylight Time	08/04/2019 03:57:53 PM Eastern Daylight Time	08/02/2019 01:18:06 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-259 (HMO D-SNP)	1	1		1			H1036	259	0	2020	Palm Beach County		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	261	0	1	1	1	H1036_261_0	2	1	2	1	05/24/2019	2020.01	05/24/2019 01:50:58 PM Eastern Daylight Time	08/04/2019 04:37:17 PM Eastern Daylight Time	08/02/2019 01:18:06 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-261 (HMO D-SNP)	1	1		1			H1036	261	0	2020	Sarasota County		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	262	0	1	1	1	H1036_262_0	2	1	2	1	05/22/2019	2020.01	05/22/2019 01:27:18 PM Eastern Daylight Time	08/04/2019 04:39:13 PM Eastern Daylight Time	08/02/2019 01:18:06 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-262 (HMO D-SNP)	1	1		1			H1036	262	0	2020	Sarasota County		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	263	0	1	1	1	H1036_263_0	3	1			08/01/2019	2020.01	08/01/2019 06:45:33 PM Eastern Daylight Time	08/04/2019 04:44:48 PM Eastern Daylight Time	08/02/2019 01:18:06 PM Eastern Daylight Time			08/05/2019 11:28:04 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-263 (HMO)	1	1		1			H1036	263	0	2020	Charlotte Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	264	0	1	1	1	H1036_264_0	2	1			05/26/2019	2020.01	05/26/2019 09:48:51 AM Eastern Daylight Time	08/04/2019 04:04:56 PM Eastern Daylight Time	08/02/2019 01:18:06 PM Eastern Daylight Time			08/05/2019 11:10:25 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Value Plus H1036-264 (HMO)	1	1		1			H1036	264	0	2020	Miami-Dade County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	265	1	1	1	1	H1036_265_1	3	1			08/01/2019	2020.01	08/01/2019 03:14:59 PM Eastern Daylight Time	08/04/2019 04:46:22 PM Eastern Daylight Time	08/02/2019 01:18:06 PM Eastern Daylight Time			08/05/2019 11:15:13 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-265 (HMO)	1	1		1			H1036	265	1	2020	Tampa Metro Area	Tampa Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	265	2	1	1	1	H1036_265_2	3	1			08/01/2019	2020.01	08/01/2019 03:16:41 PM Eastern Daylight Time	08/04/2019 04:42:30 PM Eastern Daylight Time	08/02/2019 01:18:06 PM Eastern Daylight Time			08/05/2019 11:15:13 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-265 (HMO)	1	1		1			H1036	265	2	2020	Tampa Metro Area	Manatee County	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	266	0	1	1	1	H1036_266_0	3	1			08/01/2019	2020.01	08/01/2019 03:03:09 PM Eastern Daylight Time	08/04/2019 04:41:09 PM Eastern Daylight Time	08/02/2019 01:18:07 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-266 (HMO)	1	1		1			H1036	266	0	2020	Citrus County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	267	0	1	1	1	H1036_267_0	3	1			08/01/2019	2020.01	08/01/2019 03:05:22 PM Eastern Daylight Time	08/04/2019 04:52:42 PM Eastern Daylight Time	08/02/2019 01:18:07 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-267 (HMO)	1	1		1			H1036	267	0	2020	Sarasota County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	268	0	1	1	1	H1036_268_0	3	1			08/01/2019	2020.01	08/01/2019 03:06:18 PM Eastern Daylight Time	08/04/2019 04:43:45 PM Eastern Daylight Time	08/02/2019 01:18:07 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-268 (HMO)	1	1		1			H1036	268	0	2020	"Hardee, Highlands and Polk counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	269	0	1	1	1	H1036_269_0	3	1			08/01/2019	2020.01	08/01/2019 03:19:25 PM Eastern Daylight Time	08/04/2019 04:45:04 PM Eastern Daylight Time	08/02/2019 01:18:07 PM Eastern Daylight Time			08/05/2019 11:15:13 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-269 (HMO)	1	1		1			H1036	269	0	2020	Greater Orlando		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	270	0	1	1	1	H1036_270_0	3	1			08/01/2019	2020.01	08/01/2019 03:58:58 PM Eastern Daylight Time	08/04/2019 04:50:09 PM Eastern Daylight Time	08/02/2019 01:18:07 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-270 (HMO)	1	1		1			H1036	270	0	2020	Jacksonville Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	271	0	1	1	1	H1036_271_0	3	1			08/01/2019	2020.01	08/01/2019 03:10:23 PM Eastern Daylight Time	08/04/2019 04:47:37 PM Eastern Daylight Time	08/02/2019 01:18:07 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-271 (HMO)	1	1		1			H1036	271	0	2020	Select counties of Panhandle East		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	275	1	1	1	1	H1036_275_1	3	1			08/01/2019	2020.01	08/01/2019 06:48:41 PM Eastern Daylight Time	08/04/2019 04:56:31 PM Eastern Daylight Time	08/02/2019 01:18:07 PM Eastern Daylight Time			08/05/2019 11:28:04 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-275 (HMO)	1	1		1			H1036	275	1	2020	Greensboro - Winston Salem Metro Area	Greensboro - Winston Salem	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	275	2	1	1	1	H1036_275_2	3	1			08/01/2019	2020.01	08/01/2019 06:51:45 PM Eastern Daylight Time	08/04/2019 05:17:45 PM Eastern Daylight Time	08/02/2019 01:18:07 PM Eastern Daylight Time			08/05/2019 11:28:04 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-275 (HMO)	1	1		1			H1036	275	2	2020	Greensboro - Winston Salem Metro Area	Greensboro - Winston Salem	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	276	0	1	1	1	H1036_276_0	2	1	2	1	05/30/2019	2020.01	05/30/2019 04:50:22 PM Eastern Daylight Time	08/04/2019 04:48:03 PM Eastern Daylight Time	08/02/2019 01:18:08 PM Eastern Daylight Time			08/05/2019 11:28:04 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-276 (HMO D-SNP)	1	1		1			H1036	276	0	2020	Raleigh Metro Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	277	0	1	1	1	H1036_277_0	4	1			08/01/2019	2020.01	08/01/2019 03:21:01 PM Eastern Daylight Time	08/04/2019 04:55:18 PM Eastern Daylight Time	08/02/2019 01:18:08 PM Eastern Daylight Time			08/05/2019 11:15:13 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-277 (HMO)	1	1		1			H1036	277	0	2020	"Lake, Marion and Sumter counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	278	0	1	1	1	H1036_278_0	3	1			08/01/2019	2020.01	08/01/2019 03:13:08 PM Eastern Daylight Time	08/04/2019 04:54:02 PM Eastern Daylight Time	08/02/2019 01:18:08 PM Eastern Daylight Time			08/05/2019 11:11:15 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-278 (HMO)	1	1		1			H1036	278	0	2020	"Charlotte, Collier and Lee counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	279	0	1	1	1	H1036_279_0	2	1			07/15/2019	2020.01	07/15/2019 04:28:07 PM Eastern Daylight Time	05/31/2019 11:30:04 AM Eastern Daylight Time				07/16/2019 05:55:27 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1036-279 (HMO)	1	1		1			H1036	279	0	2020	Palm Beach County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1036	280	0	1	1	1	H1036_280_0	3	1	2	1	07/19/2019	2020.01	07/19/2019 03:08:48 PM Eastern Daylight Time	08/04/2019 04:08:22 PM Eastern Daylight Time	08/02/2019 01:18:08 PM Eastern Daylight Time			08/05/2019 11:10:23 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Fully Integrated H1036-280 (HMO D-SNP)	1	1		1			H1036	280	0	2020	Miami-Dade County		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	281	0	1	1	1	H1036_281_0	3	1	2	1	07/19/2019	2020.01	07/19/2019 03:10:46 PM Eastern Daylight Time	08/04/2019 04:10:04 PM Eastern Daylight Time	08/02/2019 01:18:08 PM Eastern Daylight Time			08/05/2019 11:10:23 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Fully Integrated H1036-281 (HMO D-SNP)	1	1		1			H1036	281	0	2020	Palm Beach County		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	282	0	1	1	1	H1036_282_0	3	1	2	1	07/19/2019	2020.01	07/19/2019 03:14:42 PM Eastern Daylight Time	08/04/2019 04:06:40 PM Eastern Daylight Time	08/02/2019 01:18:08 PM Eastern Daylight Time			08/05/2019 11:10:23 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Fully Integrated H1036-282 (HMO D-SNP)	1	1		1			H1036	282	0	2020	Broward County		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	283	0	1	1	1	H1036_283_0	3	1	2	1	07/19/2019	2020.01	07/19/2019 03:14:05 PM Eastern Daylight Time	08/04/2019 04:59:09 PM Eastern Daylight Time	08/02/2019 01:18:08 PM Eastern Daylight Time			08/05/2019 11:15:13 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Fully Integrated H1036-283 (HMO D-SNP)	1	1		1			H1036	283	0	2020	Select Counties in Central Florida		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	284	0	1	1	1	H1036_284_0	3	1	2	1	07/15/2019	2020.01	07/15/2019 04:20:32 PM Eastern Daylight Time	08/04/2019 04:56:33 PM Eastern Daylight Time	08/02/2019 01:18:09 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-284 (HMO D-SNP)	1	1		1			H1036	284	0	2020	"Charlotte, Collier and Lee counties"		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	285	0	1	1	1	H1036_285_0	2	1	2	1	05/25/2019	2020.01	05/25/2019 12:16:49 PM Eastern Daylight Time	08/04/2019 04:57:47 PM Eastern Daylight Time	08/02/2019 01:18:09 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP)	1	1		1			H1036	285	0	2020	"Charlotte, Collier and Lee counties"		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1036	801	0	1	1	1	H1036_801_0	1	1			05/29/2019	2020.01	05/29/2019 10:28:58 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	801	0	2020	Select counties in Florida		1	71432	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1036	806	0	1	1	1	H1036_806_0	1	1			05/29/2019	2020.01	05/29/2019 10:29:45 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	806	0	2020	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1036	810	0	1	1	1	H1036_810_0	1	1			05/29/2019	2020.01	05/29/2019 10:30:48 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	810	0	2020	"Select Counties in MS, OR and NC"		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1036	811	0	1	1	1	H1036_811_0	1	1			05/29/2019	2020.01	05/29/2019 10:31:22 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	811	0	2020	"Select Counties in MS, OR and NC"		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1036	814	0	1	1	1	H1036_814_0	1	1			05/29/2019	2020.01	05/29/2019 12:01:18 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	814	0	2020	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1036	815	0	1	1	1	H1036_815_0	1	1			05/29/2019	2020.01	05/29/2019 12:02:42 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	815	0	2020	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1036	816	0	1	1	1	H1036_816_0	1	1			05/29/2019	2020.01	05/29/2019 12:04:54 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	816	0	2020	"Select counties in MS, OR and NC"		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1036	817	0	1	1	1	H1036_817_0	1	1			05/29/2019	2020.01	05/29/2019 12:08:05 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	817	0	2020	"Select counties in MS, OR and NC"		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1036	818	0	1	1	1	H1036_818_0	1	1			05/29/2019	2020.01	05/29/2019 12:10:10 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	818	0	2020	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1036	819	0	1	1	1	H1036_819_0	1	1			05/29/2019	2020.01	05/29/2019 12:12:04 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	819	0	2020	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1036	820	0	1	1	1	H1036_820_0	1	1			05/29/2019	2020.01	05/29/2019 12:13:54 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	820	0	2020	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1036	821	0	1	1	1	H1036_821_0	1	1			05/29/2019	2020.01	05/29/2019 12:15:50 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	821	0	2020	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1036	822	0	1	1	1	H1036_822_0	1	1			05/29/2019	2020.01	05/29/2019 12:17:21 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	822	0	2020	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1036	823	0	1	1	1	H1036_823_0	1	1			05/29/2019	2020.01	05/29/2019 12:19:15 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1036	823	0	2020	Select counties in Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1043	1	0	1	20	8	H1043_001_0	1	1			05/28/2019	2020.01	05/28/2019 01:49:50 PM Eastern Daylight Time		05/28/2019 02:17:15 PM Eastern Daylight Time			05/28/2019 02:19:42 PM Eastern Daylight Time	"FLORIDA PACE CENTERS, INC."	"Florida Pace Centers, Inc."	miamijewishhealthsystems.org	"Florida PACE Centers, Inc. (PACE)"	8	20		1			H1043	1	0	2020	"Florida PACE Centers, Inc."		2		2			2						www.floridapace.org	www.noformulary.com										(855)737-7223		(305)751-8626	66725	(855)737-7223		(305)751-8626	66725									(855)737-7223		(305)751-8626	66725	(855)737-7223		(305)751-8626	66725															
H1043	2	0	1	20	8	H1043_002_0	1	1			05/28/2019	2020.01	05/28/2019 01:52:11 PM Eastern Daylight Time		05/28/2019 02:07:07 PM Eastern Daylight Time			05/28/2019 02:19:42 PM Eastern Daylight Time	"FLORIDA PACE CENTERS, INC."	"Florida Pace Centers, Inc."	miamijewishhealthsystems.org	"Florida PACE Centers, Inc (PACE)"	8	20		1			H1043	2	0	2020	"Florida PACE Centers, Inc."		2		2			2						www.floridapace.org	www.noformulary.com										(855)737-7223		(305)751-8626	66725	(855)737-7223		(305)751-8626	8465									(855)737-7223		(305)751-8626	66725	(855)737-7223		(305)751-8626	8465															
H1045	1	0	1	1	1	H1045_001_0	2	1			08/05/2019	2020.01	08/05/2019 02:46:06 PM Central Daylight Time	08/02/2019 10:47:16 AM Central Daylight Time	07/30/2019 06:31:27 PM Central Daylight Time			08/06/2019 08:44:53 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.myPreferredCare.com	Preferred Choice Dade (HMO)	1	1		1			H1045	1	0	2020	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	2			
H1045	5	0	1	1	1	H1045_005_0	3	1			08/02/2019	2020.01	08/02/2019 11:29:01 AM Central Daylight Time	08/02/2019 10:49:24 AM Central Daylight Time	07/30/2019 06:32:02 PM Central Daylight Time			08/06/2019 08:44:53 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.myPreferredCare.com	Preferred Choice Broward (HMO)	1	1		1			H1045	5	0	2020	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	2			
H1045	12	0	1	1	1	H1045_012_0	3	1	2	1	06/01/2019	2020.01	06/01/2019 02:35:27 PM Central Daylight Time	08/02/2019 10:51:28 AM Central Daylight Time	07/30/2019 06:32:31 PM Central Daylight Time			08/06/2019 08:44:53 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.myPreferredCare.com	Preferred Medicare Assist (HMO D-SNP)	1	1		1			H1045	12	0	2020	Miami-Dade and Broward Counties		2		2			1	3		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	2			
H1045	18	0	1	1	1	H1045_018_0	3	1		1	08/02/2019	2020.01	08/02/2019 11:29:33 AM Central Daylight Time	08/02/2019 10:53:36 AM Central Daylight Time	07/30/2019 06:33:05 PM Central Daylight Time			08/06/2019 08:44:53 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.myPreferredCare.com	Preferred Special Care Miami-Dade (HMO C-SNP)	1	1		1			H1045	18	0	2020	Miami-Dade County		2		2			1	4			10		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	2			
H1045	25	0	1	1	1	H1045_025_0	3	1			08/05/2019	2020.01	08/05/2019 02:49:47 PM Central Daylight Time	08/02/2019 10:55:48 AM Central Daylight Time	07/30/2019 06:33:36 PM Central Daylight Time			08/06/2019 08:44:53 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare The Villages Medicare Advantage 1 (HMO)	1	1		1			H1045	25	0	2020	"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	2			
H1045	26	0	1	2	1	H1045_026_0	3	1			08/02/2019	2020.01	08/02/2019 11:31:03 AM Central Daylight Time	08/02/2019 12:31:45 PM Central Daylight Time	07/30/2019 06:34:08 PM Central Daylight Time			08/06/2019 08:44:53 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H1045	26	0	2020	Select Counties in Jacksonville		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H1045	27	0	1	2	1	H1045_027_0	2	1			08/02/2019	2020.01	08/02/2019 11:31:29 AM Central Daylight Time	08/02/2019 10:58:15 AM Central Daylight Time	07/30/2019 06:34:40 PM Central Daylight Time			08/06/2019 08:44:53 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare The Villages Medicare Advantage 2 (HMO-POS)	1	2		1			H1045	27	0	2020	"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	2			
H1045	28	0	1	2	1	H1045_028_0	3	1			08/02/2019	2020.01	08/02/2019 11:34:32 AM Central Daylight Time	08/02/2019 11:00:26 AM Central Daylight Time	07/30/2019 06:35:15 PM Central Daylight Time			08/06/2019 08:44:53 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H1045	28	0	2020	Select Counties in Central Florida		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	30	0	1	2	1	H1045_030_0	3	1			08/02/2019	2020.01	08/02/2019 11:41:59 AM Central Daylight Time	08/02/2019 11:02:35 AM Central Daylight Time	07/30/2019 06:35:48 PM Central Daylight Time			08/06/2019 08:44:53 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H1045	30	0	2020	"Brevard, Orange, Osceola and Seminole counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	31	0	1	2	1	H1045_031_0	3	1			08/02/2019	2020.01	08/02/2019 11:42:37 AM Central Daylight Time	08/02/2019 11:04:35 AM Central Daylight Time	07/30/2019 06:36:25 PM Central Daylight Time			08/06/2019 09:06:32 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H1045	31	0	2020	"Escambia, Okaloosa and Santa Rosa counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H1045	32	0	1	2	1	H1045_032_0	3	1			08/02/2019	2020.01	08/02/2019 11:45:14 AM Central Daylight Time	08/02/2019 11:06:41 AM Central Daylight Time	07/30/2019 06:36:57 PM Central Daylight Time			08/06/2019 09:06:32 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H1045	32	0	2020	Bay and Walton counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H1045	33	0	1	1	1	H1045_033_0	2	1			08/02/2019	2020.01	08/02/2019 11:45:42 AM Central Daylight Time	08/02/2019 11:08:44 AM Central Daylight Time	07/30/2019 06:37:29 PM Central Daylight Time			08/06/2019 09:06:32 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H1045	33	0	2020	Select counties in Gainesville		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H1045	34	0	1	1	1	H1045_034_0	2	1			08/02/2019	2020.01	08/02/2019 11:46:08 AM Central Daylight Time	08/02/2019 11:10:48 AM Central Daylight Time	07/30/2019 06:38:02 PM Central Daylight Time			08/06/2019 09:06:32 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H1045	34	0	2020	Select counties in Fort Myers/Naples Florida		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H1045	36	0	1	2	1	H1045_036_0	4	1			08/02/2019	2020.01	08/02/2019 11:47:15 AM Central Daylight Time	08/06/2019 11:26:32 AM Central Daylight Time	07/30/2019 06:38:34 PM Central Daylight Time			08/06/2019 12:07:19 PM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO-POS)	1	2		1			H1045	36	0	2020	"Indian River, Martin and St. Lucie counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H1045	37	0	1	1	1	H1045_037_0	2	1			08/05/2019	2020.01	08/05/2019 11:15:08 AM Central Daylight Time	08/02/2019 11:15:01 AM Central Daylight Time	07/30/2019 06:39:07 PM Central Daylight Time			08/06/2019 09:06:32 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.myPreferredCare.com	Preferred Choice Palm Beach (HMO)	1	1		1			H1045	37	0	2020	Palm Beach 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	2			
H1045	38	0	1	1	1	H1045_038_0	2	1	2	1	06/02/2019	2020.01	06/02/2019 11:09:37 AM Central Daylight Time	08/02/2019 11:17:08 AM Central Daylight Time	07/30/2019 06:39:41 PM Central Daylight Time			08/06/2019 09:06:32 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.myPreferredCare.com	Preferred Medicare Assist Palm Beach (HMO D-SNP)	1	1		1			H1045	38	0	2020	Palm Beach county		2		2			1	3		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	2			
H1045	39	0	1	1	1	H1045_039_0	2	1	2	1	08/05/2019	2020.01	08/05/2019 05:07:58 PM Central Daylight Time	08/02/2019 11:19:26 AM Central Daylight Time	07/30/2019 06:40:16 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO D-SNP)	1	1		1			H1045	39	0	2020	Select counties in Central Florida		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	41	0	1	2	1	H1045_041_0	3	1			08/02/2019	2020.01	08/02/2019 12:06:22 PM Central Daylight Time	08/02/2019 11:21:28 AM Central Daylight Time	07/30/2019 06:40:50 PM Central Daylight Time			08/06/2019 09:43:01 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H1045	41	0	2020	Select counties in Tallahassee		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H1045	42	0	1	2	1	H1045_042_0	3	1			08/02/2019	2020.01	08/02/2019 12:07:34 PM Central Daylight Time	08/02/2019 11:23:38 AM Central Daylight Time	07/30/2019 06:41:27 PM Central Daylight Time			08/06/2019 09:43:01 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H1045	42	0	2020	"DeSoto, Highlands, and Hardee counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H1045	43	0	1	2	1	H1045_043_0	3	1			08/02/2019	2020.01	08/02/2019 12:07:59 PM Central Daylight Time	08/02/2019 11:25:42 AM Central Daylight Time	07/30/2019 06:42:03 PM Central Daylight Time			08/06/2019 09:43:01 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H1045	43	0	2020	Citrus and Levy counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H1045	45	0	1	2	1	H1045_045_0	4	1			08/02/2019	2020.01	08/02/2019 12:08:23 PM Central Daylight Time	08/06/2019 11:27:02 AM Central Daylight Time	07/30/2019 06:42:32 PM Central Daylight Time			08/06/2019 12:07:19 PM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO-POS)	1	2		1			H1045	45	0	2020	Select Counties in Tampa		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H1045	46	0	1	1	1	H1045_046_0	2	1			05/30/2019	2020.01	05/30/2019 02:13:56 PM Central Daylight Time	08/02/2019 12:14:22 PM Central Daylight Time	07/30/2019 06:43:08 PM Central Daylight Time			08/06/2019 09:43:01 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.myPreferredCare.com	Preferred Complete Care (HMO)	1	1		1			H1045	46	0	2020	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	2			
H1045	48	1	1	1	1	H1045_048_1	3	1		1	08/02/2019	2020.01	08/02/2019 12:08:57 PM Central Daylight Time	08/02/2019 11:47:18 AM Central Daylight Time	07/30/2019 06:43:40 PM Central Daylight Time			08/06/2019 09:43:01 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)	1	1		1			H1045	48	1	2020	State of Florida	Orlando Metro	2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	48	2	1	1	1	H1045_048_2	2	1		1	08/05/2019	2020.01	08/05/2019 04:19:25 PM Central Daylight Time	08/02/2019 11:49:26 AM Central Daylight Time	07/30/2019 06:44:12 PM Central Daylight Time			08/06/2019 09:43:01 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)	1	1		1			H1045	48	2	2020	State of Florida	Southwest Florida	2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	48	3	1	1	1	H1045_048_3	2	1		1	08/05/2019	2020.01	08/05/2019 04:19:53 PM Central Daylight Time	08/02/2019 11:51:38 AM Central Daylight Time	07/30/2019 06:44:46 PM Central Daylight Time			08/06/2019 09:50:09 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)	1	1		1			H1045	48	3	2020	State of Florida	Tampa Metro	2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	48	4	1	1	1	H1045_048_4	3	1		1	08/02/2019	2020.01	08/02/2019 12:10:23 PM Central Daylight Time	08/02/2019 11:53:50 AM Central Daylight Time	07/30/2019 06:45:18 PM Central Daylight Time			08/06/2019 09:50:09 AM Central Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Walgreens (HMO C-SNP)	1	1		1			H1045	48	4	2020	State of Florida	"Lake, Marion & Sumter Counties"	2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1045	801	0	1	1	1	H1045_801_0	1	1			05/11/2019	2020.01	05/11/2019 09:06:03 AM Eastern Daylight Time					06/03/2019 07:10:04 AM Eastern Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H1045	801	0	2020	Select counties in Florida		1	216	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H1045	802	0	1	1	1	H1045_802_0	1	1			05/30/2019	2020.01	05/30/2019 12:18:54 PM Eastern Daylight Time					06/03/2019 07:10:04 AM Eastern Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H1045	802	0	2020	Select counties in Florida		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H1045	803	0	1	1	1	H1045_803_0	1	1			05/31/2019	2020.01	05/31/2019 06:54:35 PM Eastern Daylight Time					06/03/2019 07:10:04 AM Eastern Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H1045	803	0	2020	Select counties in Florida		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H1045	804	0	2	1	1	H1045_804_0	1	1			05/31/2019	2020.01	05/31/2019 06:54:45 PM Eastern Daylight Time					06/03/2019 07:10:04 AM Eastern Daylight Time	"PREFERRED CARE PARTNERS, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		2	2		H1045	804	0	2020	Select counties in Florida		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H1099	1	0	1	2	1	H1099_001_0	7	1			07/11/2019	2020.01	07/11/2019 03:59:07 PM Eastern Daylight Time	07/31/2019 11:14:00 AM Eastern Daylight Time	07/31/2019 09:25:44 PM Eastern Daylight Time			08/06/2019 06:32:18 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	"Health First Health Plans, Inc."	myHFHP.org	Health First Classic Plan (HMO-POS)	1	2		1			H1099	1	0	2020	"Counties: BR, IR"		2	122606	2			2						myHFHP.org	myHFHP.org	myHFHP.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	2			
H1099	6	0	1	1	1	H1099_006_0	8	1			08/05/2019	2020.01	08/05/2019 06:43:18 PM Eastern Daylight Time	07/31/2019 11:47:42 AM Eastern Daylight Time	07/31/2019 09:26:58 PM Eastern Daylight Time			08/06/2019 06:32:18 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	"Health First Health Plans, Inc."	myHFHP.org	Health First Value Plan (HMO)	1	1		1			H1099	6	0	2020	"Counties: BR, IR"		2	113499	2			2						myHFHP.org	myHFHP.org	myHFHP.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	2			
H1099	9	0	1	1	1	H1099_009_0	7	1			08/02/2019	2020.01	08/02/2019 09:55:21 AM Eastern Daylight Time	06/29/2019 04:55:12 PM Eastern Daylight Time				08/07/2019 01:20:17 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	"Health First Health Plans, Inc."	myHFHP.org	Health First Secure Plan (HMO)	1	1		1			H1099	9	0	2020	"Counties: BR, IR"		2	8390	2			2						myHFHP.org	myHFHP.org	myHFHP.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	2			
H1099	14	0	1	1	1	H1099_014_0	8	1			08/02/2019	2020.01	08/02/2019 09:54:08 AM Eastern Daylight Time	07/31/2019 11:53:52 AM Eastern Daylight Time	07/31/2019 09:29:22 PM Eastern Daylight Time			08/06/2019 06:32:18 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	"Health First Health Plans, Inc."	myHFHP.org	Health First Rewards Plan (HMO)	1	1		1			H1099	14	0	2020	"Counties: BR, IR"		2	109364	2			2						myHFHP.org	myHFHP.org	myHFHP.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	2			
H1099	16	0	1	1	1	H1099_016_0	5	1			07/11/2019	2020.01	07/11/2019 04:00:47 PM Eastern Daylight Time	07/31/2019 10:08:35 AM Eastern Daylight Time	07/31/2019 09:30:48 PM Eastern Daylight Time			08/06/2019 06:32:18 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	"Health First Health Plans, Inc."	myAHplan.com	AdventHealth SunSaver Plan (HMO)	1	1		1			H1099	16	0	2020	"Counties: VO, FL, HA, HI, SE"		2	104135	2			2						myAHplan.com	myAHplan.com	myAHplan.com	(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	2			
H1099	802	0	1	1	1	H1099_802_0	1	1			05/24/2019	2020.01	05/24/2019 12:45:56 PM Eastern Daylight Time					05/28/2019 04:50:35 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	"Health First Health Plans, Inc."	myHFHP.org	Employer Group Plus (HMO)	1	1		1			H1099	802	0	2020	Central Florida Area		1	14502	2			2						myHFHP.org	myHFHP.org	myHFHP.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		1	1	1a;1b;2;3-1;3-2;3-3;3-4;6;7c;7i;7k;8a;8b1;8b2;9a1;9b;9c;9d;10a;11a;11b;11c;14e2;14e6;15;16b;	2		1					1				
H1099	804	0	1	2	1	H1099_804_0	1	1			05/24/2019	2020.01	05/24/2019 12:44:27 PM Eastern Daylight Time					05/28/2019 04:47:25 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	"Health First Health Plans, Inc."	myHFHP.org	Employer Group POS (HMO-POS)	1	2		1			H1099	804	0	2020	Central Florida Area		1	1249	2			2						myHFHP.org	myHFHP.org	myHFHP.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		1	1	1a;1b;2;3-1;3-2;3-3;3-4;6;7c;7i;7k;8a;8b1;8b2;9a1;9b;9c;9d;10a;11a;11b;11c;14e2;14e6;15;16b;	2		1	1	1a;1b;2;3-1;3-2;3-3;3-4;6;7c;7i;7k;8a;8b1;8b2;9a1;9b;9c;9d;10a;11a;11b;11c;14e2;14e6;15;16b;	2		1				
H1100	1	0	1	4	1	H1100_001_0	5	1			07/31/2019	2020.01	07/31/2019 05:27:58 PM Eastern Daylight Time	08/02/2019 09:40:25 AM Eastern Daylight Time	07/30/2019 08:25:48 PM Eastern Daylight Time			08/02/2019 03:09:47 PM Eastern Daylight Time	INNOVATION HEALTH INSURANCE COMPANY	Innovation Health Medicare	www.innovationhealthmedicare.com	Innovation Health-Aetna Medicare Voyager (PPO)	1	4		1			H1100	1	0	2020	Fairfax County and Surrounding Area		2		2			2						www.innovationhealthmedicare.com/findpharmacy	www.innovationhealthmedicare.com/formulary	www.innovationhealthmedicare.com/findprovider	(855)249-1282		(855)249-1282		(844)656-8722		(844)656-8722		(855)249-1282		(855)249-1282		(844)656-8722		(844)656-8722		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	1	4b;7a;7d;7g;	
H1100	2	0	1	4	1	H1100_002_0	4	1			07/31/2019	2020.01	07/31/2019 05:27:39 PM Eastern Daylight Time	08/02/2019 09:45:23 AM Eastern Daylight Time	07/30/2019 08:27:00 PM Eastern Daylight Time			08/02/2019 03:09:47 PM Eastern Daylight Time	INNOVATION HEALTH INSURANCE COMPANY	Innovation Health Medicare	www.innovationhealthmedicare.com	Innovation Health-Aetna Medicare Premier (PPO)	1	4		1			H1100	2	0	2020	Fairfax County and Surrounding Area		2		2			2						www.innovationhealthmedicare.com/findpharmacy	www.innovationhealthmedicare.com/formulary	www.innovationhealthmedicare.com/findprovider	(855)249-1282		(855)249-1282		(844)656-8722		(844)656-8722		(855)249-1282		(855)249-1282		(844)656-8722		(844)656-8722		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	1	7a;7d;7g;	
H1109	5	0	1	1	1	H1109_005_0	5	1			08/01/2019	2020.01	08/01/2019 05:18:32 PM Eastern Daylight Time	08/01/2019 05:51:49 PM Eastern Daylight Time	07/30/2019 08:28:11 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	1	1		1			H1109	5	0	2020	Select Counties in Atlanta and Macon Markets		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1109	6	0	1	1	1	H1109_006_0	3	1			08/01/2019	2020.01	08/01/2019 05:20:11 PM Eastern Daylight Time	08/01/2019 05:52:23 PM Eastern Daylight Time	07/30/2019 08:29:23 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	1	1		1			H1109	6	0	2020	Hall County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1109	801	0	1	1	1	H1109_801_0	1	1			05/30/2019	2020.01	05/30/2019 01:03:28 PM Eastern Daylight Time					05/30/2019 05:40:37 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H1109	801	0	2020	Georgia		1	1630	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-1637		(888)267-1637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1109	802	0	1	1	1	H1109_802_0	1	1			05/30/2019	2020.01	05/30/2019 01:04:05 PM Eastern Daylight Time					05/30/2019 05:40:37 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H1109	802	0	2020	Georgia		1	6210	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1109	804	0	1	1	1	H1109_804_0	2	1			05/31/2019	2020.01	05/31/2019 11:47:00 AM Eastern Daylight Time					05/31/2019 12:13:05 PM Eastern Daylight Time	AETNA HEALTH INC.(GA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H1109	804	0	2020	Georgia		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1111	9	1	1	1	1	H1111_009_1	8	1			08/02/2019	2020.01	08/02/2019 11:16:59 AM Central Daylight Time	08/02/2019 10:33:58 AM Central Daylight Time	07/30/2019 06:45:51 PM Central Daylight Time			08/05/2019 06:02:49 PM Central Daylight Time	"UNITEDHEALTHCARE OF GEORGIA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 1 (HMO)	1	1		1			H1111	9	1	2020	Select counties in Georgia	"Cobb, DeKalb, and Fulton Counties"	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1111	9	2	1	1	1	H1111_009_2	8	1			08/02/2019	2020.01	08/02/2019 11:18:19 AM Central Daylight Time	08/02/2019 10:34:24 AM Central Daylight Time	07/30/2019 06:46:26 PM Central Daylight Time			08/05/2019 06:02:49 PM Central Daylight Time	"UNITEDHEALTHCARE OF GEORGIA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 1 (HMO)	1	1		1			H1111	9	2	2020	Select counties in Georgia	Select Counties in Georgia	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1111	10	1	1	1	1	H1111_010_1	8	1			08/02/2019	2020.01	08/02/2019 11:20:42 AM Central Daylight Time	08/02/2019 10:34:51 AM Central Daylight Time	07/30/2019 06:46:59 PM Central Daylight Time			08/05/2019 06:02:49 PM Central Daylight Time	"UNITEDHEALTHCARE OF GEORGIA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 2 (HMO)	1	1		1			H1111	10	1	2020	Select counties in Georgia	"Cobb, DeKalb, and Fulton Counties"	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1111	10	2	1	1	1	H1111_010_2	8	1			08/02/2019	2020.01	08/02/2019 11:21:31 AM Central Daylight Time	08/02/2019 10:35:17 AM Central Daylight Time	07/30/2019 06:47:33 PM Central Daylight Time			08/05/2019 06:02:49 PM Central Daylight Time	"UNITEDHEALTHCARE OF GEORGIA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 2 (HMO)	1	1		1			H1111	10	2	2020	Select counties in Georgia	Select Counties in Georgia	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1111	801	0	1	1	1	H1111_801_0	1	1			05/11/2019	2020.01	05/11/2019 09:10:06 AM Eastern Daylight Time					06/03/2019 07:25:00 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF GEORGIA, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H1111	801	0	2020	GA Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H1111	804	0	1	1	1	H1111_804_0	1	1			05/11/2019	2020.01	05/11/2019 09:10:47 AM Eastern Daylight Time					06/03/2019 07:25:00 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF GEORGIA, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H1111	804	0	2020	GA Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H1111	805	0	1	1	1	H1111_805_0	1	1			05/11/2019	2020.01	05/11/2019 09:11:43 AM Eastern Daylight Time					06/03/2019 07:25:00 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF GEORGIA, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H1111	805	0	2020	GA Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H1111	807	0	2	1	1	H1111_807_0	1	1			05/11/2019	2020.01	05/11/2019 09:12:20 AM Eastern Daylight Time					06/03/2019 07:25:00 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF GEORGIA, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		2	2		H1111	807	0	2020	GA Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H1112	6	0	1	1	1	H1112_006_0	7	1	2	1	07/12/2019	2020.01	07/12/2019 11:36:39 AM Eastern Daylight Time	08/02/2019 04:29:44 AM Eastern Daylight Time	07/30/2019 09:53:09 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H1112	6	0	2020	Select Counties in GA		2	164599	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	33	0	1	1	1	H1112_033_0	5	1	2	1	07/12/2019	2020.01	07/12/2019 11:37:20 AM Eastern Daylight Time	08/02/2019 04:31:36 AM Eastern Daylight Time	07/30/2019 09:53:45 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H1112	33	0	2020	Select Counties in GA		2	62823	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	34	0	1	2	1	H1112_034_0	6	1			05/29/2019	2020.01	05/29/2019 07:54:52 PM Eastern Daylight Time	06/02/2019 06:07:07 AM Eastern Daylight Time				06/02/2019 03:27:58 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO-POS)	1	2		1			H1112	34	0	2020	Select Counties in GA		2	19442	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1112	35	0	1	1	1	H1112_035_0	6	1			07/01/2019	2020.01	07/01/2019 12:00:07 PM Eastern Daylight Time	08/02/2019 04:35:02 AM Eastern Daylight Time	07/30/2019 09:54:21 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Choice (HMO)	1	1		1			H1112	35	0	2020	Select counties in GA		2	13483	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	37	0	1	1	1	H1112_037_0	7	1		1	07/12/2019	2020.01	07/12/2019 11:38:29 AM Eastern Daylight Time	08/02/2019 04:36:36 AM Eastern Daylight Time	07/30/2019 09:54:57 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Guardian (HMO C-SNP)	1	1		1			H1112	37	0	2020	Select counties in GA		2	2140	2			1	4			1E+13		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7a;7g;	
H1112	38	0	1	1	1	H1112_038_0	7	1			07/01/2019	2020.01	07/01/2019 12:00:42 PM Eastern Daylight Time	08/02/2019 04:38:18 AM Eastern Daylight Time	07/30/2019 09:55:34 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H1112	38	0	2020	Select counties in GA		2	192578	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	39	0	1	1	1	H1112_039_0	6	1			07/01/2019	2020.01	07/01/2019 12:01:18 PM Eastern Daylight Time	08/02/2019 04:39:58 AM Eastern Daylight Time	07/30/2019 09:56:09 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H1112	39	0	2020	Select counties in GA		2	116994	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	40	0	1	1	1	H1112_040_0	6	1			07/12/2019	2020.01	07/12/2019 11:39:07 AM Eastern Daylight Time	08/02/2019 04:41:33 AM Eastern Daylight Time	07/30/2019 09:56:46 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Focus (HMO)	1	1		1			H1112	40	0	2020	Select counties in GA		2	6913	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7a;7g;	
H1112	42	0	1	1	1	H1112_042_0	6	1			05/29/2019	2020.01	05/29/2019 08:03:24 PM Eastern Daylight Time	08/02/2019 04:43:23 AM Eastern Daylight Time	07/30/2019 09:57:22 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1112	42	0	2020	Select counties in GA		2	10560	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	43	0	1	1	1	H1112_043_0	7	1			05/30/2019	2020.01	05/30/2019 09:40:52 AM Eastern Daylight Time	08/02/2019 02:55:45 PM Eastern Daylight Time	07/30/2019 09:57:58 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Compass (HMO)	1	1		1			H1112	43	0	2020	Select counties in GA		2	15205	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1112	44	0	1	1	1	H1112_044_0	7	1			05/29/2019	2020.01	05/29/2019 08:05:38 PM Eastern Daylight Time	08/02/2019 04:46:50 AM Eastern Daylight Time	07/30/2019 09:58:34 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF GEORGIA, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H1112	44	0	2020	Select counties in GA		2	6338	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1119	1	0	1	1	1	H1119_001_0	5	1		1	08/02/2019	2020.01	08/02/2019 09:01:55 AM Eastern Daylight Time	08/02/2019 08:58:32 AM Eastern Daylight Time	08/02/2019 08:58:32 AM Eastern Daylight Time			08/02/2019 09:03:12 AM Eastern Daylight Time	"TSG GUARD, INC."	Valor Health Plan	www.valorhealthplan.com	Valor Health Plan (HMO I-SNP)	1	1		1			H1119	1	0	2020	Northeast and Central Ohio		2	9614	2			1	1	1				www.valorhealthplan.com	www.valorhealthplan.com	www.valorhealthplan.com	(800)485-3793		(501)255-0109		(800)485-3793		(501)255-0109		(800)485-3793		(501)255-0109		(800)485-3793		(501)255-0109		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					1	2			
H1142	1	0	1	1	1	H1142_001_0	8	1			07/16/2019	2020.01	07/16/2019 03:19:56 PM Central Daylight Time	08/02/2019 04:28:18 PM Central Daylight Time	08/02/2019 05:01:58 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF OHIO, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage (HMO)	1	1		1			H1142	1	0	2020	"Cincinnati, Toledo, and Youngstown Metro Areas"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1142	2	0	1	1	1	H1142_002_0	6	1			07/16/2019	2020.01	07/16/2019 01:14:54 PM Central Daylight Time	08/02/2019 04:28:11 PM Central Daylight Time	08/02/2019 05:01:55 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF OHIO, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Plus (HMO)	1	1		1			H1142	2	0	2020	"Cincinnati, Toledo, and Youngstown Metro Areas"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1142	3	0	1	1	1	H1142_003_0	7	1			07/16/2019	2020.01	07/16/2019 01:15:04 PM Central Daylight Time	08/02/2019 04:28:04 PM Central Daylight Time	08/02/2019 05:01:32 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF OHIO, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage (HMO)	1	1		1			H1142	3	0	2020	Cleveland and Akron Metro Areas		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-5484		(844)221-5484		(833)412-7707		(833)412-7707		(844)221-5484		(844)221-5484		(833)412-7707		(833)412-7707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1142	6	0	1	1	1	H1142_006_0	6	1			08/01/2019	2020.01	08/01/2019 02:44:27 PM Central Daylight Time	08/02/2019 04:27:13 PM Central Daylight Time	08/02/2019 05:00:43 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF OHIO, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Assist (HMO)	1	1		1			H1142	6	0	2020	"Cincinnati, Toledo, and Youngstown Metro Areas"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1170	2	0	1	1	1	H1170_002_0	7	1			05/31/2019	2020.01	05/31/2019 07:59:37 PM Eastern Daylight Time	08/01/2019 02:33:48 PM Eastern Daylight Time	08/01/2019 02:44:25 PM Eastern Daylight Time			08/02/2019 12:04:02 PM Eastern Daylight Time	"KAISER FOUNDATION HP OF GA, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced (HMO)	1	1		1			H1170	2	0	2020	Atlanta Metro Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H1170	8	0	1	1	1	H1170_008_0	6	1	2	1	05/31/2019	2020.01	05/31/2019 08:01:37 PM Eastern Daylight Time	08/01/2019 02:38:10 PM Eastern Daylight Time	08/01/2019 02:55:00 PM Eastern Daylight Time			08/02/2019 12:04:02 PM Eastern Daylight Time	"KAISER FOUNDATION HP OF GA, INC."	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid Plan (HMO D-SNP)	1	1		1			H1170	8	0	2020	Atlanta Metro Area		2		2			1	3		2		2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H1170	9	0	1	1	1	H1170_009_0	6	1			05/31/2019	2020.01	05/31/2019 08:02:27 PM Eastern Daylight Time	08/01/2019 02:36:06 PM Eastern Daylight Time	08/01/2019 02:49:27 PM Eastern Daylight Time			08/02/2019 12:04:02 PM Eastern Daylight Time	"KAISER FOUNDATION HP OF GA, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic (HMO)	1	1		1			H1170	9	0	2020	Atlanta Metro Area		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H1170	801	0	1	1	1	H1170_801_0	3	1			05/16/2019	2020.01	05/16/2019 09:25:33 AM Eastern Daylight Time					06/03/2019 03:33:14 PM Eastern Daylight Time	"KAISER FOUNDATION HP OF GA, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Employer Group Plan (HMO)	1	1		1			H1170	801	0	2020	Atlanta Metro Area		1	1	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;16b;	1					2				
H1170	802	0	1	1	1	H1170_802_0	3	1			05/16/2019	2020.01	05/16/2019 09:25:54 AM Eastern Daylight Time					06/03/2019 03:33:14 PM Eastern Daylight Time	"KAISER FOUNDATION HP OF GA, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Employer Group With Part D (HMO)	1	1		1			H1170	802	0	2020	Atlanta Metro Area		1	53634	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;16b;	1					2				
H1170	805	0	1	1	1	H1170_805_0	3	1			05/16/2019	2020.01	05/16/2019 09:26:10 AM Eastern Daylight Time					06/03/2019 03:33:14 PM Eastern Daylight Time	"KAISER FOUNDATION HP OF GA, INC."	Kaiser Permanente	kp.org/medicare	FEHB Part AB  with D (HMO)	1	1		1			H1170	805	0	2020	Atlanta Metro Area		1	21046	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;16b;	1					2				
H1181	1	0		7	2	H1181_001_0	6	2			05/27/2019	2020.01	05/27/2019 05:32:49 PM Central Daylight Time			05/30/2019 09:23:42 PM Central Daylight Time		05/31/2019 04:41:37 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealth.com	NetworkPrime (MSA)	2	7	2				H1181	1	0	2020	Wisconsin		2		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	1	0	1	1	1	H1189_001_0	5	1			07/24/2019	2020.01	07/24/2019 07:19:51 AM Pacific Daylight Time	08/02/2019 04:20:30 PM Pacific Daylight Time	07/31/2019 11:27:33 AM Pacific Daylight Time			08/05/2019 04:56:26 PM Pacific Daylight Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan Generations	http://www.christushealthplan.org	CHRISTUS Health Plan Generations (HMO)	1	1		1			H1189	1	0	2020	North Central New Mexico		2		2			2						www.christushealthplan.org	www.christushealthplan.org		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	10		13a;
H1189	2	0	1	1	1	H1189_002_0	5	1			07/11/2019	2020.01	07/11/2019 10:52:36 AM Pacific Daylight Time	08/02/2019 04:21:35 PM Pacific Daylight Time	07/31/2019 11:28:37 AM Pacific Daylight Time			08/05/2019 04:56:26 PM Pacific Daylight Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan Generations	http://www.christushealthplan.org	CHRISTUS Health Plan Generations Plus (HMO)	1	1		1			H1189	2	0	2020	North Central New Mexico		2		2			2						www.christushealthplan.org	www.christushealthplan.org		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	10		13a;
H1189	3	0	1	1	1	H1189_003_0	5	1			07/11/2019	2020.01	07/11/2019 10:52:27 AM Pacific Daylight Time	08/02/2019 04:22:52 PM Pacific Daylight Time	07/31/2019 11:33:23 AM Pacific Daylight Time			08/05/2019 04:56:26 PM Pacific Daylight Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan Generations	http://www.christushealthplan.org/	CHRISTUS Health Plan Generations (HMO)	1	1		1			H1189	3	0	2020	North East Texas		2		2			2						www.christushealthplan.org	www.christushealthplan.org		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1189	4	0	1	1	1	H1189_004_0	5	1			07/11/2019	2020.01	07/11/2019 10:53:04 AM Pacific Daylight Time	08/02/2019 04:25:23 PM Pacific Daylight Time	07/31/2019 11:35:09 AM Pacific Daylight Time			08/05/2019 04:56:26 PM Pacific Daylight Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan Generations	http://www.christushealthplan.org/	CHRISTUS Health Plan Generations Plus (HMO)	1	1		1			H1189	4	0	2020	North East Texas		2		2			2						www.christushealthplan.org	www.christushealthplan.org		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(844)282-3026		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1205	1	0	1	1	1	H1205_001_0	3	1	2	1	08/02/2019	2020.01	08/02/2019 12:53:50 PM Eastern Daylight Time	08/02/2019 01:00:05 PM Eastern Daylight Time	08/02/2019 12:59:32 PM Eastern Daylight Time			08/02/2019 01:01:26 PM Eastern Daylight Time	"INTEGRA MLTC, INC."	Integra Managed Care	www.integramanagedcare.com	Integra Harmony (HMO SNP) (HMO D-SNP)	1	1		1			H1205	1	0	2020	"Bronx, Kings, Queens and New York counties"		2	1126	2			1	3		2		1	integramanagedcare.com	integramanagedcare.com		(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1205	2	0	1	1	1	H1205_002_0	3	1	2	1	08/02/2019	2020.01	08/02/2019 12:57:05 PM Eastern Daylight Time	08/02/2019 01:00:05 PM Eastern Daylight Time	08/02/2019 12:59:32 PM Eastern Daylight Time			08/02/2019 01:01:26 PM Eastern Daylight Time	"INTEGRA MLTC, INC."	Integra Managed Care	www.integramanagedcare.com	Integra Synergy (MAP) (HMO D-SNP)	1	1		1			H1205	2	0	2020	"Bronx, Kings, Queens and New York counties"		2	1126	2			1	3		1		1	integramanagedcare.com	integramanagedcare.com		(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1205	5	0	1	1	1	H1205_005_0	3	1	2	1	08/02/2019	2020.01	08/02/2019 12:57:25 PM Eastern Daylight Time	08/02/2019 01:00:05 PM Eastern Daylight Time	08/02/2019 12:59:32 PM Eastern Daylight Time			08/02/2019 01:01:26 PM Eastern Daylight Time	"INTEGRA MLTC, INC."	Integra Managed Care	www.integramanagedcare.com	Integra Harmony (HMO SNP) (HMO D-SNP)	1	1		1			H1205	5	0	2020	Nassau County		2	1126	2			1	3		2		1	integramanagedcare.com	integramanagedcare.com		(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(711)-	711	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1205	6	0	1	1	1	H1205_006_0	3	1	2	1	08/02/2019	2020.01	08/02/2019 12:57:48 PM Eastern Daylight Time	08/02/2019 01:00:05 PM Eastern Daylight Time	08/02/2019 12:59:32 PM Eastern Daylight Time			08/02/2019 01:01:26 PM Eastern Daylight Time	"INTEGRA MLTC, INC."	Integra Managed Care	www.integramanagedcare.com	Integra Synergy (MAP) (HMO D-SNP)	1	1		1			H1205	6	0	2020	Nassau County		2	1126	2			1	3		1		1	integramanagedcare.com	integramanagedcare.com		(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(877)388-5195		(877)388-5195		(877)388-5190		(877)388-5190		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1225	1	0	1	1	1	H1225_001_0	9	1			08/02/2019	2020.01	08/02/2019 02:14:52 PM Eastern Daylight Time	08/02/2019 07:51:32 AM Eastern Daylight Time	08/01/2019 10:18:34 AM Eastern Daylight Time			08/05/2019 11:13:24 AM Eastern Daylight Time	"HOPKINS HEALTH ADVANTAGE, INC."	Johns Hopkins HealthCare	https://www.hopkinsmedicare.com/	Johns Hopkins Advantage MD (HMO)	1	1		1			H1225	1	0	2020	Counties: AA BL CV CR FR HW MG SS WH WC WR		2	68258	2			2						https://www.hopkinsmedicare.com/	https://www.hopkinsmedicare.com/	https://www.hopkinsmedicare.com/	(877)293-4998		(877)293-4998		(888)403-7682		(888)403-7682		(877)293-4998		(877)293-4998		(888)403-7682		(888)403-7682		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1225	2	0	1	1	1	H1225_002_0	9	1			08/02/2019	2020.01	08/02/2019 09:17:35 AM Eastern Daylight Time	08/01/2019 04:28:18 PM Eastern Daylight Time	08/01/2019 10:19:00 AM Eastern Daylight Time			08/05/2019 11:13:24 AM Eastern Daylight Time	"HOPKINS HEALTH ADVANTAGE, INC."	Johns Hopkins HealthCare	https://www.hopkinsmedicare.com/	Johns Hopkins Advantage MD (HMO)	1	1		1			H1225	2	0	2020	Baltimore City		2	53123	2			2						https://www.hopkinsmedicare.com/	https://www.hopkinsmedicare.com/	https://www.hopkinsmedicare.com/	(877)293-4998		(877)293-4998		(888)403-7682		(888)403-7682		(877)293-4998		(877)293-4998		(888)403-7682		(888)403-7682		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1230	1	0	1	1	1	H1230_001_0	10	1			05/31/2019	2020.01	05/31/2019 02:57:40 PM Hawaiian Standard Time	07/31/2019 11:42:55 AM Hawaiian Standard Time	07/31/2019 01:35:34 PM Hawaiian Standard Time			08/05/2019 01:52:22 PM Hawaiian Standard Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced (HMO)	1	1		1			H1230	1	0	2020	Island of Oahu		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H1230	3	0	1	1	1	H1230_003_0	12	1			05/31/2019	2020.01	05/31/2019 01:59:22 PM Hawaiian Standard Time	07/31/2019 11:47:12 AM Hawaiian Standard Time	07/31/2019 01:37:56 PM Hawaiian Standard Time			08/05/2019 01:52:22 PM Hawaiian Standard Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic (HMO)	1	1		1			H1230	3	0	2020	Island of Oahu		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H1230	8	0	1	1	1	H1230_008_0	12	1	2	1	07/26/2019	2020.01	07/26/2019 11:59:18 AM Hawaiian Standard Time	07/31/2019 11:51:28 AM Hawaiian Standard Time	07/31/2019 01:40:41 PM Hawaiian Standard Time			08/05/2019 01:52:22 PM Hawaiian Standard Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid (HMO D-SNP)	1	1		1			H1230	8	0	2020	Islands of Oahu and Maui		2		2			1	3		1		2	kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H1230	13	0	1	1	1	H1230_013_0	10	1			06/01/2019	2020.01	06/01/2019 09:49:54 AM Hawaiian Standard Time	07/31/2019 11:55:59 AM Hawaiian Standard Time	07/31/2019 01:43:14 PM Hawaiian Standard Time			08/05/2019 01:52:22 PM Hawaiian Standard Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Maui (HMO)	1	1		1			H1230	13	0	2020	Island of Maui		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H1230	14	0	1	1	1	H1230_014_0	11	1			07/10/2019	2020.01	07/10/2019 09:32:45 AM Hawaiian Standard Time	07/31/2019 12:00:28 PM Hawaiian Standard Time	07/31/2019 01:45:54 PM Hawaiian Standard Time			08/05/2019 01:52:22 PM Hawaiian Standard Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Hawaii Island (HMO)	1	1		1			H1230	14	0	2020	Island of Hawaii except for 3 ZIPs		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H1230	801	0	1	1	1	H1230_801_0	8	1			05/29/2019	2020.01	05/29/2019 02:16:57 PM Hawaiian Standard Time					06/03/2019 11:03:22 AM Hawaiian Standard Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Employer Group MA only (HMO)	1	1		1			H1230	801	0	2020	"Islands of Oahu, Maui and Hawaii except for 3 ZIPs"		1	1115	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e3;16b;17a;18a;	1					2				
H1230	803	0	1	1	1	H1230_803_0	8	1			05/29/2019	2020.01	05/29/2019 02:17:32 PM Hawaiian Standard Time					06/03/2019 11:03:22 AM Hawaiian Standard Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Employer Group MA-PD (HMO)	1	1		1			H1230	803	0	2020	"Islands of Oahu, Maui and Hawaii except for 3 ZIPs"		1	162628	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e3;16b;17a;18a;	1					2				
H1230	804	0	2	1	1	H1230_804_0	8	1			05/29/2019	2020.01	05/29/2019 02:18:11 PM Hawaiian Standard Time					06/03/2019 11:03:22 AM Hawaiian Standard Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Employer Group MA-PD Part B (HMO)	1	1		2	1		H1230	804	0	2020	"Islands of Oahu, Maui and Hawaii except for 3 ZIPs"		1	314	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e3;16b;17a;18a;	1					2				
H1230	805	0	1	1	1	H1230_805_0	8	1			05/29/2019	2020.01	05/29/2019 02:18:41 PM Hawaiian Standard Time					06/03/2019 11:03:22 AM Hawaiian Standard Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	1	1		1			H1230	805	0	2020	"Islands of Oahu, Maui and Hawaii except for 3 ZIPs"		1	24589	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e3;16b;17a;18a;	1					2				
H1230	806	0	2	1	1	H1230_806_0	8	1			05/29/2019	2020.01	05/29/2019 02:19:14 PM Hawaiian Standard Time					06/03/2019 11:03:22 AM Hawaiian Standard Time	"KAISER FOUNDATION HP, INC."	Kaiser Permanente	kp.org/medicare	FEHB B only with D (HMO)	1	1		2	1		H1230	806	0	2020	"Islands of Oahu, Maui and Hawaii except for 3 ZIPs"		1	98	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e3;16b;17a;18a;	1					2				
H1234	1	0	1	20	8	H1234_001_0	1	1			05/21/2019	2020.01	05/21/2019 04:47:08 PM Eastern Daylight Time		05/20/2019 04:17:33 PM Eastern Daylight Time			05/21/2019 04:51:51 PM Eastern Daylight Time	LIFE ST. FRANCIS	LIFE St. Francis	www.stfrancismedical.org/LIFE	SFMC-Dual (PACE)	8	20		1			H1234	1	0	2020	Mercer County and portions of Burlington County		2		2			2						www.pharmastarpbm.com	www.stfrancismedical.org										(609)599-5433		(609)599-5433		(609)599-5433		(609)599-5433										(609)599-5433		(609)599-5433		(609)599-5433		(609)599-5433																
H1234	2	0	1	20	8	H1234_002_0	1	1			05/21/2019	2020.01	05/21/2019 04:47:48 PM Eastern Daylight Time		05/20/2019 04:17:30 PM Eastern Daylight Time			05/21/2019 04:51:51 PM Eastern Daylight Time	LIFE ST. FRANCIS	LIFE St. Francis	www.stfrancismedical.org/LIFE	SFMC-Medicare only (PACE)	8	20		1			H1234	2	0	2020	Mercer County and portions of Burlington County		2		2			2						www.pharmastarpbm.com	www.stfrancismedical.org										(609)599-5433		(609)599-5433		(609)599-5433		(609)599-5433										(609)599-5433		(609)599-5433		(609)599-5433		(609)599-5433																
H1239	1	0	1	20	8	H1239_001_0	1	1			05/16/2019	2020.01	05/16/2019 03:09:45 PM Mountain Daylight Time		05/16/2019 02:32:44 PM Mountain Daylight Time			05/16/2019 03:12:32 PM Mountain Daylight Time	"INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC"	InnovAge Virginia PACE- Roanoke Valley	www.MyInnovAge.com	InnovAge Virginia PACE- Roanoke Valley (PACE)	8	20		1			H1239	1	0	2020	Roanoke Valley Area		2		2			2						https://www.granerx.com/	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H1239	2	0	1	20	8	H1239_002_0	1	1			05/16/2019	2020.01	05/16/2019 03:10:04 PM Mountain Daylight Time		05/16/2019 02:32:45 PM Mountain Daylight Time			05/16/2019 03:12:32 PM Mountain Daylight Time	"INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC"	InnovAge Virginia PACE- Roanoke Valley	www.MyInnovAge.com	InnovAge Virginia PACE- Roanoke Valley (PACE)	8	20		1			H1239	2	0	2020	Roanoke Valley Area		2		2			2						https://www.granerx.com/	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H1248	1	0	1	4	1	H1248_001_0	9	1			07/22/2019	2020.01	07/22/2019 10:48:34 AM Central Daylight Time	08/06/2019 09:29:10 AM Central Daylight Time	08/06/2019 09:52:30 AM Central Daylight Time			08/06/2019 11:59:23 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	1	4		1			H1248	1	0	2020	"Baton Rouge, Surrounding Parishes"		2	2040	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	2	0	1	4	1	H1248_002_0	9	1			06/28/2019	2020.01	06/28/2019 03:09:06 PM Central Daylight Time	08/06/2019 09:31:56 AM Central Daylight Time	08/06/2019 09:56:54 AM Central Daylight Time			08/06/2019 11:59:23 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	1	4		1			H1248	2	0	2020	"New Orleans, Surrounding Parishes"		2	3528	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	3	0	1	4	1	H1248_003_0	9	1			07/25/2019	2020.01	07/25/2019 11:15:54 AM Central Daylight Time	08/06/2019 09:10:06 AM Central Daylight Time	08/06/2019 09:59:54 AM Central Daylight Time			08/06/2019 11:59:23 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	1	4		1			H1248	3	0	2020	"Tangipahoa, St. Tammany, Washington Parishes"		2	1488	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	4	0	1	4	1	H1248_004_0	9	1			06/28/2019	2020.01	06/28/2019 05:16:59 PM Central Daylight Time	08/06/2019 09:14:36 AM Central Daylight Time	08/06/2019 09:43:22 AM Central Daylight Time			08/06/2019 11:59:23 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	1	4		1			H1248	4	0	2020	"Alexandria, LC, Lafayette, Surrounding Parishes"		2	5268	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	5	0	1	4	1	H1248_005_0	9	1			06/28/2019	2020.01	06/28/2019 03:09:39 PM Central Daylight Time	08/06/2019 09:15:50 AM Central Daylight Time	08/06/2019 09:44:22 AM Central Daylight Time			08/06/2019 11:59:23 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	1	4		1			H1248	5	0	2020	Northwest Parishes		2	2256	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	6	0	1	4	1	H1248_006_0	9	1			06/28/2019	2020.01	06/28/2019 03:09:55 PM Central Daylight Time	08/06/2019 09:17:08 AM Central Daylight Time	08/06/2019 09:46:04 AM Central Daylight Time			08/06/2019 11:59:23 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	1	4		1			H1248	6	0	2020	Northeast Parishes		2	1764	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1248	801	0	1	4	1	H1248_801_0	6	1			06/13/2019	2020.01	06/13/2019 04:32:10 PM Central Daylight Time					06/18/2019 11:02:37 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	1	4		1			H1248	801	0	2020	State of Louisiana		1	8681	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;	2		1									
H1248	802	0	1	4	1	H1248_802_0	6	1			06/13/2019	2020.01	06/13/2019 04:49:59 PM Central Daylight Time					06/18/2019 11:02:37 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	1	4		1			H1248	802	0	2020	State of Louisiana		1	1	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;	2		1									
H1248	803	0	1	4	1	H1248_803_0	6	1			06/13/2019	2020.01	06/13/2019 04:54:11 PM Central Daylight Time					06/18/2019 11:02:37 AM Central Daylight Time	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Blue Cross and Blue Shield of Louisiana	www.bcbsla.com/blueadvantage	Blue Advantage (PPO)	1	4		1			H1248	803	0	2020	State of Louisiana		1	1	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;	2		1									
H1277	1	0	1	1	1	H1277_001_0	5	1		1	07/16/2019	2020.01	07/16/2019 10:03:20 AM Mountain Daylight Time	07/31/2019 08:54:54 PM Eastern Daylight Time	07/31/2019 09:06:28 PM Eastern Daylight Time			08/06/2019 11:55:36 AM Eastern Daylight Time	"ALIGN SENIOR CARE, INC."	Align Senior Care	www.alignseniorcare.com	Align Thrive (HMO I-SNP)	1	1		1			H1277	1	0	2020	Virginia (partial)		2	2737	2			1	1	3				www.PLACEHOLDER.com	www.PLACEHOLDER.com	www.alignseniorcare.com			(804)396-6412				(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		2					2					2	2			
H1277	2	0	1	1	1	H1277_002_0	6	1		1	07/17/2019	2020.01	07/17/2019 03:56:03 PM Mountain Daylight Time	08/05/2019 03:21:36 PM Eastern Daylight Time	07/31/2019 09:02:33 PM Eastern Daylight Time			08/06/2019 11:55:36 AM Eastern Daylight Time	"ALIGN SENIOR CARE, INC."	Align Senior Care	www.alignseniorcare.com	Align Connect (HMO C-SNP)	1	1		1			H1277	2	0	2020	Virginia (partial)		2	2737	2			1	4			1E+14		www.PLACEHOLDER.com	www.PLACEHOLDER.com	www.alignseniorcare.com			(804)396-6412				(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		2					2					2	2			
H1278	1	0	1	4	1	H1278_001_0	3	1			08/02/2019	2020.01	08/02/2019 10:54:05 AM Central Daylight Time	08/02/2019 10:35:44 AM Central Daylight Time	07/30/2019 06:48:06 PM Central Daylight Time			08/06/2019 10:17:26 AM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H1278	1	0	2020	Select Counties in IA and NE		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1278	3	0	1	4	1	H1278_003_0	4	1			08/02/2019	2020.01	08/02/2019 10:06:58 AM Central Daylight Time	08/02/2019 10:36:10 AM Central Daylight Time	07/30/2019 06:48:38 PM Central Daylight Time			08/05/2019 04:45:35 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H1278	3	0	2020	West Texas		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1278	4	0	1	4	1	H1278_004_0	5	1			08/05/2019	2020.01	08/05/2019 10:19:43 AM Central Daylight Time	08/02/2019 10:36:36 AM Central Daylight Time	07/30/2019 06:49:12 PM Central Daylight Time			08/05/2019 04:45:35 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H1278	4	0	2020	Austin Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1278	5	0	1	4	1	H1278_005_0	5	1			08/02/2019	2020.01	08/02/2019 10:08:57 AM Central Daylight Time	08/02/2019 10:37:04 AM Central Daylight Time	07/30/2019 06:49:46 PM Central Daylight Time			08/05/2019 04:45:35 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H1278	5	0	2020	San Antonio Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1278	7	0	1	4	1	H1278_007_0	3	1			08/02/2019	2020.01	08/02/2019 11:12:27 AM Central Daylight Time	08/02/2019 10:37:30 AM Central Daylight Time	07/30/2019 06:50:18 PM Central Daylight Time			08/06/2019 10:17:26 AM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H1278	7	0	2020	Sioux Falls Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1278	9	0	1	4	1	H1278_009_0	3	1			08/02/2019	2020.01	08/02/2019 11:13:11 AM Central Daylight Time	08/02/2019 10:37:58 AM Central Daylight Time	07/30/2019 06:50:52 PM Central Daylight Time			08/06/2019 10:17:26 AM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H1278	9	0	2020	Rapid City Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1278	10	0	1	4	1	H1278_010_0	4	1			08/02/2019	2020.01	08/02/2019 10:09:41 AM Central Daylight Time	08/02/2019 10:38:24 AM Central Daylight Time	07/30/2019 06:51:31 PM Central Daylight Time			08/05/2019 04:45:35 PM Central Daylight Time	HARKEN HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H1278	10	0	2020	Brownsville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1286	2	0	1	1	1	H1286_002_0	3	1			07/11/2019	2020.01	07/11/2019 03:29:34 PM Central Daylight Time	08/02/2019 10:38:50 AM Central Daylight Time	07/30/2019 06:52:06 PM Central Daylight Time			08/06/2019 08:51:16 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H1286	2	0	2020	Spokane County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1286	3	0	1	1	1	H1286_003_0	2	1			07/12/2019	2020.01	07/12/2019 08:39:59 AM Central Daylight Time	05/31/2019 03:17:15 PM Central Daylight Time				07/12/2019 08:42:59 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Essential (HMO)	1	1		1			H1286	3	0	2020	Spokane County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1286	9	0	1	1	1	H1286_009_0	3	1			07/12/2019	2020.01	07/12/2019 08:40:12 AM Central Daylight Time	08/02/2019 01:29:39 PM Central Daylight Time	07/30/2019 06:52:39 PM Central Daylight Time			08/06/2019 08:51:16 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H1286	9	0	2020	Spokane County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	1	0	1	1	1	H1290_001_0	5	1			07/16/2019	2020.01	07/16/2019 04:02:50 PM Eastern Daylight Time	08/01/2019 04:52:48 PM Eastern Daylight Time	08/01/2019 04:08:37 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	www.Devoted.com	Devoted Health Miami-Dade (HMO)	1	1		1			H1290	1	0	2020	Miami-Dade County		2	9974	2			2						www.Devoted.com/search-drugs	www.Devoted.com/drug-search	www.Devoted.com/search-providers	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	2	0	1	1	1	H1290_002_0	5	1			07/16/2019	2020.01	07/16/2019 02:17:09 PM Eastern Daylight Time	08/01/2019 04:54:51 PM Eastern Daylight Time	08/01/2019 04:09:34 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	www.Devoted.com	Devoted Health Broward (HMO)	1	1		1			H1290	2	0	2020	Broward County		2	14746	2			2						www.Devoted.com/search-drugs	www.Devoted.com/drug-search	www.Devoted.com/search-providers	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	3	0	1	1	1	H1290_003_0	5	1			07/16/2019	2020.01	07/16/2019 02:28:56 PM Eastern Daylight Time	08/01/2019 04:56:36 PM Eastern Daylight Time	08/01/2019 04:10:23 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	www.Devoted.com	Devoted Health Palm Beach (HMO)	1	1		1			H1290	3	0	2020	Palm Beach County		2	6520	2			2						www.Devoted.com/search-drugs	www.Devoted.com/drug-search	www.Devoted.com/search-providers	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	4	0	1	1	1	H1290_004_0	5	1			07/16/2019	2020.01	07/16/2019 03:12:52 PM Eastern Daylight Time	08/01/2019 04:59:01 PM Eastern Daylight Time	08/01/2019 04:11:14 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	www.Devoted.com	Devoted Health Greater Tampa Bay (HMO)	1	1		1			H1290	4	0	2020	Greater Tampa Bay		2	33265	2			2						www.Devoted.com/search-drugs	www.Devoted.com/drug-search	www.Devoted.com/search-providers	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	5	0	1	1	1	H1290_005_0	5	1			07/16/2019	2020.01	07/16/2019 03:14:51 PM Eastern Daylight Time	08/01/2019 05:00:26 PM Eastern Daylight Time	08/01/2019 04:12:05 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	www.Devoted.com	Devoted Health Central Florida (HMO)	1	1		1			H1290	5	0	2020	Osceola and Seminole Counties		2	2553	2			2						www.Devoted.com/search-drugs	www.Devoted.com/drug-search	www.Devoted.com/search-providers	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	6	0	1	1	1	H1290_006_0	5	1			07/16/2019	2020.01	07/16/2019 02:19:37 PM Eastern Daylight Time	08/01/2019 05:02:00 PM Eastern Daylight Time	08/01/2019 04:13:05 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	www.Devoted.com	Devoted Health Prime Miami-Dade (HMO)	1	1		1			H1290	6	0	2020	Miami-Dade County		2	11439	2			2						www.Devoted.com/search-drugs	www.Devoted.com/drug-search	www.Devoted.com/search-providers	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	7	0	1	1	1	H1290_007_0	5	1			07/16/2019	2020.01	07/16/2019 02:19:53 PM Eastern Daylight Time	08/01/2019 05:03:31 PM Eastern Daylight Time	08/01/2019 04:14:06 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	www.Devoted.com	Devoted Health Prime Broward (HMO)	1	1		1			H1290	7	0	2020	Broward County		2	9150	2			2						www.Devoted.com/search-drugs	www.Devoted.com/drug-search	www.Devoted.com/search-providers	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	8	0	1	1	1	H1290_008_0	5	1			07/16/2019	2020.01	07/16/2019 02:20:08 PM Eastern Daylight Time	08/01/2019 05:05:16 PM Eastern Daylight Time	08/01/2019 04:15:17 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	www.Devoted.com	Devoted Health Prime Palm Beach (HMO)	1	1		1			H1290	8	0	2020	Palm Beach County		2	6530	2			2						www.Devoted.com/search-drugs	www.Devoted.com/drug-search	www.Devoted.com/search-providers	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	9	0	1	1	1	H1290_009_0	5	1			07/16/2019	2020.01	07/16/2019 02:20:25 PM Eastern Daylight Time	08/01/2019 05:09:03 PM Eastern Daylight Time	08/01/2019 04:16:49 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	www.Devoted.com	Devoted Health Prime Greater Tampa Bay (HMO)	1	1		1			H1290	9	0	2020	Greater Tampa Bay		2	24670	2			2						www.Devoted.com/search-drugs	www.Devoted.com/drug-search	www.Devoted.com/search-providers	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	10	0	1	1	1	H1290_010_0	5	1			07/16/2019	2020.01	07/16/2019 02:20:40 PM Eastern Daylight Time	08/01/2019 05:11:50 PM Eastern Daylight Time	08/01/2019 04:17:58 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	www.Devoted.com	Devoted Health Prime Central Florida (HMO)	1	1		1			H1290	10	0	2020	Osceola and Seminole Counties		2	4847	2			2						www.Devoted.com/search-drugs	www.Devoted.com/drug-search	www.Devoted.com/search-providers	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	13	0	1	1	1	H1290_013_0	5	1			07/16/2019	2020.01	07/16/2019 03:44:40 PM Eastern Daylight Time	08/01/2019 05:13:31 PM Eastern Daylight Time	08/01/2019 04:20:12 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	Devoted.com	Devoted Health Miami-Dade Saver (HMO)	1	1		1			H1290	13	0	2020	Miami-Dade County		2	900	2			2						www.Devoted.com/search-drugs	www.Devoted.com	Devoted.com	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	14	0	1	1	1	H1290_014_0	5	1			07/16/2019	2020.01	07/16/2019 02:22:01 PM Eastern Daylight Time	08/01/2019 05:15:50 PM Eastern Daylight Time	08/01/2019 04:21:21 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	Devoted.com	Devoted Health Broward Saver (HMO)	1	1		1			H1290	14	0	2020	Broward County		2	900	2			2						www.Devoted.com/search-drugs	www.Devoted.com	Devoted.com	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	15	0	1	1	1	H1290_015_0	5	1			07/16/2019	2020.01		08/01/2019 05:17:16 PM Eastern Daylight Time	08/01/2019 04:22:13 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	Devoted.com	Devoted Health Palm Beach Saver (HMO)	1	1		1			H1290	15	0	2020	Palm Beach		2	900	2			2						www.Devoted.com/search-drugs	www.Devoted.com	Devoted.com	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	16	0	1	1	1	H1290_016_0	5	1			07/16/2019	2020.01	07/16/2019 03:48:26 PM Eastern Daylight Time	08/01/2019 05:18:44 PM Eastern Daylight Time	08/01/2019 04:23:23 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	Devoted.com	Devoted Health Greater Tampa Bay Saver (HMO)	1	1		1			H1290	16	0	2020	Hillsborough & Pinellas Counties		2	900	2			2						www.Devoted.com/search-drugs	www.Devoted.com	Devoted.com	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	17	0	1	1	1	H1290_017_0	5	1			07/16/2019	2020.01	07/16/2019 03:50:11 PM Eastern Daylight Time	08/01/2019 05:20:13 PM Eastern Daylight Time	08/01/2019 04:25:59 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	Devoted.com	Devoted Health Greater Tampa Bay Saver (HMO)	1	1		1			H1290	17	0	2020	Polk County		2	900	2			2						www.Devoted.com/search-drugs	www.Devoted.com	Devoted.com	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1290	18	0	1	1	1	H1290_018_0	5	1			07/16/2019	2020.01	07/16/2019 03:50:58 PM Eastern Daylight Time	08/01/2019 05:21:30 PM Eastern Daylight Time	08/01/2019 04:27:02 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	"DEVOTED HEALTH PLAN OF FLORIDA, INC."	Devoted Health	Devoted.com	Devoted Health Central Florida Saver (HMO)	1	1		1			H1290	18	0	2020	Osceola & Seminole Counties		2	900	2			2						www.Devoted.com/search-drugs	www.Devoted.com	Devoted.com	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1302	4	0	1	4	1	H1302_004_0	2	2			07/05/2019	2020.01	07/05/2019 12:58:59 PM Mountain Daylight Time	05/29/2019 04:40:26 PM Mountain Daylight Time				07/09/2019 09:13:04 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	medicare.bcidaho.com	Secure Blue no Rx (PPO)	1	4		1			H1302	4	0	2020	Select Counties in Idaho		2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindSecureBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673										(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363										2					2						2			
H1302	802	0	1	4	1	H1302_802_0	1	2			05/30/2019	2020.01	05/30/2019 12:36:02 PM Mountain Daylight Time					05/31/2019 10:48:27 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	www.bcidaho.com/medicare	Secure Blue Employer (PPO)	1	4		1			H1302	802	0	2020	Idaho		1	3000	2			2						bcidaho.com/ma_formulary	bcidaho.com/ma_formulary	www.bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673										(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363										1	2		2		1									
H1304	1	0	1	4	1	H1304_001_0	10	1			07/18/2019	2020.01	07/18/2019 10:20:37 PM Mountain Daylight Time	07/05/2019 02:09:54 PM Mountain Daylight Time				07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	1	4		1			H1304	1	0	2020	"Select Counties in Idaho/Asotin Co, WA"		2	3906	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						2			
H1304	4	0	1	4	1	H1304_004_0	11	1			07/25/2019	2020.01	07/25/2019 03:10:05 PM Mountain Daylight Time	08/05/2019 10:07:28 AM Mountain Daylight Time	07/31/2019 10:26:33 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	1	4		1			H1304	4	0	2020	"Select Counties in Idaho/Asotin Co, WA"		2	13473	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						2			
H1304	11	1	1	4	1	H1304_011_1	11	1			07/18/2019	2020.01	07/18/2019 10:21:13 PM Mountain Daylight Time	08/05/2019 10:08:34 AM Mountain Daylight Time	07/31/2019 10:28:18 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	1	4		1			H1304	11	1	2020	"Select Counties in Idaho/Asotin Co, WA"	South	2	2366	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						2			
H1304	11	2	1	4	1	H1304_011_2	11	1			07/18/2019	2020.01	07/18/2019 10:21:28 PM Mountain Daylight Time	08/05/2019 10:09:42 AM Mountain Daylight Time	07/31/2019 10:30:05 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	1	4		1			H1304	11	2	2020	"Select Counties in Idaho/Asotin Co, WA"	North	2	5966	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						2			
H1304	12	1	1	4	1	H1304_012_1	12	1			07/18/2019	2020.01	07/18/2019 10:21:48 PM Mountain Daylight Time	08/05/2019 10:10:51 AM Mountain Daylight Time	07/31/2019 10:31:54 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	1	4		1			H1304	12	1	2020	"Select Counties in Idaho/Asotin Co, WA"	South	2	6299	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						2			
H1304	12	2	1	4	1	H1304_012_2	12	1			07/18/2019	2020.01	07/18/2019 10:22:15 PM Mountain Daylight Time	08/05/2019 10:11:59 AM Mountain Daylight Time	07/31/2019 10:33:47 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	1	4		1			H1304	12	2	2020	"Select Counties in Idaho/Asotin Co, WA"	North	2	31193	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						2			
H1304	803	0	1	4	1	H1304_803_0	4	1			07/18/2019	2020.01	07/18/2019 10:22:36 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage (PPO)	1	4		1			H1304	803	0	2020	Nationwide except territories		1	12	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)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H1304	804	0	1	4	1	H1304_804_0	3	1			07/18/2019	2020.01	07/18/2019 10:23:09 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	1	4		1			H1304	804	0	2020	Nationwide except territories		1	5515	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)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H1304	805	0	1	4	1	H1304_805_0	3	1			07/18/2019	2020.01	07/18/2019 10:23:39 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx 02 (PPO)	1	4		1			H1304	805	0	2020	Nationwide except Territories		1	12	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)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H1304	806	0	1	4	1	H1304_806_0	3	1			07/18/2019	2020.01	07/18/2019 10:23:59 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx 03 (PPO)	1	4		1			H1304	806	0	2020	Nationwide except Territories		1	12	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)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H1310	1	0	1	20	8	H1310_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:07:14 PM Eastern Daylight Time		05/21/2019 01:51:31 PM Eastern Daylight Time			05/22/2019 01:13:51 PM Eastern Daylight Time	COMPREHENSIVE SENIOR CARE CORPORATION	Senior Care Partners P.A.C.E.	www.SeniorCarePartnersMI.org	Senior Care Partners PACE Dual (PACE)	8	20		1			H1310	1	0	2020	Greater Kalamazoo and Calhoun County Areas		2		2			2						mycentracare.com	mycentracare.com										(877)284-4071		(269)441-9300		(877)284-4071		(269)441-9300										(800)649-3777		(269)280-9584		(800)649-3777		(269)280-9584																
H1310	3	0	1	20	8	H1310_003_0	1	1			05/22/2019	2020.01	05/22/2019 01:08:59 PM Eastern Daylight Time		05/21/2019 01:51:30 PM Eastern Daylight Time			05/22/2019 01:13:51 PM Eastern Daylight Time	COMPREHENSIVE SENIOR CARE CORPORATION	Senior Care Partners P.A.C.E.	www.SeniorCarePartnersMI.org	Senior Care Partners PACE Medicare-only (PACE)	8	20		1			H1310	3	0	2020	Greater Kalamazoo and Calhoun County Areas		2		2			2						mycentracare.com	mycentracare.com										(877)284-4071		(269)441-9300		(877)284-4071		(269)441-9300										(800)649-3777		(269)280-9584		(800)649-3777		(269)280-9584																
H1350	6	0	1	1	1	H1350_006_0	2	1			07/09/2019	2020.01	07/09/2019 08:33:28 AM Mountain Daylight Time	05/29/2019 04:41:50 PM Mountain Daylight Time				07/09/2019 09:13:04 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	medicare.bcidaho.com	True Blue no Rx (HMO)	1	1		1			H1350	6	0	2020	Select Counties in Idaho		2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673										(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363										2					2					2	2			
H1350	9	0	1	1	1	H1350_009_0	3	1	2	1	07/09/2019	2020.01	07/09/2019 08:33:44 AM Mountain Daylight Time	08/01/2019 05:24:17 PM Mountain Daylight Time	08/01/2019 05:24:19 PM Mountain Daylight Time			08/02/2019 09:21:59 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	idahotruebluesnp.com	True Blue Special Needs Plan (HMO D-SNP)	1	1		1			H1350	9	0	2020	Select Counties in Idaho		2		2			1	3		1		2	bcidaho.com/FindASNPpharmacy	bcidaho.com/SNPDrugList	bcidaho.com/FindSNPDoctors	(888)495-2583		(208)286-3675		(888)495-2583		(208)286-3675		(855)479-3661		(855)479-3661		(888)495-2583		(208)286-3675		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	15	1	1	1	1	H1350_015_1	3	1			08/01/2019	2020.01	08/01/2019 01:52:15 PM Mountain Daylight Time	08/01/2019 05:24:20 PM Mountain Daylight Time	08/01/2019 05:24:22 PM Mountain Daylight Time			08/02/2019 09:21:59 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Option I (HMO)	1	1		1			H1350	15	1	2020	Select Counties Idaho	Select Counties 1 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	15	2	1	1	1	H1350_015_2	3	1			08/01/2019	2020.01	08/01/2019 01:52:41 PM Mountain Daylight Time	08/01/2019 05:24:24 PM Mountain Daylight Time	08/01/2019 05:24:26 PM Mountain Daylight Time			08/02/2019 09:21:59 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Option I (HMO)	1	1		1			H1350	15	2	2020	Select Counties Idaho	Select Counties 2 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	16	1	1	1	1	H1350_016_1	3	1			08/01/2019	2020.01	08/01/2019 01:53:13 PM Mountain Daylight Time	08/01/2019 05:24:28 PM Mountain Daylight Time	08/01/2019 05:24:29 PM Mountain Daylight Time			08/02/2019 09:21:59 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Option II (HMO)	1	1		1			H1350	16	1	2020	Select Counties Idaho	Select Counties 1 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	16	2	1	1	1	H1350_016_2	3	1			08/01/2019	2020.01	08/01/2019 01:53:41 PM Mountain Daylight Time	08/01/2019 05:24:31 PM Mountain Daylight Time	08/01/2019 05:24:32 PM Mountain Daylight Time			08/02/2019 09:21:59 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Option II (HMO)	1	1		1			H1350	16	2	2020	Select Counties Idaho	Select Counties 2 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	19	1	1	1	1	H1350_019_1	3	1			08/01/2019	2020.01	08/01/2019 01:54:21 PM Mountain Daylight Time	08/01/2019 05:24:34 PM Mountain Daylight Time	08/01/2019 05:24:36 PM Mountain Daylight Time			08/02/2019 09:21:59 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx (HMO)	1	1		1			H1350	19	1	2020	Select Counties Idaho	Select Counties 1 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	19	2	1	1	1	H1350_019_2	3	1			08/01/2019	2020.01	08/01/2019 01:54:56 PM Mountain Daylight Time	08/01/2019 05:24:38 PM Mountain Daylight Time	08/01/2019 05:24:39 PM Mountain Daylight Time			08/02/2019 09:21:59 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx (HMO)	1	1		1			H1350	19	2	2020	Select Counties Idaho	Select Counties 2 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	21	0	1	1	1	H1350_021_0	3	1			08/01/2019	2020.01	08/01/2019 01:55:24 PM Mountain Daylight Time	08/01/2019 05:24:41 PM Mountain Daylight Time	08/01/2019 05:24:44 PM Mountain Daylight Time			08/02/2019 09:21:59 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Preferred (HMO)	1	1		1			H1350	21	0	2020	Ada and Canyon counties		2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBluePreferredDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	1	1	4b;7a;8a2;8b3;	
H1350	22	1	1	1	1	H1350_022_1	3	1			08/01/2019	2020.01	08/01/2019 01:56:49 PM Mountain Daylight Time	08/01/2019 05:24:47 PM Mountain Daylight Time	08/01/2019 05:24:50 PM Mountain Daylight Time			08/02/2019 09:21:59 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Gem (HMO)	1	1		1			H1350	22	1	2020	Select Counties in Idaho	Select Counties 1 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	22	2	1	1	1	H1350_022_2	3	1			08/01/2019	2020.01	08/01/2019 01:58:22 PM Mountain Daylight Time	08/01/2019 05:24:52 PM Mountain Daylight Time	08/01/2019 05:24:54 PM Mountain Daylight Time			08/02/2019 09:21:59 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx Gem (HMO)	1	1		1			H1350	22	2	2020	Select Counties in Idaho	Select Counties 2 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	23	1	1	1	1	H1350_023_1	3	1			08/01/2019	2020.01	08/01/2019 01:59:18 PM Mountain Daylight Time	08/01/2019 05:24:56 PM Mountain Daylight Time	08/01/2019 05:24:57 PM Mountain Daylight Time			08/02/2019 09:21:59 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx St Luke's Health Partners (HMO)	1	1		1			H1350	23	1	2020	Select Counties in Idaho	Select Counties 1 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueStLukesHealthPartnersDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	23	2	1	1	1	H1350_023_2	3	1			08/01/2019	2020.01	08/01/2019 01:59:43 PM Mountain Daylight Time	08/01/2019 05:24:59 PM Mountain Daylight Time	08/01/2019 05:25:01 PM Mountain Daylight Time			08/02/2019 09:21:59 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	medicare.bcidaho.com	True Blue Rx St Luke's Health Partners (HMO)	1	1		1			H1350	23	2	2020	Select Counties in Idaho	Select Counties 2 Idaho	2		2			2						bcidaho.com/FindAPharmacy	bcidaho.com/DrugList	bcidaho.com/FindTrueBlueStLukesHealthPartnersDoctors	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		2					2					2	2			
H1350	803	0	1	1	1	H1350_803_0	1	1			05/29/2019	2020.01	05/29/2019 08:29:39 AM Mountain Daylight Time					05/31/2019 10:48:27 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	bcidaho.com/medicare	True Blue Employer (HMO)	1	1		1			H1350	803	0	2020	Idaho		1	3000	2			2						bcidaho.com/ma_formulary	bcidaho.com/ma_formulary	bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673										(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363										1	2		2		1					1				
H1350	804	0	1	1	1	H1350_804_0	1	1			05/29/2019	2020.01	05/29/2019 08:30:07 AM Mountain Daylight Time					05/31/2019 10:48:27 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	bcidaho.com/medicare	True Blue Employer (HMO)	1	1		1			H1350	804	0	2020	Idaho		1	3000	2			2						bcidaho.com/ma_formulary	bcidaho.com/ma_formulary	bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		1	2		2		1					1				
H1350	805	0	1	1	1	H1350_805_0	1	1			05/29/2019	2020.01	05/29/2019 08:32:01 AM Mountain Daylight Time					05/31/2019 10:48:27 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	bcidaho.com/medicare	True Blue Employer (HMO)	1	1		1			H1350	805	0	2020	Idaho		1	3000	2			2						bcidaho.com/ma_formulary	bcidaho.com/ma_formulary	bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		1	2		2		1					1				
H1350	806	0	1	2	1	H1350_806_0	1	1			05/29/2019	2020.01	05/29/2019 08:33:00 AM Mountain Daylight Time					05/31/2019 10:48:27 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	bcidaho.com/medicare	True Blue Employer (HMO-POS)	1	2		1			H1350	806	0	2020	Idaho		1	3000	2			2						bcidaho.com/ma_formulary	bcidaho.com/ma_formulary	bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		1	2		2		1	2		2		1				
H1350	807	0	1	2	1	H1350_807_0	1	1			05/29/2019	2020.01	05/29/2019 08:33:29 AM Mountain Daylight Time					05/31/2019 10:48:27 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	bcidaho.com/medicare	True Blue Employer (HMO-POS)	1	2		1			H1350	807	0	2020	Idaho		1	3000	2			2						bcidaho.com/ma_formulary	bcidaho.com/ma_formulary	bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		1	2		2		1	2		2		1				
H1350	808	0	1	1	1	H1350_808_0	1	1			05/29/2019	2020.01	05/29/2019 08:33:58 AM Mountain Daylight Time					05/31/2019 10:48:27 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	bcidaho.com/medicare	True Blue Employer (HMO)	1	1		1			H1350	808	0	2020	Idaho		1	3000	2			2						bcidaho.com/ma_formulary	bcidaho.com/ma_formulary	bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		1	2		2		1					1				
H1350	809	0	1	1	1	H1350_809_0	1	1			05/29/2019	2020.01	05/29/2019 08:34:08 AM Mountain Daylight Time					05/31/2019 10:48:27 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	bcidaho.com/medicare	True Blue Employer (HMO)	1	1		1			H1350	809	0	2020	Idaho		1	3000	2			2						bcidaho.com/ma_formulary	bcidaho.com/ma_formulary	bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		1	2		2		1					1				
H1350	810	0	1	2	1	H1350_810_0	1	1			05/29/2019	2020.01	05/29/2019 08:34:32 AM Mountain Daylight Time					05/31/2019 10:48:27 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	bcidaho.com/medicare	True Blue Employer (HMO-POS)	1	2		1			H1350	810	0	2020	Idaho		1	3000	2			2						bcidaho.com/ma_formulary	bcidaho.com/ma_formulary	bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		1	2		2		1	2		2		1				
H1350	811	0	1	2	1	H1350_811_0	1	1			05/29/2019	2020.01	05/29/2019 08:34:57 AM Mountain Daylight Time					05/31/2019 10:48:27 AM Mountain Daylight Time	"BLUE CROSS OF IDAHO CARE PLUS, INC."	Blue Cross of Idaho	bcidaho.com/medicare	True Blue Employer (HMO-POS)	1	2		1			H1350	811	0	2020	Idaho		1	3000	2			2						bcidaho.com/ma_formulary	bcidaho.com/ma_formulary	bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)286-3673		(855)479-3661		(855)479-3661		(888)492-2583		(208)286-3673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(711)-		(711)-		(800)377-1363		(800)377-1363		1	2		2		1	2		2		1				
H1352	1	0	1	1	1	H1352_001_0	16	1			07/17/2019	2020.01	07/17/2019 01:45:12 PM Central Daylight Time	08/06/2019 09:31:48 AM Central Daylight Time	08/06/2019 09:32:07 AM Central Daylight Time			08/06/2019 09:35:27 AM Central Daylight Time	"BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC."	Blue Cross and Blue Shield of Kansas City (Blue KC	www.MedicareBlueKC.com	Blue Medicare Advantage Complete (HMO)	1	1		1			H1352	1	0	2020	Kansas City Area		2		2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1352	2	0	1	1	1	H1352_002_0	16	1			07/17/2019	2020.01	07/17/2019 01:45:33 PM Central Daylight Time	08/06/2019 09:31:48 AM Central Daylight Time	08/06/2019 09:32:08 AM Central Daylight Time			08/06/2019 09:35:27 AM Central Daylight Time	"BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC."	Blue Cross and Blue Shield of Kansas City (Blue KC	www.MedicareBlueKC.com	Blue Medicare Advantage Plus (HMO)	1	1		1			H1352	2	0	2020	Kansas City Area		2		2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1352	801	0	1	1	1	H1352_801_0	3	1			05/30/2019	2020.01	05/30/2019 07:14:57 PM Central Daylight Time					06/03/2019 01:51:23 PM Central Daylight Time	"BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC."	Blue Cross and Blue Shield of Kansas City (Blue KC	www.MedicareBlueKC.com	Blue Medicare Advantage Employer Group Plan MA-CY (HMO)	1	1		1			H1352	801	0	2020	Kansas City Area		1	13200	2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7e;7g;7h;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1					1				
H1352	803	0	1	1	1	H1352_803_0	3	1			05/30/2019	2020.01	05/30/2019 07:15:16 PM Central Daylight Time					06/03/2019 01:51:23 PM Central Daylight Time	"BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC."	Blue Cross and Blue Shield of Kansas City (Blue KC	www.MedicareBlueKC.com	Blue Medicare Advantage Employer Group Plan MAPDCY (HMO)	1	1		1			H1352	803	0	2020	Kansas City Area		1	13200	2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7e;7g;7h;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1					1				
H1352	804	0	1	1	1	H1352_804_0	3	1			05/30/2019	2020.01	05/30/2019 07:15:40 PM Central Daylight Time					06/03/2019 01:51:23 PM Central Daylight Time	"BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC."	Blue Cross and Blue Shield of Kansas City (Blue KC	www.MedicareBlueKC.com	Blue Medicare Advantage Employer Group Plan MAPDBY (HMO)	1	1		1			H1352	804	0	2020	Kansas City Area		1	13200	2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7e;7g;7h;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1					1				
H1353	1	0	1	1	1	H1353_001_0	4	1			07/11/2019	2020.01	07/11/2019 02:05:09 PM Eastern Daylight Time	08/02/2019 04:48:24 AM Eastern Daylight Time	07/30/2019 09:59:10 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE OF WASHINGTON, INC."	Wellcare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H1353	1	0	2020	Select counties in WA		2	2980	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1353	2	0	1	1	1	H1353_002_0	5	1	2	1	07/12/2019	2020.01	07/12/2019 03:17:02 PM Eastern Daylight Time	08/02/2019 04:49:59 AM Eastern Daylight Time	07/30/2019 09:59:46 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE OF WASHINGTON, INC."	Wellcare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H1353	2	0	2020	Select counties in WA		2	535	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1353	3	0	1	1	1	H1353_003_0	4	1			07/12/2019	2020.01	07/12/2019 05:29:17 PM Eastern Daylight Time	08/04/2019 06:00:03 PM Eastern Daylight Time	07/30/2019 10:00:23 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE OF WASHINGTON, INC."	Wellcare	www.wellcare.com/medicare	WellCare Plus (HMO)	1	1		1			H1353	3	0	2020	Select counties in WA		2	12	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1353	4	0	1	1	1	H1353_004_0	4	1	2	1	07/12/2019	2020.01	07/12/2019 05:29:53 PM Eastern Daylight Time	08/02/2019 02:57:21 PM Eastern Daylight Time	07/30/2019 10:00:59 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE OF WASHINGTON, INC."	Wellcare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H1353	4	0	2020	Select counties in WA		2	2613	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1353	5	0	1	1	1	H1353_005_0	4	1			07/11/2019	2020.01	07/11/2019 02:03:12 PM Eastern Daylight Time	08/02/2019 04:54:44 AM Eastern Daylight Time	07/30/2019 10:01:35 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE OF WASHINGTON, INC."	Wellcare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H1353	5	0	2020	Select counties in WA		2	2627	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1357	1	0	1	20	8	H1357_001_0	1	1			05/23/2019	2020.01	05/23/2019 10:27:30 AM Eastern Daylight Time		05/20/2019 01:33:57 PM Eastern Daylight Time			05/23/2019 10:29:47 AM Eastern Daylight Time	CAROLINA SENIORCARE	Carolina SeniorCare	http://www.carolinaseniorcare.org/	Carolina SeniorCare (PACE)	8	20		1			H1357	1	0	2020	Carolina SeniorCare		2		2			2						https://www.carolinaseniorcare.org/	https://www.carolinaseniorcare.org/										(800)223-4476		(336)746-3500		(800)223-4476		(336)746-3500										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H1357	2	0	1	20	8	H1357_002_0	1	1			05/23/2019	2020.01	05/23/2019 10:27:51 AM Eastern Daylight Time		05/20/2019 01:34:32 PM Eastern Daylight Time			05/23/2019 10:29:47 AM Eastern Daylight Time	CAROLINA SENIORCARE	Carolina SeniorCare	http://www.carolinaseniorcare.org/	Carolina SeniorCare (PACE)	8	20		1			H1357	2	0	2020	Carolina SeniorCare		2		2			2						https://www.carolinaseniorcare.org/	https://www.carolinaseniorcare.org/										(800)223-4476		(336)746-3500		(800)223-4476		(336)746-3500										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H1365	1	0	1	4	1	H1365_001_0	6	1			07/26/2019	2020.01	07/26/2019 02:20:19 PM Eastern Daylight Time	08/05/2019 01:19:50 PM Eastern Daylight Time	08/05/2019 01:19:51 PM Eastern Daylight Time			08/05/2019 02:20:17 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Select (PPO)	1	4		1			H1365	1	0	2020	Southern Maine & Southern New Hampshire		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			
H1365	2	0	1	4	1	H1365_002_0	6	1			07/17/2019	2020.01	07/17/2019 04:57:10 PM Eastern Daylight Time	08/05/2019 01:19:52 PM Eastern Daylight Time	08/05/2019 01:19:54 PM Eastern Daylight Time			08/05/2019 02:20:17 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Select (PPO)	1	4		1			H1365	2	0	2020	Northern Maine & Northern New Hampshire		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			
H1365	802	0	1	4	1	H1365_802_0	2	1			05/07/2019	2020.01	05/07/2019 11:36:31 AM Eastern Daylight Time					06/01/2019 08:09:03 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Premier Group (PPO)	1	4		1			H1365	802	0	2020	National		1	0	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			
H1365	803	0	1	4	1	H1365_803_0	2	1			04/15/2019	2020.01	04/15/2019 01:03:26 PM Eastern Daylight Time					06/01/2019 08:09:03 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Premier Group (PPO)	1	4		1			H1365	803	0	2020	National		1	0	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			
H1372	1	0	1	1	1	H1372_001_0	5	1		1	06/25/2019	2020.01	06/25/2019 10:17:38 PM Central Daylight Time	08/01/2019 04:02:01 PM Central Daylight Time	07/31/2019 03:18:41 PM Central Daylight Time			08/05/2019 03:45:39 PM Central Daylight Time	"MARQUIS ADVANTAGE, INC."	AgeRight Advantage	www.agerightadvantage.com	AgeRight Advantage Health Plan (HMO I-SNP)	1	1		1			H1372	1	0	2020	"OR Counties: CLK, KLA, LAN, MUL, WSH & YAM"		2	10356	2			1	1	3				www.agerightadvantage.com	www.agerightadvantage.com	www.agerightadvantage.com	(844)854-6885		(844)854-6885		(844)854-6885		(844)854-6885		(844)854-6885		(844)854-6885		(844)854-6885		(844)854-6885		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1375	1	0	1	1	1	H1375_001_0	2	1	2	1	05/29/2019	2020.01	05/29/2019 05:57:11 PM Central Daylight Time	08/02/2019 10:40:09 AM Central Daylight Time	07/30/2019 06:53:13 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	"UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC"	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H1375	1	0	2020	Alameda County		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.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	2			
H1375	2	0	1	1	1	H1375_002_0	3	1	2	1	07/11/2019	2020.01	07/11/2019 01:50:29 PM Central Daylight Time	08/02/2019 10:40:38 AM Central Daylight Time	07/30/2019 06:53:46 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	"UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC"	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H1375	2	0	2020	"Fresno, Kings, and Madera Counties"		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.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	2			
H1393	1	0	1	4	1	H1393_001_0	7	1			07/16/2019	2020.01	07/16/2019 12:19:50 PM Central Daylight Time	08/02/2019 04:26:27 PM Central Daylight Time	08/02/2019 05:00:20 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF TENNESSEE	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex Choice (PPO)	1	4		1			H1393	1	0	2020	Nashville Metro Area		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1393	2	0	1	4	1	H1393_002_0	7	1			07/16/2019	2020.01	07/16/2019 12:18:39 PM Central Daylight Time	08/02/2019 04:26:23 PM Central Daylight Time	08/02/2019 04:59:54 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF TENNESSEE	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex Plus (PPO)	1	4		1			H1393	2	0	2020	Nashville Metro Area		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1393	3	0	1	4	1	H1393_003_0	7	1			07/16/2019	2020.01	07/16/2019 12:20:56 PM Central Daylight Time	08/02/2019 04:26:18 PM Central Daylight Time	08/02/2019 04:59:07 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF TENNESSEE	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex Choice (PPO)	1	4		1			H1393	3	0	2020	"Fayette, Haywood, and Shelby Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-5489		(844)221-5489		(833)412-7710		(833)412-7710		(844)221-5489		(844)221-5489		(833)412-7710		(833)412-7710		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1393	4	0	1	4	1	H1393_004_0	7	1			08/01/2019	2020.01	08/01/2019 02:44:53 PM Central Daylight Time	08/02/2019 04:26:10 PM Central Daylight Time	08/02/2019 04:58:20 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF TENNESSEE	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Assist (PPO)	1	4		1			H1393	4	0	2020	"Fayette, Haywood, and Shelby Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-5489		(844)221-5489		(833)412-7710		(833)412-7710		(844)221-5489		(844)221-5489		(833)412-7710		(833)412-7710		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1415	13	0	1	1	1	H1415_013_0	3	1			07/08/2019	2020.01	07/08/2019 04:37:03 PM Central Daylight Time	05/29/2019 02:59:28 PM Central Daylight Time				07/12/2019 02:10:55 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	1	1		1			H1415	13	0	2020	Chicago Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)721-1535		(855)721-1535										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1415	21	0	1	2	1	H1415_021_0	4	1			07/08/2019	2020.01	07/08/2019 04:37:44 PM Central Daylight Time	07/31/2019 04:52:01 PM Central Daylight Time	07/30/2019 04:11:20 PM Central Daylight Time			08/02/2019 11:28:40 AM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	1	2		1			H1415	21	0	2020	Chicago Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)721-1535		(855)721-1535		(800)668-3813		(800)668-3813		(855)721-1535		(855)721-1535		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1415	24	0	1	1	1	H1415_024_0	4	1			07/08/2019	2020.01	07/08/2019 04:38:38 PM Central Daylight Time	07/31/2019 04:52:23 PM Central Daylight Time	07/30/2019 04:11:34 PM Central Daylight Time			08/02/2019 11:28:40 AM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H1415	24	0	2020	Chicago Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)721-1535		(855)721-1535		(800)668-3813		(800)668-3813		(855)721-1535		(855)721-1535		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	9	0	1	2	1	H1416_009_0	5	1			07/11/2019	2020.01	07/11/2019 12:54:18 PM Eastern Daylight Time	08/02/2019 04:56:20 AM Eastern Daylight Time	07/30/2019 10:02:11 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	1	2		1			H1416	9	0	2020	Select counties in IL		2	93080	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	23	0	1	1	1	H1416_023_0	5	1			05/29/2019	2020.01	05/29/2019 10:14:57 AM Eastern Daylight Time	08/02/2019 04:57:58 AM Eastern Daylight Time	07/30/2019 10:02:46 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	1	1		1			H1416	23	0	2020	Select counties in IL		2	49287	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	24	0	1	2	1	H1416_024_0	6	1			06/01/2019	2020.01	06/01/2019 12:52:19 PM Eastern Daylight Time	08/02/2019 04:59:33 AM Eastern Daylight Time	07/30/2019 10:03:23 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Choice (HMO-POS)	1	2		1			H1416	24	0	2020	Select counties in IL		2	4716	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	26	0	1	2	1	H1416_026_0	6	1			07/11/2019	2020.01	07/11/2019 01:29:59 PM Eastern Daylight Time	08/02/2019 05:01:23 AM Eastern Daylight Time	07/30/2019 10:04:00 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H1416	26	0	2020	Select Counties in MS		2	51281	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	31	0	1	2	1	H1416_031_0	6	1			07/11/2019	2020.01	07/11/2019 12:57:34 PM Eastern Daylight Time	08/02/2019 05:03:25 AM Eastern Daylight Time	07/30/2019 10:04:36 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	1	2		1			H1416	31	0	2020	Select Counties in TN		2	16561	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	32	0	1	2	1	H1416_032_0	6	1			07/11/2019	2020.01	07/11/2019 01:31:07 PM Eastern Daylight Time	08/02/2019 05:05:16 AM Eastern Daylight Time	07/30/2019 10:05:12 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO-POS)	1	2		1			H1416	32	0	2020	Select Counties in AR		2	29341	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	33	0	1	2	1	H1416_033_0	6	1	2	1	07/12/2019	2020.01	07/12/2019 11:56:14 AM Eastern Daylight Time	08/02/2019 02:59:12 PM Eastern Daylight Time	07/30/2019 10:05:48 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO-POS D-SNP)	1	2		1			H1416	33	0	2020	Select Counties in AR		2	48271	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	34	0	1	1	1	H1416_034_0	5	1	2	1	07/12/2019	2020.01	07/12/2019 11:57:18 AM Eastern Daylight Time	08/02/2019 05:08:58 AM Eastern Daylight Time	07/30/2019 10:06:23 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H1416	34	0	2020	Select Counties in MS		2	108468	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	35	0	1	1	1	H1416_035_0	5	1	2	1	07/12/2019	2020.01	07/12/2019 11:58:08 AM Eastern Daylight Time	08/02/2019 05:11:03 AM Eastern Daylight Time	07/30/2019 10:06:59 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H1416	35	0	2020	Select Counties in TN		2	46496	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	36	0	1	1	1	H1416_036_0	5	1	2	1	07/12/2019	2020.01	07/12/2019 12:00:26 PM Eastern Daylight Time	08/02/2019 05:12:41 AM Eastern Daylight Time	07/30/2019 10:07:36 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H1416	36	0	2020	Select Counties in SC		2	33899	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	38	0	1	1	1	H1416_038_0	7	1			07/12/2019	2020.01	07/12/2019 11:59:28 AM Eastern Daylight Time	08/02/2019 05:14:31 AM Eastern Daylight Time	07/30/2019 10:08:11 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H1416	38	0	2020	Select Counties in MS		2	149901	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	39	0	1	1	1	H1416_039_0	6	1			07/11/2019	2020.01	07/11/2019 01:20:28 PM Eastern Daylight Time	08/02/2019 05:16:19 AM Eastern Daylight Time	07/30/2019 10:08:47 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1416	39	0	2020	Select Counties in TN		2	33852	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	41	0	1	1	1	H1416_041_0	6	1			07/12/2019	2020.01	07/12/2019 12:02:09 PM Eastern Daylight Time	08/02/2019 05:18:11 AM Eastern Daylight Time	07/30/2019 10:09:23 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	1	1		1			H1416	41	0	2020	Select Counties in AR		2	54958	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	42	0	1	1	1	H1416_042_0	6	1			07/12/2019	2020.01	07/12/2019 12:03:24 PM Eastern Daylight Time	08/02/2019 05:20:07 AM Eastern Daylight Time	07/30/2019 10:09:59 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	1	1		1			H1416	42	0	2020	Select Counties in TN		2	25931	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	43	0	1	2	1	H1416_043_0	6	1	2	1	08/02/2019	2020.01	08/02/2019 02:07:15 PM Eastern Daylight Time	08/02/2019 10:53:39 AM Eastern Daylight Time	07/30/2019 10:10:35 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO-POS D-SNP)	1	2		1			H1416	43	0	2020	Select Counties in AR		2	21035	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	44	0	1	1	1	H1416_044_0	6	1	2	1	07/12/2019	2020.01	07/12/2019 12:04:50 PM Eastern Daylight Time	08/02/2019 05:23:56 AM Eastern Daylight Time	07/30/2019 10:11:11 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H1416	44	0	2020	Select Counties in MS		2	31999	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	48	0	1	1	1	H1416_048_0	5	1			07/11/2019	2020.01	07/11/2019 01:09:19 PM Eastern Daylight Time	08/04/2019 06:11:05 PM Eastern Daylight Time	07/30/2019 10:11:46 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Plus (HMO)	1	1		1			H1416	48	0	2020	Select counties in IL		2	71257	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	53	0	1	2	1	H1416_053_0	5	1			07/11/2019	2020.01	07/11/2019 01:10:05 PM Eastern Daylight Time	06/02/2019 06:33:42 AM Eastern Daylight Time				07/12/2019 08:57:50 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO-POS)	1	2		1			H1416	53	0	2020	Select counties in IL		2	1103	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1416	55	0	1	1	1	H1416_055_0	6	1			07/12/2019	2020.01	07/12/2019 12:05:56 PM Eastern Daylight Time	08/02/2019 04:24:06 PM Eastern Daylight Time	07/30/2019 10:12:23 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Preferred (HMO)	1	1		1			H1416	55	0	2020	Selected Counties in AR		2	75834	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	56	0	1	1	1	H1416_056_0	6	1			07/01/2019	2020.01	07/01/2019 11:55:56 AM Eastern Daylight Time	08/02/2019 05:30:46 AM Eastern Daylight Time	07/30/2019 10:12:59 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H1416	56	0	2020	Select counties in SC		2	41183	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	57	0	1	1	1	H1416_057_0	6	1			07/01/2019	2020.01	07/01/2019 11:56:11 AM Eastern Daylight Time	08/02/2019 05:32:20 AM Eastern Daylight Time	07/30/2019 10:13:35 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H1416	57	0	2020	Select counties in SC		2	9499	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	58	0	1	2	1	H1416_058_0	3	1			05/29/2019	2020.01	05/29/2019 09:54:09 AM Eastern Daylight Time	06/02/2019 06:37:07 AM Eastern Daylight Time				06/02/2019 05:25:31 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO-POS)	1	2		1			H1416	58	0	2020	Selected Counties in AR		2	7456	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1416	59	0	1	2	1	H1416_059_0	3	1			05/29/2019	2020.01	05/29/2019 08:15:29 PM Eastern Daylight Time	06/02/2019 06:37:59 AM Eastern Daylight Time				06/02/2019 05:25:31 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO-POS)	1	2		1			H1416	59	0	2020	Select counties in SC		2	2782	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1416	60	0	1	2	1	H1416_060_0	4	1			07/12/2019	2020.01	07/12/2019 12:07:52 PM Eastern Daylight Time	06/02/2019 06:38:49 AM Eastern Daylight Time				07/12/2019 08:57:50 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO-POS)	1	2		1			H1416	60	0	2020	Select counties in MS		2	5235	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1416	61	0	1	2	1	H1416_061_0	3	1			05/29/2019	2020.01	05/29/2019 11:45:49 AM Eastern Daylight Time	06/02/2019 06:39:41 AM Eastern Daylight Time				06/02/2019 05:25:31 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO-POS)	1	2		1			H1416	61	0	2020	Selected counties in TN		2	4035	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1416	62	0	1	1	1	H1416_062_0	5	1			07/12/2019	2020.01	07/12/2019 12:09:18 PM Eastern Daylight Time	08/02/2019 03:04:04 PM Eastern Daylight Time	07/30/2019 10:14:11 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Plus (HMO)	1	1		1			H1416	62	0	2020	Selected Counties in MS		2	1085	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	63	0	1	1	1	H1416_063_0	5	1			07/11/2019	2020.01	07/11/2019 01:15:37 PM Eastern Daylight Time	08/02/2019 03:06:19 PM Eastern Daylight Time	07/30/2019 10:14:47 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Plus (HMO)	1	1		1			H1416	63	0	2020	Selected Counties in TN		2	472	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	64	0	1	1	1	H1416_064_0	5	1			07/11/2019	2020.01	07/11/2019 01:16:47 PM Eastern Daylight Time	08/02/2019 05:45:23 AM Eastern Daylight Time	07/30/2019 10:15:25 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1416	64	0	2020	Selected counties in AR		2	9971	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	65	0	1	1	1	H1416_065_0	5	1			07/11/2019	2020.01	07/11/2019 01:26:01 PM Eastern Daylight Time	08/02/2019 05:47:11 AM Eastern Daylight Time	07/30/2019 10:16:00 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H1416	65	0	2020	Selected counties in MS		2	9971	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1416	66	0	1	1	1	H1416_066_0	5	1		1	05/29/2019	2020.01	05/29/2019 09:30:57 AM Eastern Daylight Time	08/02/2019 05:48:44 AM Eastern Daylight Time	07/30/2019 10:16:36 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"HARMONY HEALTH PLAN,  INC."	WellCare	www.wellcare.com/medicare	WellCare Guardian (HMO C-SNP)	1	1		1			H1416	66	0	2020	Selected counties in IL		2	670	2			1	4			1E+13		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1426	1	0	1	1	1	H1426_001_0	3	1			08/01/2019	2020.01	08/01/2019 12:13:45 PM Pacific Daylight Time	08/05/2019 12:12:18 PM Pacific Daylight Time	08/05/2019 12:12:54 PM Pacific Daylight Time			08/05/2019 12:17:18 PM Pacific Daylight Time	"VITALITY HEALTH PLAN OF CALIFORNIA, INC."	Vitality Health Plan of California	www.VitalityHP.net	Choice (HMO)	1	1		1			H1426	1	0	2020	San Joaquin County		2		2			2						www.VitalityHP.net	www.VitalityHP.net	www.VitalityHP.net	(866)333-3530		(866)333-3530		(866)333-3530		(866)333-3530		(888)254-9907		(888)254-9907		(866)333-3530		(866)333-3530		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1426	2	0	1	1	1	H1426_002_0	3	1			08/05/2019	2020.01	08/05/2019 12:16:47 PM Pacific Daylight Time	08/05/2019 12:12:19 PM Pacific Daylight Time	08/05/2019 12:12:54 PM Pacific Daylight Time			08/05/2019 12:17:18 PM Pacific Daylight Time	"VITALITY HEALTH PLAN OF CALIFORNIA, INC."	Vitality Health Plan of California	www.VitalityHP.net	Choice (HMO)	1	1		1			H1426	2	0	2020	Santa Clara County		2		2			2						www.VitalityHP.net	www.VitalityHP.net	www.VitalityHP.net	(866)333-3530		(866)333-3530		(866)333-3530		(866)333-3530		(888)254-9907		(888)254-9907		(866)333-3530		(866)333-3530		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1426	3	0	1	1	1	H1426_003_0	3	1			08/05/2019	2020.01	08/05/2019 11:49:13 AM Pacific Daylight Time	08/05/2019 12:12:18 PM Pacific Daylight Time	08/05/2019 12:12:54 PM Pacific Daylight Time			08/05/2019 12:17:18 PM Pacific Daylight Time	"VITALITY HEALTH PLAN OF CALIFORNIA, INC."	Vitality Health Plan of California	www.VitalityHP.net	Plus (HMO)	1	1		1			H1426	3	0	2020	San Joaquin and Santa Clara counties		2		2			2						www.VitalityHP.net	www.VitalityHP.net	www.VitalityHP.net	(866)333-3530		(866)333-3530		(866)333-3530		(866)333-3530		(888)254-9907		(888)254-9907		(866)333-3530		(866)333-3530		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	2	0	1	1	1	H1436_002_0	4	1			08/01/2019	2020.01	08/01/2019 01:15:44 PM Eastern Daylight Time	08/05/2019 04:14:22 PM Central Daylight Time	08/05/2019 03:08:35 PM Central Daylight Time			08/06/2019 08:51:25 AM Central Daylight Time	"ABSOLUTE TOTAL CARE, INC."	Allwell	allwell.absolutetotalcare.com	Allwell Medicare (HMO)	1	1		1			H1436	2	0	2020	Greater Charleston Area		2		2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	4	0	1	1	1	H1436_004_0	4	1			08/01/2019	2020.01	08/01/2019 01:16:02 PM Eastern Daylight Time	08/05/2019 04:14:29 PM Central Daylight Time	08/05/2019 03:08:29 PM Central Daylight Time			08/06/2019 08:51:25 AM Central Daylight Time	"ABSOLUTE TOTAL CARE, INC."	Allwell	allwell.absolutetotalcare.com	Allwell Medicare (HMO)	1	1		1			H1436	4	0	2020	Greater Greenville/Spartanburg Area		2		2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	5	0	1	1	1	H1436_005_0	5	1	2	1	08/01/2019	2020.01	08/01/2019 01:17:28 PM Eastern Daylight Time	08/05/2019 04:14:17 PM Central Daylight Time	08/05/2019 03:08:33 PM Central Daylight Time			08/06/2019 08:51:25 AM Central Daylight Time	"ABSOLUTE TOTAL CARE, INC."	Allwell	allwell.absolutetotalcare.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H1436	5	0	2020	Statewide		2		2			1	3		1		1	allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1436	801	0	1	1	1	H1436_801_0	2	1			05/13/2019	2020.01	05/13/2019 03:27:28 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"ABSOLUTE TOTAL CARE, INC."	Allwell	allwell.absolutetotalcare.com	Allwell Group (HMO)	1	1		1			H1436	801	0	2020	South Carolina		1	100	2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1436	802	0	1	1	1	H1436_802_0	2	1			05/03/2019	2020.01	05/03/2019 10:48:32 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"ABSOLUTE TOTAL CARE, INC."	Allwell	allwell.absolutetotalcare.com	Allwell Group (HMO)	1	1		1			H1436	802	0	2020	South Carolina		1	100	2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1436	803	0	1	1	1	H1436_803_0	2	1			05/03/2019	2020.01	05/03/2019 10:49:00 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"ABSOLUTE TOTAL CARE, INC."	Allwell	allwell.absolutetotalcare.com	Allwell Group (HMO)	1	1		1			H1436	803	0	2020	South Carolina		1	100	2			2						allwell.absolutetotalcare.com/findadoctor	allwell.absolutetotalcare.com/formulary	allwell.absolutetotalcare.com/findadoctor	(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(855)766-1497		(855)766-1497		(877)893-7276		(877)893-7276		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1463	3	0	1	1	1	H1463_003_0	9	1			06/27/2019	2020.01	06/27/2019 04:08:50 PM Central Daylight Time	08/05/2019 10:24:14 AM Central Daylight Time	07/30/2019 04:20:53 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare HMO 20 Rx (HMO)	1	1		1			H1463	3	0	2020	"North Central, Central, Southern, & Quad Cities"		2	43397	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	8	0	1	1	1	H1463_008_0	8	1			06/27/2019	2020.01	06/27/2019 04:09:03 PM Central Daylight Time	05/31/2019 01:27:53 AM Central Daylight Time				06/27/2019 06:09:26 PM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare HMO Basic (HMO)	1	1		1			H1463	8	0	2020	"North Central, Central, Southern, & Quad Cities"		2	8717	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1463	9	0	1	1	1	H1463_009_0	11	1			06/27/2019	2020.01	06/27/2019 04:09:17 PM Central Daylight Time	08/05/2019 10:27:58 AM Central Daylight Time	07/30/2019 04:21:29 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare HMO Basic Rx (HMO)	1	1		1			H1463	9	0	2020	"North Central, Central, Southern, & Quad Cities"		2	34141	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	10	0	1	1	1	H1463_010_0	10	1			06/27/2019	2020.01	06/27/2019 04:11:55 PM Central Daylight Time	08/05/2019 10:58:59 AM Central Daylight Time	07/30/2019 04:22:10 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare HMO 40 Rx (HMO)	1	1		1			H1463	10	0	2020	"North Central, Central, Southern, & Quad Cities"		2	33159	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	12	0	1	1	1	H1463_012_0	6	1			06/27/2019	2020.01	06/27/2019 04:12:27 PM Central Daylight Time	08/05/2019 11:00:12 AM Central Daylight Time	07/30/2019 04:34:02 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Reid Health Alliance Medicare HMO Rx Plus (HMO)	1	1		1			H1463	12	0	2020	East Central IN and Western OH		2	591	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002		(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	13	0	1	1	1	H1463_013_0	6	1			06/27/2019	2020.01	06/27/2019 04:12:48 PM Central Daylight Time	08/05/2019 11:01:23 AM Central Daylight Time	07/31/2019 09:27:58 AM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Reid Health Alliance Medicare HMO Rx (HMO)	1	1		1			H1463	13	0	2020	East Central IN and Western OH		2	6005	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002		(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	14	0	1	2	1	H1463_014_0	8	1			06/27/2019	2020.01	06/27/2019 04:13:09 PM Central Daylight Time	05/31/2019 01:31:48 AM Central Daylight Time				06/27/2019 06:09:26 PM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare POS Basic (HMO-POS)	1	2		1			H1463	14	0	2020	"North Central, Central, Southern, & Quad Cities"		2	1774	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1463	15	0	1	2	1	H1463_015_0	9	1			06/27/2019	2020.01	06/27/2019 04:13:23 PM Central Daylight Time	08/05/2019 11:04:50 AM Central Daylight Time	07/30/2019 04:22:44 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare POS Basic Rx (HMO-POS)	1	2		1			H1463	15	0	2020	"North Central, Central, Southern, & Quad Cities"		2	7013	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	17	0	1	2	1	H1463_017_0	9	1			06/27/2019	2020.01	06/27/2019 04:13:37 PM Central Daylight Time	08/05/2019 11:07:04 AM Central Daylight Time	07/30/2019 04:23:23 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare POS 30 Rx (HMO-POS)	1	2		1			H1463	17	0	2020	"North Central, Central, Southern, & Quad Cities"		2	14666	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	19	0	1	2	1	H1463_019_0	9	1			06/27/2019	2020.01	06/27/2019 04:13:45 PM Central Daylight Time	08/05/2019 11:08:09 AM Central Daylight Time	07/30/2019 04:24:00 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare POS 10 Rx (HMO-POS)	1	2		1			H1463	19	0	2020	"North Central, Central, Southern, & Quad Cities"		2	27149	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	20	0	1	1	1	H1463_020_0	4	1			06/27/2019	2020.01	06/27/2019 04:14:23 PM Central Daylight Time	05/31/2019 01:34:55 AM Central Daylight Time				06/27/2019 06:09:26 PM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Reid Health Alliance Medicare HMO (HMO)	1	1		1			H1463	20	0	2020	East Central IN and Western OH		2	751	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1463	21	0	1	1	1	H1463_021_0	6	1			06/27/2019	2020.01	06/27/2019 04:14:46 PM Central Daylight Time	08/05/2019 11:12:30 AM Central Daylight Time	07/30/2019 04:24:39 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare Guide HMO Rx 2 (HMO)	1	1		1			H1463	21	0	2020	"Whiteside, Henry, Mercer, and Rock Island Counties"		2	6012	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(800)965-4022		(800)965-4022		(877)933-8454		(877)933-8454		(800)965-4022		(800)965-4022		(877)933-8454		(877)933-8454		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	22	0	1	2	1	H1463_022_0	7	1			07/09/2019	2020.01	07/09/2019 12:09:32 PM Central Daylight Time	08/05/2019 11:15:27 AM Central Daylight Time	07/30/2019 06:06:01 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	healthalliancemedicare.org	Reid Health Alliance Medicare POS Rx (HMO-POS)	1	2		1			H1463	22	0	2020	East Central IN		2	1949	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002		(877)749-3253		(877)749-3253		(877)749-3002		(877)749-3002		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	23	0	1	1	1	H1463_023_0	6	1			06/27/2019	2020.01	06/27/2019 04:15:28 PM Central Daylight Time	08/05/2019 11:16:39 AM Central Daylight Time	07/30/2019 04:25:36 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	healthalliancemedicare.org	Simplete 1 (HMO)	1	1		1			H1463	23	0	2020	Central IL		2	22331	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	24	0	1	1	1	H1463_024_0	6	1			06/27/2019	2020.01	06/27/2019 04:15:41 PM Central Daylight Time	08/05/2019 11:17:41 AM Central Daylight Time	07/30/2019 04:26:13 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	healthalliancemedicare.org	Simplete 2 (HMO)	1	1		1			H1463	24	0	2020	Eastern and Central IL		2	12588	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7a;7b;7d;7g;8a1;8a2;8b1;8b2;8b3;9a1;9b;17a;	
H1463	25	0	1	2	1	H1463_025_0	7	1			07/12/2019	2020.01	07/12/2019 01:25:52 PM Central Daylight Time	08/05/2019 11:19:52 AM Central Daylight Time	07/30/2019 04:27:33 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	healthalliancemedicare.org	Simplete 3 (HMO-POS)	1	2		1			H1463	25	0	2020	Eastern and Central IL		2	14320	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(877)933-8475		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	7a;7b;7d;7g;7j;7k;8a1;8a2;8b1;8b2;8b3;9a1;9b;9c;11c1;12;17a;	17a1;
H1463	32	0	1	1	1	H1463_032_0	6	1			06/27/2019	2020.01	06/27/2019 04:16:11 PM Central Daylight Time	08/05/2019 11:21:46 AM Central Daylight Time	07/30/2019 04:29:27 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	healthalliancemedicare.org	Simplete Riverside 1 (HMO)	1	1		1			H1463	32	0	2020	Kankakee and Iroquois Counties		2	2588	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	33	0	1	1	1	H1463_033_0	6	1			06/27/2019	2020.01	06/27/2019 04:16:33 PM Central Daylight Time	08/05/2019 11:23:07 AM Central Daylight Time	07/30/2019 04:30:37 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	healthalliancemedicare.org	Simplete Riverside 2 (HMO)	1	1		1			H1463	33	0	2020	Greater Kankakee Area of NE IL/NW IN		2	1189	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7a;7b;7d;8a1;8a2;8b1;8b2;8b3;9a1;17a;	
H1463	34	0	1	2	1	H1463_034_0	7	1			07/12/2019	2020.01	07/12/2019 01:23:57 PM Central Daylight Time	08/05/2019 11:24:16 AM Central Daylight Time	07/30/2019 04:31:08 PM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	healthalliancemedicare.org	Simplete Riverside 3 (HMO-POS)	1	2		1			H1463	34	0	2020	Greater Kankakee Area of NE IL/NW IN		2	1066	2			2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(877)933-8481		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7a;7b;7c;7d;7g;7i;7j;7k;8a1;8a2;8b1;8b2;8b3;9a1;9a2;9b;11c1;12;17a;	
H1463	35	0	1	1	1	H1463_035_0	6	1			06/27/2019	2020.01	06/27/2019 04:17:06 PM Central Daylight Time	08/05/2019 03:34:09 PM Central Daylight Time	07/31/2019 09:28:32 AM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	OSF MedAdvantage Core (HMO)	1	1		1			H1463	35	0	2020	OSF		2	10656	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)933-8480		(217)902-8910		(877)933-8480		(217)902-8910		(877)933-8480		(217)902-8910		(877)933-8480		(217)902-8910		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	3-1;3-2;3-3;3-4;7a;7c;7d;8a2;8b1;8b2;8b3;9a1;9a2;9b;12;17b;18a;	
H1463	36	0	1	2	1	H1463_036_0	7	1			07/12/2019	2020.01	07/12/2019 01:18:12 PM Central Daylight Time	08/05/2019 03:31:11 PM Central Daylight Time	07/31/2019 09:29:25 AM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	OSF MedAdvantage Open (HMO-POS)	1	2		1			H1463	36	0	2020	OSF		2	3552	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)933-8480		(217)902-8910		(877)933-8480		(217)902-8910		(877)933-8480		(217)902-8910		(877)933-8480		(217)902-8910		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	3-1;3-2;3-3;3-4;7a;7c;7d;7f;7g;7i;7j;7k;8a1;8a2;8b1;8b2;8b3;9a1;9a2;9b;9c;11c1;11c2;12;17a;17b;18a;	
H1463	37	0	1	2	1	H1463_037_0	8	1			07/12/2019	2020.01	07/12/2019 01:15:03 PM Central Daylight Time	08/05/2019 03:28:25 PM Central Daylight Time	07/31/2019 09:30:06 AM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	OSF MedAdvantage Plus (HMO-POS)	1	2		1			H1463	37	0	2020	OSF		2	1776	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)933-8480		(217)902-8910		(877)933-8480		(217)902-8910		(877)933-8480		(217)902-8910		(877)933-8480		(217)902-8910		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	3-1;3-2;3-3;3-4;7a;7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7j;7k;8a1;8a2;8b1;8b2;8b3;9a1;9a2;9b;9c;11a;11b1;11b2;11c1;11c2;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;17a;17b;18a;	14b;
H1463	38	0	1	1	1	H1463_038_0	6	1			06/27/2019	2020.01	06/27/2019 04:17:46 PM Central Daylight Time	08/05/2019 03:25:20 PM Central Daylight Time	07/31/2019 09:30:56 AM Central Daylight Time			08/06/2019 11:22:59 AM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	OSF MedAdvantage Select (HMO)	1	1		1			H1463	38	0	2020	OSF		2	1776	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)933-8480		(217)902-8910		(877)933-8480		(217)902-8910		(877)933-8480		(217)902-8910		(877)933-8480		(217)902-8910		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	801	0	1	1	1	H1463_801_0	3	1			05/23/2019	2020.01	05/23/2019 02:48:10 PM Central Daylight Time					05/31/2019 03:11:44 PM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	1	1		1			H1463	801	0	2020	Illinois		1	1800	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1463	802	0	1	1	1	H1463_802_0	3	1			05/22/2019	2020.01	05/22/2019 02:55:28 PM Central Daylight Time					05/31/2019 03:11:44 PM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	1	1		1			H1463	802	0	2020	Illinois		1	31644	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	810	0	1	1	1	H1463_810_0	2	1			05/21/2019	2020.01	05/21/2019 01:10:37 PM Central Daylight Time					05/31/2019 03:11:44 PM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO) - non calendar year (HMO)	1	1		1			H1463	810	0	2020	Illinois		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	811	0	1	2	1	H1463_811_0	3	1			05/21/2019	2020.01	05/21/2019 01:17:42 PM Central Daylight Time					05/31/2019 03:11:44 PM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO-POS (HMO-POS)	1	2		1			H1463	811	0	2020	Illinois		1	1020	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1463	812	0	1	2	1	H1463_812_0	3	1			05/21/2019	2020.01	05/21/2019 01:29:10 PM Central Daylight Time					05/31/2019 03:11:44 PM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO-POS with Rx (HMO-POS)	1	2		1			H1463	812	0	2020	Illinois		1	6204	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1463	813	0	1	2	1	H1463_813_0	3	1			05/21/2019	2020.01	05/21/2019 01:50:42 PM Central Daylight Time					05/31/2019 03:11:44 PM Central Daylight Time	"HEALTH ALLIANCE CONNECT, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO-POS with Rx (HMO-POS)	1	2		1			H1463	813	0	2020	Illinois		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(800)965-4022		(800)965-4022		(888)382-9771		(888)382-9771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1468	7	0	1	1	1	H1468_007_0	3	1			08/02/2019	2020.01	08/02/2019 10:20:45 AM Eastern Daylight Time	08/04/2019 02:51:47 PM Eastern Daylight Time	08/02/2019 01:18:09 PM Eastern Daylight Time			08/05/2019 10:54:42 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1468-007 (HMO)	1	1		1			H1468	7	0	2020	Peoria and Rockford Illinois Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1468	13	0	1	1	1	H1468_013_0	3	1			08/01/2019	2020.01	08/01/2019 03:34:42 PM Eastern Daylight Time	08/04/2019 02:54:18 PM Eastern Daylight Time	08/02/2019 01:18:09 PM Eastern Daylight Time			08/05/2019 10:54:42 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1468-013 (HMO)	1	1		1			H1468	13	0	2020	"Cook, DuPage, Lake, and Will counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1468	14	0	1	1	1	H1468_014_0	3	1			07/15/2019	2020.01	07/15/2019 11:36:25 AM Eastern Daylight Time	08/04/2019 03:00:36 PM Eastern Daylight Time	08/02/2019 01:18:09 PM Eastern Daylight Time			08/05/2019 10:54:42 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1468-014 (HMO)	1	1		1			H1468	14	0	2020	"Kane, Kendall and McHenry counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1468	17	0	1	1	1	H1468_017_0	3	1		1	08/01/2019	2020.01	08/01/2019 03:36:05 PM Eastern Daylight Time	08/04/2019 03:16:07 PM Eastern Daylight Time	08/02/2019 01:18:09 PM Eastern Daylight Time			08/05/2019 10:54:42 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Community HMO Diabetes and Heart (HMO C-SNP)	1	1		1			H1468	17	0	2020	"Cook, DuPage and Will counties"		2		2			1	4			10		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1468	18	0	1	1	1	H1468_018_0	3	1			08/01/2019	2020.01	08/01/2019 03:37:02 PM Eastern Daylight Time	08/04/2019 03:32:12 PM Eastern Daylight Time	08/02/2019 01:18:09 PM Eastern Daylight Time			08/05/2019 10:54:42 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Community Select HMO H1468-018 (HMO)	1	1		1			H1468	18	0	2020	Chicago area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1468	802	0	1	1	1	H1468_802_0	1	1			05/29/2019	2020.01	05/29/2019 10:34:15 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1468	802	0	2020	Select counties in Peoria Metro area		1	83586	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1468	803	0	1	1	1	H1468_803_0	1	1			05/29/2019	2020.01	05/29/2019 10:35:28 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1468	803	0	2020	Select counties in Peoria Metro area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1468	805	0	1	1	1	H1468_805_0	1	1			05/29/2019	2020.01	05/29/2019 12:21:08 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1468	805	0	2020	Select counties in Peoria Metro area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1468	806	0	1	1	1	H1468_806_0	1	1			05/29/2019	2020.01	05/29/2019 12:22:02 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1468	806	0	2020	Select counties in Peoria Metro area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1475	1	0	1	1	1	H1475_001_0	3	1			08/01/2019	2020.01	08/01/2019 12:37:55 PM Eastern Daylight Time	08/05/2019 04:14:44 PM Central Daylight Time	08/05/2019 03:09:33 PM Central Daylight Time			08/06/2019 09:13:50 AM Central Daylight Time	ILLINICARE HEALTH PLAN	Allwell	allwell.illinicare.com	Allwell Medicare (HMO)	1	1		1			H1475	1	0	2020	"Cook, Will, and Kane Counties"		2		2			2						allwell.illinicare.com/findadoctor	allwell.illinicare.com/formulary	allwell.illinicare.com/findadoctor	(855)766-1736		(855)766-1736		(866)445-1077		(866)445-1077		(855)766-1736		(855)766-1736		(866)445-1077		(866)445-1077		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1475	801	0	1	1	1	H1475_801_0	2	1			05/03/2019	2020.01	05/03/2019 10:50:03 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	ILLINICARE HEALTH PLAN	Allwell	allwell.illinicare.com	Allwell Group (HMO)	1	1		1			H1475	801	0	2020	Illinois		1	100	2			2						allwell.illinicare.com/findadoctor	allwell.illinicare.com/formulary	allwell.illinicare.com/findadoctor	(855)766-1736		(855)766-1736		(866)445-1077		(866)445-1077		(855)766-1736		(855)766-1736		(866)445-1077		(866)445-1077		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1475	802	0	1	1	1	H1475_802_0	2	1			05/03/2019	2020.01	05/03/2019 10:50:39 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	ILLINICARE HEALTH PLAN	Allwell	allwell.illinicare.com	Allwell Group (HMO)	1	1		1			H1475	802	0	2020	Illinois		1	100	2			2						allwell.illinicare.com/findadoctor	allwell.illinicare.com/formulary	allwell.illinicare.com/findadoctor	(855)766-1736		(855)766-1736		(866)445-1077		(866)445-1077										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1475	803	0	1	1	1	H1475_803_0	2	1			05/03/2019	2020.01	05/03/2019 12:55:41 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	ILLINICARE HEALTH PLAN	Allwell	allwell.illinicare.com	Allwell Group (HMO)	1	1		1			H1475	803	0	2020	Illinois		1	100	2			2						allwell.illinicare.com/findadoctor	allwell.illinicare.com/formulary	allwell.illinicare.com/findadoctor	(855)766-1736		(855)766-1736		(866)445-1077		(866)445-1077		(855)766-1736		(855)766-1736		(866)445-1077		(866)445-1077		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1500	1	0	1	20	8	H1500_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:07:10 PM Eastern Daylight Time		05/22/2019 01:09:35 PM Eastern Daylight Time			05/22/2019 01:13:52 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)	8	20		1			H1500	1	0	2020	LIFE St. Joseph of the Pines		2		2			2						www.sjp.org	www.sjp.org												(910)483-4911		(910)483-4911		(910)483-4911										(877)452-2514		(877)452-2514		(877)452-2514		(877)452-2514																
H1500	2	0	1	20	8	H1500_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:07:37 PM Eastern Daylight Time		05/22/2019 01:09:19 PM Eastern Daylight Time			05/22/2019 01:13:52 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)	8	20		1			H1500	2	0	2020	LIFE St. Joseph of the Pines		2		2			2						www.sjp.org	www.sjp.org										(910)483-4911		(910)483-4911		(910)483-4911		(910)483-4911										(877)452-2514		(877)452-2514		(877)452-2514		(877)452-2514																
H1518	1	0	1	20	8	H1518_001_0	1	1			05/29/2019	2020.01	05/29/2019 11:33:03 AM Eastern Daylight Time		05/22/2019 10:42:19 AM Eastern Daylight Time			05/29/2019 11:35:34 AM Eastern Daylight Time	CATHOLIC HEALTH SYSTEM BUFFALO PACE	Catholic Health LIFE	https://www.chsbuffalo.org/services/pace	CHS Buffalo - Dual (PACE)	8	20		1			H1518	1	0	2020	CHS Lackawanna  Erie County		2		2			2						www.chsbuffalo.org	www.chsbuffalo.org										(855)671-3341		(716)819-5433		(855)671-3341		(716)819-5433												(716)819-5227				(716)819-5227																
H1518	2	0	1	20	8	H1518_002_0	1	1			05/29/2019	2020.01	05/29/2019 11:33:29 AM Eastern Daylight Time		05/22/2019 10:42:05 AM Eastern Daylight Time			05/29/2019 11:35:34 AM Eastern Daylight Time	CATHOLIC HEALTH SYSTEM BUFFALO PACE	Catholic Health LIFE	https://www.chsbuffalo.org/services/pace	CHS Buffalo - Medicare only (PACE)	8	20		1			H1518	2	0	2020	CHS Lackawanna Erie County		2		2			2						www.chsbuffalo.org	www.chsbuffalo.org										(855)671-3341		(716)819-5433		(855)671-3341		(716)819-5433												(716)819-5227				(716)819-5227																
H1533	1	0	1	20	8	H1533_001_0	1	1			05/31/2019	2020.01	05/31/2019 07:50:18 AM Eastern Daylight Time		05/31/2019 07:41:19 AM Eastern Daylight Time			05/31/2019 07:52:20 AM Eastern Daylight Time	"STAYWELL SENIOR CARE, INC."	StayWell Senior Care	https://www.randolphhealth.org/services/staywell	StayWell Senior Care - Dual Eligible (PACE)	8	20		1			H1533	1	0	2020	StayWell Senior Care		2		2			2						www.carekinesis.com	www.staywellseniorcare.org										(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	2	0	1	20	8	H1533_002_0	1	1			05/31/2019	2020.01	05/31/2019 07:50:43 AM Eastern Daylight Time		05/31/2019 07:41:08 AM Eastern Daylight Time			05/31/2019 07:52:20 AM Eastern Daylight Time	"STAYWELL SENIOR CARE, INC."	StayWell Senior Care	https://www.randolphhealth.org/services/staywell	StayWell Senior Care - Medicare Only (PACE)	8	20		1			H1533	2	0	2020	StayWell Senior Care		2		2			2						www.carekinesis.com	www.staywellseniorcare.org										(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	4	0	1	4	1	H1537_004_0	4	1			08/02/2019	2020.01	08/02/2019 11:23:13 AM Central Daylight Time	08/02/2019 10:41:05 AM Central Daylight Time	07/30/2019 06:54:20 PM Central Daylight Time			08/05/2019 06:10:28 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice (PPO)	1	4		1			H1537	4	0	2020	Montgomery 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						2			
H1537	801	0	1	4	1	H1537_801_0	1	1			05/11/2019	2020.01	05/11/2019 07:17:34 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	801	0	2020	Nationwide		1	25572	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	802	0	1	4	1	H1537_802_0	1	1			05/11/2019	2020.01	05/11/2019 07:18:17 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	802	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	803	0	1	4	1	H1537_803_0	1	1			05/11/2019	2020.01	05/11/2019 07:18:55 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	803	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	804	0	2	4	1	H1537_804_0	1	1			05/11/2019	2020.01	05/11/2019 07:19:30 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H1537	804	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	805	0	2	4	1	H1537_805_0	1	1			05/11/2019	2020.01	05/11/2019 07:20:08 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H1537	805	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	806	0	2	4	1	H1537_806_0	1	1			05/11/2019	2020.01	05/11/2019 07:20:49 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H1537	806	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	807	0	1	4	1	H1537_807_0	1	1			05/11/2019	2020.01	05/11/2019 07:21:31 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	807	0	2020	NY and Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	808	0	1	4	1	H1537_808_0	1	1			05/11/2019	2020.01	05/11/2019 07:22:10 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	808	0	2020	NY and Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	809	0	1	4	1	H1537_809_0	1	1			05/11/2019	2020.01	05/11/2019 07:22:54 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	809	0	2020	NY and Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	816	0	1	4	1	H1537_816_0	1	1			05/11/2019	2020.01	05/11/2019 07:23:42 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	816	0	2020	NY and Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	817	0	1	4	1	H1537_817_0	1	1			05/11/2019	2020.01	05/11/2019 07:24:23 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	817	0	2020	NY and Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	823	0	1	4	1	H1537_823_0	1	1			05/11/2019	2020.01	05/11/2019 07:25:08 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	823	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	824	0	1	4	1	H1537_824_0	1	1			05/11/2019	2020.01	05/11/2019 07:25:48 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	824	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	825	0	1	4	1	H1537_825_0	1	1			05/11/2019	2020.01	05/11/2019 07:26:28 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	825	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	826	0	1	4	1	H1537_826_0	1	1			05/11/2019	2020.01	05/11/2019 07:27:10 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	826	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	827	0	2	4	1	H1537_827_0	1	1			05/11/2019	2020.01	05/11/2019 07:27:51 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H1537	827	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	828	0	2	4	1	H1537_828_0	1	1			05/11/2019	2020.01	05/11/2019 07:28:34 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H1537	828	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	829	0	2	4	1	H1537_829_0	1	1			05/11/2019	2020.01	05/11/2019 07:29:18 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H1537	829	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	830	0	1	4	1	H1537_830_0	1	1			05/11/2019	2020.01	05/11/2019 07:29:59 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	830	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	831	0	1	4	1	H1537_831_0	1	1			05/11/2019	2020.01	05/11/2019 07:30:39 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	831	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	832	0	1	4	1	H1537_832_0	1	1			05/11/2019	2020.01	05/11/2019 07:31:19 AM Central Daylight Time					06/02/2019 05:49:52 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	832	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	833	0	1	4	1	H1537_833_0	1	1			05/11/2019	2020.01	05/11/2019 07:31:56 AM Central Daylight Time					06/02/2019 05:51:40 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	833	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	834	0	1	4	1	H1537_834_0	1	1			05/11/2019	2020.01	05/11/2019 07:32:37 AM Central Daylight Time					06/02/2019 05:51:40 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	834	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	835	0	2	4	1	H1537_835_0	1	1			05/11/2019	2020.01	05/11/2019 07:33:13 AM Central Daylight Time					06/02/2019 05:51:40 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H1537	835	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	836	0	1	4	1	H1537_836_0	1	1			05/11/2019	2020.01	05/11/2019 07:33:51 AM Central Daylight Time					06/02/2019 05:51:40 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	836	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	837	0	1	4	1	H1537_837_0	1	1			05/11/2019	2020.01	05/11/2019 07:34:30 AM Central Daylight Time					06/02/2019 05:51:40 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	837	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	838	0	1	4	1	H1537_838_0	1	1			05/11/2019	2020.01	05/11/2019 07:35:11 AM Central Daylight Time					06/02/2019 05:51:40 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	838	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	839	0	1	4	1	H1537_839_0	1	1			05/11/2019	2020.01	05/11/2019 07:37:12 AM Central Daylight Time					06/02/2019 05:51:40 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	839	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	840	0	1	4	1	H1537_840_0	1	1			05/11/2019	2020.01	05/11/2019 07:38:39 AM Central Daylight Time					06/02/2019 05:51:40 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	840	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	841	0	1	4	1	H1537_841_0	1	1			05/11/2019	2020.01	05/11/2019 07:39:16 AM Central Daylight Time					06/02/2019 05:51:40 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	841	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1537	842	0	1	4	1	H1537_842_0	1	1			05/23/2019	2020.01	05/23/2019 01:36:04 PM Central Daylight Time					06/02/2019 05:51:40 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H1537	842	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H1587	1	0	1	2	1	H1587_001_0	13	1	2	1	08/06/2019	2020.01	08/06/2019 12:33:04 PM Central Daylight Time	08/06/2019 12:25:14 PM Central Daylight Time	08/06/2019 12:25:14 PM Central Daylight Time			08/06/2019 12:37:45 PM Central Daylight Time	"ARKANSAS SUPERIOR SELECT, INC."	Superior Select Health Plans	www.superiorselectmedicare.com	Tribute Advantage (HMO-POS D-SNP)	1	2		1			H1587	1	0	2020	Arkansas		2	19320	2			1	3		1		1	www.superiorselectmedicare.com	www.superiorselectmedicare.com	www.superiorselectmedicare.com	(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1587	3	0	1	2	1	H1587_003_0	9	1		1	08/06/2019	2020.01	08/06/2019 12:35:26 PM Central Daylight Time	08/06/2019 12:24:38 PM Central Daylight Time	08/06/2019 12:24:39 PM Central Daylight Time			08/06/2019 12:37:45 PM Central Daylight Time	"ARKANSAS SUPERIOR SELECT, INC."	Superior Select Health Plans	www.superiorselectmedicare.com	Tribute Select (HMO-POS I-SNP)	1	2		1			H1587	3	0	2020	Arkansas		2	3480	2			1	1	3				www.superiorselectmedicare.com	www.superiorselectmedicare.com	www.superiorselectmedicare.com	(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(877)372-1033		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1607	12	0	1	4	1	H1607_012_0	6	1			07/25/2019	2020.01	07/25/2019 06:30:33 AM Eastern Daylight Time	08/05/2019 09:57:01 AM Eastern Daylight Time	07/30/2019 07:30:23 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Plus (PPO)	1	4		1			H1607	12	0	2020	Select Counties in Indiana		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)558-1438		(855)558-1438		(800)797-6421		(800)797-6421		(855)558-1438		(855)558-1438		(844)364-2110		(844)364-2110		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1607	14	0	1	4	1	H1607_014_0	8	1			07/29/2019	2020.01	07/29/2019 11:27:33 AM Eastern Daylight Time	08/05/2019 09:57:01 AM Eastern Daylight Time	07/30/2019 07:31:05 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	1	4		1			H1607	14	0	2020	Select Counties in Indiana		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)558-1438		(855)558-1438		(800)797-6421		(800)797-6421		(855)558-1438		(855)558-1438		(844)364-2110		(844)364-2110		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1607	809	0	1	4	1	H1607_809_0	2	1			05/30/2019	2020.01	05/30/2019 04:12:21 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H1607	809	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H1607	810	0	1	4	1	H1607_810_0	2	1			05/30/2019	2020.01	05/30/2019 04:12:29 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H1607	810	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H1607	811	0	1	4	1	H1607_811_0	2	1			05/30/2019	2020.01	05/30/2019 04:12:37 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H1607	811	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H1607	812	0	1	4	1	H1607_812_0	2	1			05/30/2019	2020.01	05/30/2019 04:12:45 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H1607	812	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H1607	813	0	1	4	1	H1607_813_0	2	1			05/30/2019	2020.01	05/30/2019 04:12:57 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H1607	813	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H1607	814	0	1	4	1	H1607_814_0	2	1			05/30/2019	2020.01	05/30/2019 04:13:06 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H1607	814	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H1607	815	0	1	4	1	H1607_815_0	2	1			05/30/2019	2020.01	05/30/2019 04:17:06 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H1607	815	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H1607	816	0	1	4	1	H1607_816_0	2	1			05/30/2019	2020.01	05/30/2019 04:17:13 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H1607	816	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H1607	817	0	2	4	1	H1607_817_0	2	1			05/30/2019	2020.01	05/30/2019 04:17:23 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H1607	817	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H1607	818	0	2	4	1	H1607_818_0	2	1			05/30/2019	2020.01	05/30/2019 04:17:33 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H1607	818	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H1607	819	0	2	4	1	H1607_819_0	2	1			05/30/2019	2020.01	05/30/2019 04:17:41 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H1607	819	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H1607	820	0	2	4	1	H1607_820_0	2	1			05/30/2019	2020.01	05/30/2019 04:17:49 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H1607	820	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H1608	1	0	1	4	1	H1608_001_0	6	1			07/31/2019	2020.01	07/31/2019 01:07:10 PM Central Daylight Time	07/31/2019 01:02:44 PM Central Daylight Time	07/30/2019 07:30:35 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Advantra (PPO)	1	4		1			H1608	1	0	2020	Partial State of Iowa and South Dakota		2	373788	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	4	0	1	4	1	H1608_004_0	4	1			07/31/2019	2020.01	07/31/2019 01:07:32 PM Central Daylight Time	07/31/2019 01:05:52 PM Central Daylight Time	07/30/2019 07:31:46 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (PPO)	1	4		1			H1608	4	0	2020	"Lincoln, McCook, Minnehaha Counties South Dakota"		2	12612	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	7	0	1	4	1	H1608_007_0	4	1			08/01/2019	2020.01	08/01/2019 02:12:21 PM Central Daylight Time	08/01/2019 03:21:28 PM Central Daylight Time	07/30/2019 07:32:57 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (PPO)	1	4		1			H1608	7	0	2020	Marshall and Story Counties Iowa		2	9336	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	8	0	1	4	1	H1608_008_0	4	1			08/01/2019	2020.01	08/01/2019 02:12:39 PM Central Daylight Time	08/01/2019 03:23:37 PM Central Daylight Time	07/30/2019 07:34:09 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (PPO)	1	4		1			H1608	8	0	2020	"Ida, Monona, Plymouth, Woodbury Counties Iowa"		2	28512	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	12	0	1	4	1	H1608_012_0	4	1			07/03/2019	2020.01	07/03/2019 05:00:33 PM Central Daylight Time	07/31/2019 01:20:12 PM Central Daylight Time	07/30/2019 07:35:20 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Advantra (PPO)	1	4		1			H1608	12	0	2020	Partial State of Nebraska		2	48492	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	13	0	1	4	1	H1608_013_0	4	1			07/03/2019	2020.01	07/03/2019 05:00:41 PM Central Daylight Time	08/02/2019 07:17:40 AM Central Daylight Time	07/30/2019 07:36:32 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Advantra (PPO)	1	4		1			H1608	13	0	2020	St. Louis Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	16	0	1	4	1	H1608_016_0	4	1			08/01/2019	2020.01	08/01/2019 11:50:15 AM Central Daylight Time	08/02/2019 12:16:50 PM Central Daylight Time	07/30/2019 07:37:43 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H1608	16	0	2020	KC Metro (Kansas & Missouri) Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	17	0	1	4	1	H1608_017_0	4	1			08/01/2019	2020.01	08/01/2019 11:51:07 AM Central Daylight Time	08/02/2019 12:17:27 PM Central Daylight Time	07/30/2019 07:38:54 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H1608	17	0	2020	Wichita (Kansas) Metro Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	18	0	1	4	1	H1608_018_0	4	1			07/31/2019	2020.01	07/31/2019 02:11:26 PM Central Daylight Time	08/02/2019 12:18:04 PM Central Daylight Time	07/30/2019 07:40:05 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H1608	18	0	2020	South East Kansas & South West Missouri Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	21	0	1	4	1	H1608_021_0	4	1			08/01/2019	2020.01	08/01/2019 11:51:28 AM Central Daylight Time	08/02/2019 12:18:42 PM Central Daylight Time	07/30/2019 07:41:16 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H1608	21	0	2020	North West Arkansas Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	24	0	1	4	1	H1608_024_0	5	1			08/02/2019	2020.01	08/02/2019 08:11:52 AM Central Daylight Time	08/02/2019 12:19:18 PM Central Daylight Time	07/30/2019 07:42:28 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Premier Plus (PPO)	1	4		1			H1608	24	0	2020	North East (Topeka Area) Kansas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	26	0	1	4	1	H1608_026_0	4	1			07/03/2019	2020.01	07/03/2019 06:35:04 PM Eastern Daylight Time	08/02/2019 01:12:31 PM Eastern Daylight Time	07/30/2019 08:43:39 PM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Gold (PPO)	1	4		1			H1608	26	0	2020	Northern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	27	0	1	4	1	H1608_027_0	4	1			07/03/2019	2020.01	07/03/2019 06:40:42 PM Eastern Daylight Time	08/02/2019 01:14:07 PM Eastern Daylight Time	07/30/2019 08:44:49 PM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Gold (PPO)	1	4		1			H1608	27	0	2020	Southern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	28	0	1	4	1	H1608_028_0	3	1			07/03/2019	2020.01	07/03/2019 12:42:28 PM Eastern Daylight Time	08/01/2019 05:52:58 PM Eastern Daylight Time	07/30/2019 08:46:05 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Preferred Plan (PPO)	1	4		1			H1608	28	0	2020	Select Counties in Atlanta and Savannah Markets		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	29	0	1	4	1	H1608_029_0	4	1			07/31/2019	2020.01	07/31/2019 08:52:09 PM Eastern Daylight Time	08/02/2019 10:40:19 AM Eastern Daylight Time	07/30/2019 08:47:13 PM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (PPO)	1	4		1			H1608	29	0	2020	Northeastern/Youngstown OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	31	0	1	4	1	H1608_031_0	4	1			07/03/2019	2020.01	07/03/2019 06:40:29 PM Eastern Daylight Time	08/02/2019 01:18:46 PM Eastern Daylight Time	07/30/2019 08:48:24 PM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Credit Value (PPO)	1	4		1			H1608	31	0	2020	West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	35	0	1	4	1	H1608_035_0	5	1			07/03/2019	2020.01	07/03/2019 05:01:52 PM Central Daylight Time	08/02/2019 07:18:44 AM Central Daylight Time	07/30/2019 07:49:35 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Advantra (PPO)	1	4		1			H1608	35	0	2020	Hannibal MO		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	36	0	1	4	1	H1608_036_0	5	1			07/31/2019	2020.01	07/31/2019 03:46:38 PM Central Daylight Time	08/02/2019 12:19:56 PM Central Daylight Time	07/30/2019 07:50:47 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H1608	36	0	2020	St. Joseph (KS and MO area)		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	37	0	1	4	1	H1608_037_0	5	1			08/01/2019	2020.01	08/01/2019 02:13:04 PM Central Daylight Time	08/01/2019 03:24:29 PM Central Daylight Time	07/30/2019 07:51:59 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Advantra (PPO)	1	4		1			H1608	37	0	2020	Partial State of Iowa		2	44064	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	38	0	1	4	1	H1608_038_0	5	1			07/31/2019	2020.01	07/31/2019 01:09:32 PM Central Daylight Time	07/31/2019 01:25:24 PM Central Daylight Time	07/30/2019 07:53:11 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Advantra (PPO)	1	4		1			H1608	38	0	2020	Partial State of Nebraska		2	5676	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	39	0	1	4	1	H1608_039_0	5	1			07/31/2019	2020.01	07/31/2019 02:12:55 PM Central Daylight Time	08/02/2019 12:20:34 PM Central Daylight Time	07/30/2019 07:54:21 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	1	4		1			H1608	39	0	2020	Western Mo Eastern Kansas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	40	0	1	4	1	H1608_040_0	4	1			08/01/2019	2020.01	08/01/2019 04:18:59 PM Eastern Daylight Time	08/02/2019 01:23:22 PM Eastern Daylight Time	07/30/2019 08:55:32 PM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Value (PPO)	1	4		1			H1608	40	0	2020	Southern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	41	0	1	4	1	H1608_041_0	3	1			08/01/2019	2020.01	08/01/2019 04:20:48 PM Eastern Daylight Time	08/02/2019 01:25:02 PM Eastern Daylight Time	07/30/2019 08:56:43 PM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Value (PPO)	1	4		1			H1608	41	0	2020	Northern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	43	0	1	4	1	H1608_043_0	5	1			08/01/2019	2020.01	08/01/2019 02:13:28 PM Central Daylight Time	08/01/2019 03:25:30 PM Central Daylight Time	07/30/2019 07:57:55 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Advantra (PPO)	1	4		1			H1608	43	0	2020	Partial State of South Dakota		2	468	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	47	0	1	4	1	H1608_047_0	5	1			07/31/2019	2020.01	07/31/2019 02:13:37 PM Central Daylight Time	08/02/2019 12:21:13 PM Central Daylight Time	07/30/2019 07:59:05 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	1	4		1			H1608	47	0	2020	"Southwest Missouri, Southeast Kansas"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	48	0	1	4	1	H1608_048_0	5	1			08/01/2019	2020.01	08/01/2019 02:13:54 PM Central Daylight Time	08/01/2019 03:26:35 PM Central Daylight Time	07/30/2019 08:00:16 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus Advantra (PPO)	1	4		1			H1608	48	0	2020	Central Iowa		2	2556	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	50	0	1	4	1	H1608_050_0	5	1			07/31/2019	2020.01	07/31/2019 10:25:39 AM Central Daylight Time	08/02/2019 07:19:44 AM Central Daylight Time	07/30/2019 08:01:28 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	1	4		1			H1608	50	0	2020	St Louis Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	51	0	1	4	1	H1608_051_0	4	1			07/31/2019	2020.01	07/31/2019 10:28:35 AM Central Daylight Time	08/02/2019 07:20:54 AM Central Daylight Time	07/30/2019 08:02:39 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H1608	51	0	2020	"Cape Girardeau, MO"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	52	0	1	4	1	H1608_052_0	4	1			07/31/2019	2020.01	07/31/2019 02:18:19 PM Central Daylight Time	08/02/2019 12:21:50 PM Central Daylight Time	07/30/2019 08:03:50 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	1	4		1			H1608	52	0	2020	Northwest Missouri		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	53	0	1	4	1	H1608_053_0	4	1			07/31/2019	2020.01	07/31/2019 02:18:39 PM Central Daylight Time	08/02/2019 12:22:28 PM Central Daylight Time	07/30/2019 08:05:02 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	1	4		1			H1608	53	0	2020	Wichita Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	54	0	1	4	1	H1608_054_0	4	1			07/31/2019	2020.01	07/31/2019 02:19:46 PM Central Daylight Time	08/02/2019 12:47:10 PM Central Daylight Time	07/30/2019 08:06:14 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	1	4		1			H1608	54	0	2020	Northwest Arkansas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	55	0	1	4	1	H1608_055_0	4	1			07/31/2019	2020.01	07/31/2019 10:29:21 AM Central Daylight Time	08/02/2019 07:22:09 AM Central Daylight Time	07/30/2019 08:07:26 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (PPO)	1	4		1			H1608	55	0	2020	Central Missouri		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	56	0	1	4	1	H1608_056_0	4	1			07/31/2019	2020.01	07/31/2019 10:29:42 AM Central Daylight Time	08/02/2019 07:23:13 AM Central Daylight Time	07/30/2019 08:08:36 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H1608	56	0	2020	Southwest Illinois		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1608	801	0	1	4	1	H1608_801_0	1	1			05/30/2019	2020.01	05/30/2019 01:00:24 PM Eastern Daylight Time					05/30/2019 05:44:26 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (PPO)	1	4		1			H1608	801	0	2020	Multi-State		1	17030	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)307-4830		(800)307-4830		(888)267-2637		(888)267-2637										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	802	0	1	4	1	H1608_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:35:35 AM Eastern Daylight Time					05/30/2019 05:44:26 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx (PPO)	1	4		1			H1608	802	0	2020	Multi-Plan		1	1890	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1608	825	0	1	4	1	H1608_825_0	1	1			05/30/2019	2020.01	05/30/2019 11:27:36 AM Eastern Daylight Time					05/30/2019 05:44:26 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (PPO)	1	4		1			H1608	825	0	2020	Multi-State		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H1609	1	0	1	1	1	H1609_001_0	5	1			07/31/2019	2020.01	07/31/2019 01:10:45 PM Central Daylight Time	07/31/2019 01:32:28 PM Central Daylight Time	07/30/2019 08:09:48 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Premier Advantra (HMO)	1	1		1			H1609	1	0	2020	Partial State of Iowa		2	55236	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	9	0	1	1	1	H1609_009_0	4	1			07/31/2019	2020.01	07/31/2019 01:11:10 PM Central Daylight Time	07/31/2019 01:46:46 PM Central Daylight Time	07/30/2019 08:11:00 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (HMO)	1	1		1			H1609	9	0	2020	"Dallas, Polk, Warren Counties Iowa"		2	12816	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	16	0	1	1	1	H1609_016_0	2	1			08/01/2019	2020.01	08/01/2019 12:44:07 PM Eastern Daylight Time	08/02/2019 12:54:57 PM Eastern Daylight Time	07/30/2019 09:12:13 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Summit Select (HMO)	1	1		1			H1609	16	0	2020	South FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	17	0	1	1	1	H1609_017_0	3	1	2	1	07/03/2019	2020.01	07/03/2019 06:52:22 PM Eastern Daylight Time	08/02/2019 01:28:00 PM Eastern Daylight Time	07/30/2019 09:13:25 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	1	1		1			H1609	17	0	2020	South FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	18	0	1	1	1	H1609_018_0	2	1			08/01/2019	2020.01	08/01/2019 02:21:29 PM Eastern Daylight Time	08/02/2019 12:55:57 PM Eastern Daylight Time	07/30/2019 09:14:36 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Summit Select (HMO)	1	1		1			H1609	18	0	2020	South FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	19	0	1	1	1	H1609_019_0	3	1	2	1	08/01/2019	2020.01	08/01/2019 12:45:07 PM Eastern Daylight Time	08/02/2019 12:56:38 PM Eastern Daylight Time	07/30/2019 09:15:47 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	1	1		1			H1609	19	0	2020	"South FL, Treasure Coast FL, West FL"		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	20	0	1	1	1	H1609_020_0	3	1			08/01/2019	2020.01	08/01/2019 02:21:55 PM Eastern Daylight Time	08/02/2019 12:57:20 PM Eastern Daylight Time	07/30/2019 09:16:57 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Summit Select (HMO)	1	1		1			H1609	20	0	2020	South FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	21	0	1	1	1	H1609_021_0	3	1			08/01/2019	2020.01	08/01/2019 12:46:27 PM Eastern Daylight Time	08/02/2019 12:58:01 PM Eastern Daylight Time	07/30/2019 09:18:09 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Summit Select (HMO)	1	1		1			H1609	21	0	2020	"North FL, Treasure Coast FL"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	22	0	1	1	1	H1609_022_0	3	1			08/01/2019	2020.01	08/01/2019 02:22:48 PM Eastern Daylight Time	08/02/2019 12:58:41 PM Eastern Daylight Time	07/30/2019 09:19:20 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	1	1		1			H1609	22	0	2020	West FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	23	0	1	1	1	H1609_023_0	3	1	2	1	08/01/2019	2020.01	08/01/2019 12:47:10 PM Eastern Daylight Time	08/02/2019 12:59:21 PM Eastern Daylight Time	07/30/2019 09:20:32 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	1	1		1			H1609	23	0	2020	Central FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	25	0	1	1	1	H1609_025_0	3	1			08/01/2019	2020.01	08/01/2019 11:57:24 AM Eastern Daylight Time	08/02/2019 01:00:05 PM Eastern Daylight Time	07/30/2019 09:21:43 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	1	1		1			H1609	25	0	2020	Southwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	26	0	1	1	1	H1609_026_0	3	1			08/01/2019	2020.01	08/01/2019 12:08:27 PM Eastern Daylight Time	08/02/2019 01:00:48 PM Eastern Daylight Time	07/30/2019 09:22:55 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (HMO)	1	1		1			H1609	26	0	2020	Southwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	27	0	1	1	1	H1609_027_0	3	1			08/01/2019	2020.01	08/01/2019 12:08:38 PM Eastern Daylight Time	08/02/2019 01:01:36 PM Eastern Daylight Time	07/30/2019 09:24:07 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	1	1		1			H1609	27	0	2020	Southwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	28	0	1	2	1	H1609_028_0	3	1			08/01/2019	2020.01	08/01/2019 12:02:32 PM Eastern Daylight Time	08/02/2019 01:02:23 PM Eastern Daylight Time	07/30/2019 09:25:19 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice (HMO-POS)	1	2		1			H1609	28	0	2020	"North, Central, West, SW, Treasure Coast, South FL"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	34	0	1	1	1	H1609_034_0	3	1			08/01/2019	2020.01	08/01/2019 02:10:45 PM Eastern Daylight Time	08/02/2019 01:03:07 PM Eastern Daylight Time	07/30/2019 09:26:30 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Summit Select (HMO)	1	1		1			H1609	34	0	2020	"West FL, Treasure Coast FL"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	35	0	1	1	1	H1609_035_0	3	1			08/01/2019	2020.01	08/01/2019 12:08:51 PM Eastern Daylight Time	08/02/2019 01:03:51 PM Eastern Daylight Time	07/30/2019 09:27:41 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	1	1		1			H1609	35	0	2020	West FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	37	0	1	1	1	H1609_037_0	3	1			08/01/2019	2020.01	08/01/2019 12:09:02 PM Eastern Daylight Time	08/02/2019 01:04:35 PM Eastern Daylight Time	07/30/2019 09:28:53 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	1	1		1			H1609	37	0	2020	Central FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	38	0	1	1	1	H1609_038_0	3	1			08/01/2019	2020.01	08/01/2019 12:09:13 PM Eastern Daylight Time	08/02/2019 01:05:20 PM Eastern Daylight Time	07/30/2019 09:30:04 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	1	1		1			H1609	38	0	2020	West FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	39	0	1	1	1	H1609_039_0	3	1	2	1	08/01/2019	2020.01	08/01/2019 12:47:58 PM Eastern Daylight Time	08/02/2019 01:06:08 PM Eastern Daylight Time	07/30/2019 09:31:15 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	1	1		1			H1609	39	0	2020	North FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	40	0	1	1	1	H1609_040_0	3	1	2	1	08/01/2019	2020.01	08/01/2019 12:48:26 PM Eastern Daylight Time	08/02/2019 01:06:52 PM Eastern Daylight Time	07/30/2019 09:32:26 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	1	1		1			H1609	40	0	2020	Southwest FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	41	0	1	1	1	H1609_041_0	3	1			08/01/2019	2020.01	08/01/2019 12:09:26 PM Eastern Daylight Time	08/02/2019 01:07:37 PM Eastern Daylight Time	07/30/2019 09:33:37 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	1	1		1			H1609	41	0	2020	Panhandle/Northwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	42	0	1	1	1	H1609_042_0	3	1			08/01/2019	2020.01	08/01/2019 02:11:05 PM Eastern Daylight Time	08/02/2019 01:08:22 PM Eastern Daylight Time	07/30/2019 09:34:47 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select (HMO)	1	1		1			H1609	42	0	2020	Central FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	43	0	1	1	1	H1609_043_0	6	1	2	1	07/24/2019	2020.01	07/24/2019 10:02:55 AM Eastern Daylight Time	08/02/2019 01:09:05 PM Eastern Daylight Time	07/30/2019 09:35:59 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	1	1		1			H1609	43	0	2020	South FL		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	44	0	1	1	1	H1609_044_0	4	1	2	1	08/01/2019	2020.01	08/01/2019 12:49:04 PM Eastern Daylight Time	08/02/2019 01:09:49 PM Eastern Daylight Time	07/30/2019 09:37:11 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	1	1		1			H1609	44	0	2020	"Treasure Coast FL, West FL"		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	45	0	1	1	1	H1609_045_0	4	1	2	1	08/01/2019	2020.01	08/01/2019 12:56:42 PM Eastern Daylight Time	08/02/2019 01:10:33 PM Eastern Daylight Time	07/30/2019 09:38:22 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	1	1		1			H1609	45	0	2020	North FL		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	46	0	1	1	1	H1609_046_0	5	1	2	1	07/10/2019	2020.01	07/10/2019 06:35:21 PM Eastern Daylight Time	08/02/2019 05:43:35 PM Eastern Daylight Time	07/30/2019 09:39:33 PM Eastern Daylight Time			08/02/2019 06:04:11 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	1	1		1			H1609	46	0	2020	Central FL		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	47	0	1	1	1	H1609_047_0	4	1	2	1	08/01/2019	2020.01	08/01/2019 12:56:13 PM Eastern Daylight Time	08/02/2019 01:11:59 PM Eastern Daylight Time	07/30/2019 09:40:43 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	1	1		1			H1609	47	0	2020	Southwest FL		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	48	0	1	1	1	H1609_048_0	5	1	2	1	08/01/2019	2020.01	08/01/2019 12:55:54 PM Eastern Daylight Time	08/02/2019 05:42:06 PM Eastern Daylight Time	07/30/2019 09:41:53 PM Eastern Daylight Time			08/02/2019 06:04:11 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	1	1		1			H1609	48	0	2020	Palm Beach		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	49	0	1	1	1	H1609_049_0	4	1	2	1	08/01/2019	2020.01	08/01/2019 12:55:30 PM Eastern Daylight Time	08/02/2019 01:13:25 PM Eastern Daylight Time	07/30/2019 09:43:03 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plus (HMO D-SNP)	1	1		1			H1609	49	0	2020	West FL		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	50	0	1	1	1	H1609_050_0	3	1	2	1	08/01/2019	2020.01	08/01/2019 12:54:27 PM Eastern Daylight Time	08/02/2019 01:14:07 PM Eastern Daylight Time	07/30/2019 09:44:13 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Value (HMO D-SNP)	1	1		1			H1609	50	0	2020	Dade County		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	51	0	1	1	1	H1609_051_0	3	1	2	1	08/01/2019	2020.01	08/01/2019 12:55:07 PM Eastern Daylight Time	08/02/2019 01:14:52 PM Eastern Daylight Time	07/30/2019 09:45:32 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Value (HMO D-SNP)	1	1		1			H1609	51	0	2020	Central FL		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1609	801	0	1	1	1	H1609_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:35:54 AM Eastern Daylight Time					05/30/2019 05:46:35 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H1609	801	0	2020	Florida		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1609	807	0	1	1	1	H1609_807_0	1	1			05/24/2019	2020.01	05/24/2019 09:36:05 AM Eastern Daylight Time					05/30/2019 05:46:35 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare w/Rx Plan (HMO)	1	1		1			H1609	807	0	2020	Florida		1	1420	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1609	809	0	1	1	1	H1609_809_0	1	1			05/24/2019	2020.01	05/24/2019 09:36:18 AM Eastern Daylight Time					05/30/2019 05:46:35 PM Eastern Daylight Time	AETNA HEALTH INC. (FL)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H1609	809	0	2020	Florida		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1610	1	0	1	1	1	H1610_001_0	4	1	2	1	07/31/2019	2020.01	07/31/2019 05:31:43 PM Eastern Daylight Time	08/02/2019 09:50:25 AM Eastern Daylight Time	07/30/2019 09:46:42 PM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF VIRGINIA	Aetna Better Health of Virginia	www.aetnabetterhealth.com/virginia-hmosnp	Aetna Medicare Assure (HMO D-SNP)	1	1		1			H1610	1	0	2020	Virginia		2		2			1	3		1		1	www.aetnabetterhealth.com/virginia-hmosnp/findpharmacy	www.aetnabetterhealth.com/Virginia-hmosnp/formulary	www.aetnabetterhealth.com/virginia-hmosnp/findprovider	(855)463-0933		(855)463-0933		(855)463-0933		(855)463-0933		(855)463-0933		(855)463-0933		(855)463-0933		(855)463-0933		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1644	1	0	1	1	1	H1644_001_0	4	1		1	08/01/2019	2020.01	08/01/2019 12:14:56 PM Central Daylight Time	08/01/2019 09:59:49 AM Central Daylight Time	07/31/2019 12:46:40 PM Central Daylight Time			08/02/2019 12:26:08 PM Central Daylight Time	LONGEVITY HEALTH PLAN OF FLORIDA INC.	Longevity Health Plan	www.longevityhealthplan.com	Longevity Health Plan (HMO I-SNP)	1	1		1			H1644	1	0	2020	Florida (partial)		2		2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1651	1	0	1	18	6	H1651_001_0	5	2			05/31/2019	2020.01	05/31/2019 07:08:14 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Associates SmartPlan (Cost)	6	18		1			H1651	1	0	2020	"Dubuque, Clayton, Delaware, Jackson,Jones Counties"		2	74000	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	2	0	1	18	6	H1651_002_0	5	2			05/31/2019	2020.01	05/31/2019 07:27:26 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Associates Basic Plan (Cost)	6	18		1			H1651	2	0	2020	"Dubuque, Clayton, Delaware, Jackson,Jones Counties"		2	12	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	3	0	1	18	6	H1651_003_0	5	2			05/31/2019	2020.01	05/31/2019 07:30:57 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Associates SmartPlan (Cost)	6	18		1			H1651	3	0	2020	JoDaviess County		2	15000	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	4	0	1	18	6	H1651_004_0	5	2			05/31/2019	2020.01	05/31/2019 07:31:28 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Associates Community Plan (Cost)	6	18		1			H1651	4	0	2020	"Dubuque, Clayton, Delaware, Jackson,Jones Counties"		2	40600	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	5	0	1	18	6	H1651_005_0	5	2			05/31/2019	2020.01	05/31/2019 07:35:57 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Associates Community Plan (Cost)	6	18		1			H1651	5	0	2020	JoDaviess County		2	5900	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	8	0	1	18	6	H1651_008_0	5	2			05/31/2019	2020.01	05/31/2019 07:48:49 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Associates Freedom Plan (Cost)	6	18		1			H1651	8	0	2020	"Dubuque, Clayton, Delaware, Jackson,Jones Counties"		2	9000	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	9	0	1	18	6	H1651_009_0	5	2			05/31/2019	2020.01	05/31/2019 08:04:34 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Associates Freedom Plan (Cost)	6	18		1			H1651	9	0	2020	JoDaviess County		2	2200	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	10	0	1	18	6	H1651_010_0	5	2			05/31/2019	2020.01	05/31/2019 08:17:47 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Cedar Valley Health Senior Plan (Cost)	6	18		1			H1651	10	0	2020	Cedar Valley		2	220	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	11	0	1	18	6	H1651_011_0	5	2			05/31/2019	2020.01	05/31/2019 08:19:55 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Central Iowa Health Senior Plan (Cost)	6	18		1			H1651	11	0	2020	Central Iowa		2	625	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	12	0	1	18	6	H1651_012_0	5	2			05/31/2019	2020.01	05/31/2019 08:22:33 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Clinton Community Health Senior Plan (Cost)	6	18		1			H1651	12	0	2020	"Clinton, Scott, Jackson, Cedar Counties"		2	180	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	13	0	1	18	6	H1651_013_0	4	2			05/31/2019	2020.01	05/31/2019 08:36:00 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Quad Cities Community Health Senior Plan (Cost)	6	18		1			H1651	13	0	2020	"Clinton, Scott, Jackson, Cedar, Muscatine Counties"		2	400	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	14	0	1	18	6	H1651_014_0	5	2			05/31/2019	2020.01	05/31/2019 09:27:04 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Mercy Cedar Rapids Senior Plan (Cost)	6	18		1			H1651	14	0	2020	Cedar Rapids and Surrounding Counties		2	1800	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	15	0	1	18	6	H1651_015_0	5	2			05/31/2019	2020.01	05/31/2019 09:27:54 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	North Iowa Health Senior Plan (Cost)	6	18		1			H1651	15	0	2020	North Iowa		2	925	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	16	0	1	18	6	H1651_016_0	5	2			05/31/2019	2020.01	05/31/2019 09:25:24 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Mercy Iowa City Senior Plan (Cost)	6	18		1			H1651	16	0	2020	"Iowa, Johnson, Cedar Washington Muscatine Counties"		2	350	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	17	0	1	18	6	H1651_017_0	4	2			05/31/2019	2020.01	05/31/2019 09:23:47 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Quad Cities Community Health Senior Plan (Cost)	6	18		1			H1651	17	0	2020	Rock Island County		2	300	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	18	0	1	18	6	H1651_018_0	5	2			05/31/2019	2020.01	05/31/2019 01:23:31 PM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Associates Medicare CHI Health - Kearney (Cost)	6	18		1			H1651	18	0	2020	Central Nebraska		2	500	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	19	0	1	18	6	H1651_019_0	5	2			05/31/2019	2020.01	05/31/2019 01:46:48 PM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Assoc. Medicare CHI Health - Grand Island (Cost)	6	18		1			H1651	19	0	2020	Central Nebraska		2	500	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	20	0	1	18	6	H1651_020_0	5	2			05/31/2019	2020.01	05/31/2019 01:26:54 PM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Assoc. Medicare CHI Health - Lincoln (Cost)	6	18		1			H1651	20	0	2020	Southeast Nebraska		2	500	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	21	0	1	18	6	H1651_021_0	5	2			05/31/2019	2020.01	05/31/2019 01:28:30 PM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Assoc. Medicare CHI Health - Omaha (Cost)	6	18		1			H1651	21	0	2020	Eastern Nebraska		2	500	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	22	0	1	18	6	H1651_022_0	5	2			05/31/2019	2020.01	05/31/2019 01:30:10 PM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Assoc Medicare CHI Health - Omaha (Cost)	6	18		1			H1651	22	0	2020	Southwest Iowa		2	500	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	23	0	1	18	6	H1651_023_0	5	2			05/31/2019	2020.01	05/31/2019 01:34:48 PM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Associates Medicare MHN - Sioux City (Cost)	6	18		1			H1651	23	0	2020	Northeast Nebraska		2	300	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1651	24	0	1	18	6	H1651_024_0	5	2			05/31/2019	2020.01	05/31/2019 01:35:11 PM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	"MEDICAL ASSOCIATES HEALTH PLAN, INC."	"Medical Associates Health Plan, Inc."	www.mahealthplans.com	Medical Associates Medicare MHN - Sioux City (Cost)	6	18		1			H1651	24	0	2020	Northwest Iowa		2	300	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H1659	1	0	1	4	1	H1659_001_0	6	1			07/02/2019	2020.01	07/02/2019 11:42:34 AM Central Daylight Time	07/31/2019 02:59:22 PM Central Daylight Time	07/31/2019 12:40:16 PM Central Daylight Time			08/02/2019 12:14:33 PM Central Daylight Time	"PIEDMONT COMMUNITY HEALTHCARE, INC."	Piedmont Medicare Advantage	www.pchp.net	Piedmont Select Medicare Option One (PPO)	1	4		1			H1659	1	0	2020	"City: LYH Counties: AM,AP,BE,CA,CLT,HA,PE,PI"		2	11944	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1659	2	0	1	4	1	H1659_002_0	5	1			07/02/2019	2020.01	07/02/2019 11:43:30 AM Central Daylight Time	07/31/2019 03:00:52 PM Central Daylight Time	07/31/2019 12:41:34 PM Central Daylight Time			08/02/2019 12:14:33 PM Central Daylight Time	"PIEDMONT COMMUNITY HEALTHCARE, INC."	Piedmont Medicare Advantage	www.pchp.net	Piedmont Select Medicare Option Two (PPO)	1	4		1			H1659	2	0	2020	"City: LYH Counties: AM,AP,BE,CA,CLT,HA,PE,PI"		2	19379	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1659	3	0	1	4	1	H1659_003_0	5	1			07/02/2019	2020.01	07/02/2019 11:43:46 AM Central Daylight Time	07/31/2019 03:15:02 PM Central Daylight Time	07/31/2019 12:42:40 PM Central Daylight Time			08/02/2019 12:14:33 PM Central Daylight Time	"PIEDMONT COMMUNITY HEALTHCARE, INC."	Piedmont Medicare Advantage	www.pchp.net	Piedmont Select Medicare Option Three (PPO)	1	4		1			H1659	3	0	2020	"City: LYH Counties: AM,AP,BE,CA,CLT,HA,PE,PI"		2	29995	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1660	13	0	1	1	1	H1660_013_0	6	1			07/22/2019	2020.01	07/22/2019 05:41:17 PM Eastern Daylight Time	07/31/2019 02:44:38 PM Eastern Daylight Time	07/31/2019 10:01:52 AM Eastern Daylight Time			08/06/2019 05:52:50 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	"Harvard Pilgrim Health Care, Inc."	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	1	1		1			H1660	13	0	2020	Maine		2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	14	0	1	1	1	H1660_014_0	4	1			07/13/2019	2020.01	07/13/2019 01:39:24 AM Eastern Daylight Time	07/31/2019 02:50:52 PM Eastern Daylight Time	07/31/2019 10:06:08 AM Eastern Daylight Time			08/06/2019 05:52:50 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	"Harvard Pilgrim Health Care, Inc."	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Basic Rx (HMO)	1	1		1			H1660	14	0	2020	Massachusetts		2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	15	0	1	1	1	H1660_015_0	4	1			07/13/2019	2020.01	07/13/2019 12:58:31 AM Eastern Daylight Time	07/31/2019 02:54:54 PM Eastern Daylight Time	07/31/2019 10:11:52 AM Eastern Daylight Time			08/06/2019 05:52:50 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	"Harvard Pilgrim Health Care, Inc."	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Basic Rx (HMO)	1	1		1			H1660	15	0	2020	Maine		2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	16	1	1	1	1	H1660_016_1	4	1			07/13/2019	2020.01	07/13/2019 01:47:07 AM Eastern Daylight Time	07/31/2019 02:57:54 PM Eastern Daylight Time	07/31/2019 10:13:40 AM Eastern Daylight Time			08/06/2019 05:52:50 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	"Harvard Pilgrim Health Care, Inc."	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	1	1		1			H1660	16	1	2020	Massachusetts	Worcester County MA	2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	16	2	1	1	1	H1660_016_2	4	1			07/13/2019	2020.01	07/13/2019 01:23:15 AM Eastern Daylight Time	07/31/2019 03:00:48 PM Eastern Daylight Time	07/31/2019 10:15:24 AM Eastern Daylight Time			08/06/2019 05:52:50 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	"Harvard Pilgrim Health Care, Inc."	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	1	1		1			H1660	16	2	2020	Massachusetts	Eastern Massachusetts	2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	17	1	1	1	1	H1660_017_1	4	1			08/06/2019	2020.01	08/06/2019 03:28:50 PM Eastern Daylight Time	07/31/2019 03:04:44 PM Eastern Daylight Time	07/31/2019 10:17:10 AM Eastern Daylight Time			08/06/2019 05:52:50 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)	1	1		1			H1660	17	1	2020	Massachusetts	Worcester County MA	2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	17	2	1	1	1	H1660_017_2	4	1			08/06/2019	2020.01	08/06/2019 03:29:52 PM Eastern Daylight Time	07/31/2019 03:07:36 PM Eastern Daylight Time	07/31/2019 10:19:02 AM Eastern Daylight Time			08/06/2019 05:52:50 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)	1	1		1			H1660	17	2	2020	Massachusetts	Eastern Massachusetts	2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	18	0	1	2	1	H1660_018_0	4	1			07/13/2019	2020.01	07/13/2019 01:42:24 AM Eastern Daylight Time	08/05/2019 04:50:42 PM Eastern Daylight Time	08/05/2019 05:00:32 PM Eastern Daylight Time			08/06/2019 05:52:50 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	"Harvard Pilgrim Health Care, Inc."	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Choice Rx (HMO-POS)	1	2		1			H1660	18	0	2020	Maine		2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	801	0	1	1	1	H1660_801_0	3	1			07/13/2019	2020.01	07/13/2019 02:48:31 AM Eastern Daylight Time					07/13/2019 04:01:02 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)	1	1		1			H1660	801	0	2020	Massachusetts		1	1200	2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	802	0	1	2	1	H1660_802_0	3	1			07/13/2019	2020.01	07/13/2019 02:48:38 AM Eastern Daylight Time					07/13/2019 04:01:02 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	"Harvard Pilgrim Health Care, Inc."	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Choice Rx (HMO-POS)	1	2		1			H1660	802	0	2020	Maine		1	12	2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	803	0	1	1	1	H1660_803_0	3	1			07/13/2019	2020.01	07/13/2019 02:49:07 AM Eastern Daylight Time					07/13/2019 04:01:02 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	"Harvard Pilgrim Health Care, Inc."	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	1	1		1			H1660	803	0	2020	Massachusetts		1	1200	2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1660	804	0	1	1	1	H1660_804_0	3	1			07/13/2019	2020.01	07/13/2019 02:48:59 AM Eastern Daylight Time					07/13/2019 04:01:02 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	"Harvard Pilgrim Health Care, Inc."	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	1	1		1			H1660	804	0	2020	Maine		1	1200	2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	1	0	1	1	1	H1664_001_0	3	1			08/01/2019	2020.01	08/01/2019 04:38:28 PM Eastern Daylight Time	08/05/2019 04:15:46 PM Central Daylight Time	08/05/2019 03:10:39 PM Central Daylight Time			08/06/2019 09:20:35 AM Central Daylight Time	"HOME STATE HEALTH PLAN, INC."	Allwell	allwell.homestatehealth.com	Allwell Medicare (HMO)	1	1		1			H1664	1	0	2020	"SW, Eastern Missouri and St Louis Metro Areas"		2		2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	2	0	1	1	1	H1664_002_0	3	1			08/01/2019	2020.01	08/01/2019 01:01:44 PM Eastern Daylight Time	08/05/2019 04:15:53 PM Central Daylight Time	08/05/2019 03:10:32 PM Central Daylight Time			08/06/2019 09:20:35 AM Central Daylight Time	"HOME STATE HEALTH PLAN, INC."	Allwell	allwell.homestatehealth.com	Allwell Medicare (HMO)	1	1		1			H1664	2	0	2020	"Cass, Clay, Jackson, Platte"		2		2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	4	0	1	1	1	H1664_004_0	2	1			08/01/2019	2020.01	08/01/2019 01:28:49 PM Eastern Daylight Time	08/05/2019 04:15:35 PM Central Daylight Time	08/05/2019 03:10:34 PM Central Daylight Time			08/06/2019 09:20:35 AM Central Daylight Time	"HOME STATE HEALTH PLAN, INC."	Allwell	allwell.homestatehealth.com	Allwell Medicare (HMO)	1	1		1			H1664	4	0	2020	"SW, Eastern Missouri and St Louis Metro Areas"		2		2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	5	0	1	1	1	H1664_005_0	4	1	2	1	06/18/2019	2020.01	06/18/2019 01:56:31 PM Pacific Daylight Time	08/05/2019 04:15:41 PM Central Daylight Time	08/05/2019 03:10:37 PM Central Daylight Time			08/06/2019 09:20:35 AM Central Daylight Time	"HOME STATE HEALTH PLAN, INC."	Allwell	allwell.homestatehealth.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H1664	5	0	2020	West and South Missouri Counties		2		2			1	3		1		1	allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(833)298-3361		(833)298-3361		(877)891-6102		(877)891-6102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1664	801	0	1	1	1	H1664_801_0	2	1			05/03/2019	2020.01	05/03/2019 12:56:10 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"HOME STATE HEALTH PLAN, INC."	Allwell	allwell.homestatehealth.com	Allwell Group (HMO)	1	1		1			H1664	801	0	2020	Missouri		1	100	2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1664	802	0	1	1	1	H1664_802_0	2	1			05/03/2019	2020.01	05/03/2019 12:56:31 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"HOME STATE HEALTH PLAN, INC."	Allwell	allwell.homestatehealth.com	Allwell Group (HMO)	1	1		1			H1664	802	0	2020	Missouri		1	100	2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1664	803	0	1	1	1	H1664_803_0	2	1			05/03/2019	2020.01	05/03/2019 12:56:45 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"HOME STATE HEALTH PLAN, INC."	Allwell	allwell.homestatehealth.com	Allwell Group (HMO)	1	1		1			H1664	803	0	2020	Missouri		1	100	2			2						allwell.homestatehealth.com/findadoctor	allwell.homestatehealth.com/formulary	allwell.homestatehealth.com/findadoctor	(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(855)766-1452		(855)766-1452		(877)891-6102		(877)891-6102		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1666	1	0	1	4	1	H1666_001_0	6	1			05/31/2019	2020.01	05/31/2019 10:30:10 AM Central Daylight Time	08/06/2019 02:24:28 PM Central Daylight Time	08/06/2019 02:24:32 PM Central Daylight Time			08/06/2019 04:56:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	1	4		1			H1666	1	0	2020	Austin metro area		2	13656	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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			
H1666	2	0	1	4	1	H1666_002_0	6	1			05/31/2019	2020.01	05/31/2019 10:31:46 AM Central Daylight Time	08/06/2019 02:24:28 PM Central Daylight Time	08/06/2019 02:24:32 PM Central Daylight Time			08/06/2019 04:56:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	1	4		1			H1666	2	0	2020	"Dallas, Tarrant, Collin, and Denton counties"		2	17388	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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			
H1666	3	0	1	4	1	H1666_003_0	6	1			05/31/2019	2020.01	05/31/2019 10:34:46 AM Central Daylight Time	08/06/2019 02:24:28 PM Central Daylight Time	08/06/2019 02:24:32 PM Central Daylight Time			08/06/2019 04:56:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	1	4		1			H1666	3	0	2020	"Harris, Fort Bend, and Montgomery counties"		2	24984	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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			
H1666	4	0	1	4	1	H1666_004_0	6	1			05/31/2019	2020.01	05/31/2019 10:36:13 AM Central Daylight Time	08/06/2019 02:24:28 PM Central Daylight Time	08/06/2019 02:24:32 PM Central Daylight Time			08/06/2019 04:56:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	1	4		1			H1666	4	0	2020	Austin Metro Area		2	16920	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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			
H1666	5	0	1	4	1	H1666_005_0	6	1			05/31/2019	2020.01	05/31/2019 10:37:43 AM Central Daylight Time	08/06/2019 02:24:28 PM Central Daylight Time	08/06/2019 02:24:32 PM Central Daylight Time			08/06/2019 04:56:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	1	4		1			H1666	5	0	2020	Dallas Metro Area		2	26844	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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			
H1666	6	0	1	4	1	H1666_006_0	6	1			05/31/2019	2020.01	05/31/2019 10:39:06 AM Central Daylight Time	08/06/2019 02:24:28 PM Central Daylight Time	08/06/2019 02:24:32 PM Central Daylight Time			08/06/2019 04:56:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	1	4		1			H1666	6	0	2020	Houston Metro Area		2	33756	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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			
H1666	8	0	1	4	1	H1666_008_0	6	1			05/31/2019	2020.01	05/31/2019 10:40:40 AM Central Daylight Time	08/06/2019 02:24:28 PM Central Daylight Time	08/06/2019 02:24:32 PM Central Daylight Time			08/06/2019 04:56:13 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	1	4		1			H1666	8	0	2020	San Antonio		2	6060	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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			
H1666	801	0	1	4	1	H1666_801_0	2	1			05/30/2019	2020.01	05/30/2019 03:23:52 PM Central Daylight Time					06/03/2019 11:20:09 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	BlueCross Medicare Advantage (PPO)	1	4		1			H1666	801	0	2020	State of Texas		1	36084	2			2						www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H1666	803	0	1	4	1	H1666_803_0	2	1			05/30/2019	2020.01	05/30/2019 03:24:19 PM Central Daylight Time					06/03/2019 11:20:09 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	BlueCross  Medicare Advantage (PPO)	1	4		1			H1666	803	0	2020	State of Texas		1	1	2			2						www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H1666	805	0	1	4	1	H1666_805_0	2	1			05/30/2019	2020.01	05/30/2019 03:25:08 PM Central Daylight Time					06/03/2019 11:20:09 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	BlueCross  Medicare Advantage (PPO)	1	4		1			H1666	805	0	2020	State of Texas		1	1	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H1666	807	0	1	4	1	H1666_807_0	2	1			05/30/2019	2020.01	05/30/2019 03:25:49 PM Central Daylight Time					06/03/2019 11:20:09 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage (PPO)	1	4		1			H1666	807	0	2020	State of Texas		1	1	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H1666	808	0	1	4	1	H1666_808_0	2	1			05/30/2019	2020.01	05/30/2019 03:26:28 PM Central Daylight Time					06/03/2019 11:20:09 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage (PPO)	1	4		1			H1666	808	0	2020	State of Texas		1	1	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H1692	2	0	1	1	1	H1692_002_0	5	1			08/01/2019	2020.01	08/01/2019 04:21:53 PM Eastern Daylight Time	08/02/2019 01:25:41 PM Eastern Daylight Time	07/30/2019 09:47:52 PM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF WEST VIRGINIA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (HMO)	1	1		1			H1692	2	0	2020	Southern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	3	0	1	1	1	H1692_003_0	4	1			08/01/2019	2020.01	08/01/2019 04:22:29 PM Eastern Daylight Time	08/02/2019 01:26:21 PM Eastern Daylight Time	07/30/2019 09:49:03 PM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF WEST VIRGINIA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Elite (HMO)	1	1		1			H1692	3	0	2020	Northern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	4	0	1	1	1	H1692_004_0	4	1			08/01/2019	2020.01	08/01/2019 04:22:59 PM Eastern Daylight Time	08/02/2019 01:27:03 PM Eastern Daylight Time	07/30/2019 09:50:13 PM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF WEST VIRGINIA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Elite (HMO)	1	1		1			H1692	4	0	2020	Southern West Virginia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	5	0	1	1	1	H1692_005_0	6	1	2	1	07/10/2019	2020.01	07/10/2019 04:36:33 PM Eastern Daylight Time	08/02/2019 01:27:43 PM Eastern Daylight Time	07/30/2019 09:51:23 PM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF WEST VIRGINIA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Cares (HMO D-SNP)	1	1		1			H1692	5	0	2020	West Virginia		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1692	801	0	1	1	1	H1692_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:36:35 AM Eastern Daylight Time					05/30/2019 05:52:06 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF WEST VIRGINIA, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H1692	801	0	2020	West Virginia		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1692	802	0	1	1	1	H1692_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:36:46 AM Eastern Daylight Time					05/30/2019 05:52:06 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF WEST VIRGINIA, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H1692	802	0	2020	West Virginia		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1692	804	0	1	1	1	H1692_804_0	1	1			05/24/2019	2020.01	05/24/2019 09:36:56 AM Eastern Daylight Time					05/30/2019 05:52:06 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF WEST VIRGINIA, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H1692	804	0	2020	West Virginia		1	120	2			2						www.aetnamedicaredocfind.com	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H1693	2	0	1	20	8	H1693_002_0	2	1			05/22/2019	2020.01	05/22/2019 10:07:12 AM Pacific Daylight Time		05/22/2019 12:16:59 PM Pacific Daylight Time			05/22/2019 12:19:14 PM Pacific Daylight Time	"FHCSD, INC."	Family Health-Center for Older Adults	www.fhcsd.org/pace	FamilyHealth - Center for Older Adults (PACE)	8	20		1			H1693	2	0	2020	San Diego		2		2			2						TBD	NA												(619)515-2445				(619)515-2445												(833)530-9622				(833)530-9622																
H1693	3	0	1	20	8	H1693_003_0	1	1			05/22/2019	2020.01	05/22/2019 10:08:59 AM Pacific Daylight Time		05/22/2019 10:39:47 AM Pacific Daylight Time			05/22/2019 10:47:21 AM Pacific Daylight Time	"FHCSD, INC."	Family Health-Center for Older Adults	www.fhcsd.org/pace	FamilyHealth-Center for Older Adults-Medicare-only (PACE)	8	20		1			H1693	3	0	2020	San Diego		2		2			2						TBD	NA												(619)515-2445				(619)515-2445												(833)530-9622				(833)530-9622																
H1714	1	0	1	20	8	H1714_001_0	2	1			05/31/2019	2020.01	05/31/2019 08:48:56 PM Central Daylight Time		05/31/2019 08:50:05 PM Central Daylight Time			05/31/2019 08:51:43 PM Central Daylight Time	"VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC."	Via Christi HOPE	viachristi.org/hope	Via Christi HOPE (PACE)	8	20		1			H1714	1	0	2020	Sedgwick County		2		2			2						www.viachristihope.com	www.viachristihope.com												(316)858-1111				(316)858-1111										(800)766-3777		(800)766-3777		(800)766-3777		(800)766-3777																
H1714	2	0	1	20	8	H1714_002_0	2	1			05/31/2019	2020.01	05/31/2019 08:49:08 PM Central Daylight Time		05/31/2019 08:50:33 PM Central Daylight Time			05/31/2019 08:51:43 PM Central Daylight Time	"VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC."	Via Christi HOPE	viachristi.org/hope	Via Christi HOPE (PACE)	8	20		1			H1714	2	0	2020	Sedgwick County		2		2			2						www.viachristihope.com	www.viachristihope.com												(316)858-1111				(316)858-1111										(800)766-3777		(800)766-3777		(800)766-3777		(800)766-3777																
H1722	1	0	1	1	1	H1722_001_0	6	1		1	08/01/2019	2020.01	08/01/2019 01:22:50 PM Central Daylight Time	08/01/2019 02:20:57 PM Central Daylight Time	08/01/2019 02:21:24 PM Central Daylight Time			08/06/2019 02:08:11 PM Central Daylight Time	"HEALTH POINTE OF NEW YORK, LLC"	"Health Pointe of New York, LLC"	http://healthpointeny.com	Health Pointe Direct Complete Plan (HMO I-SNP)	1	1		1			H1722	1	0	2020	"Counties: NY, KNG, QNS, BRX, NAS, WC"		2	5139	2			1	1	1				healthpointeny.com	http://healthpointeny.com	http://healthpointeny.com	(844)269-3442		(718)637-2075		(844)269-3442		(718)637-2075		(844)269-3442		(718)637-2075		(844)269-3442		(718)637-2075		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1723	1	0	1	48	5	H1723_001_0	3	1			08/02/2019	2020.01	08/02/2019 08:49:17 AM Pacific Daylight Time					08/02/2019 02:03:35 PM Central Daylight Time	"ABSOLUTE TOTAL CARE, INC."	Absolute Total Care	mmp.absolutetotalcare.com	Absolute Total Care (Medicare-Medicaid Plan)	5	48		1			H1723	1	0	2020	Statewide		2	5000	2			2						mmp.absolutetotalcare.com/findadoctor	mmp.absolutetotalcare.com/formulary	mmp.absolutetotalcare.com/findadoctor	(855)735-4398		(855)735-4398		(855)735-4398		(855)735-4398		(855)735-4398		(855)735-4398		(855)735-4398		(855)735-4398		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H1737	1	0	1	1	1	H1737_001_0	6	1			06/27/2019	2020.01	06/27/2019 04:18:08 PM Central Daylight Time	08/05/2019 12:16:52 PM Central Daylight Time	07/30/2019 04:35:07 PM Central Daylight Time			08/06/2019 10:32:54 AM Central Daylight Time	"HEALTH ALLIANCE - MIDWEST, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Guide HMO Rx (HMO)	1	1		1			H1737	1	0	2020	Scott County		2	6302	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1737	801	0	1	1	1	H1737_801_0	2	1			05/21/2019	2020.01	05/21/2019 02:15:25 PM Central Daylight Time					05/31/2019 03:18:46 PM Central Daylight Time	"HEALTH ALLIANCE - MIDWEST, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	1	1		1			H1737	801	0	2020	Health Alliance Medicare		1	120	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)925-0424		(877)925-0424										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1737	802	0	1	1	1	H1737_802_0	2	1			05/21/2019	2020.01	05/21/2019 02:23:02 PM Central Daylight Time					05/31/2019 03:18:46 PM Central Daylight Time	"HEALTH ALLIANCE - MIDWEST, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	1	1		1			H1737	802	0	2020	Health Alliance Medicare		1	1200	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)925-0424		(877)925-0424		(877)917-8550		(877)917-8550		(877)925-0424		(877)925-0424		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1737	803	0	1	1	1	H1737_803_0	2	1			05/23/2019	2020.01	05/23/2019 08:29:20 AM Central Daylight Time					05/31/2019 03:18:46 PM Central Daylight Time	"HEALTH ALLIANCE - MIDWEST, INC."	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO) - non calendar year (HMO)	1	1		1			H1737	803	0	2020	Health Alliance Medicare		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)925-0424		(877)925-0424		(877)917-8550		(877)917-8550		(877)925-0424		(877)925-0424		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1777	7	0	1	1	1	H1777_007_0	4	1		1	08/02/2019	2020.01	08/02/2019 07:56:50 AM Eastern Daylight Time	08/01/2019 03:36:45 PM Eastern Daylight Time	08/01/2019 12:19:11 PM Eastern Daylight Time			08/06/2019 11:44:51 AM Eastern Daylight Time	"CATHOLIC SPECIAL NEEDS PLAN, LLC"	ArchCare Advantage	www.archcareadvantage.org	ArchCare  Advantage (HMO I-SNP)	1	1		1			H1777	7	0	2020	"NYC, Westchester, Putnam, Dutchess, Orange, Ononda"		2	21432	2			1	1	3				www.archcareadvantage.org	www.archcareadvantage.org	www.archcareadvantage.org	(800)373-3177		(800)373-3177		(800)373-3177		(800)373-3177		(888)816-7977		(800)373-3177		(800)373-3177		(800)373-3177		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1777	14	0	1	1	1	H1777_014_0	6	1	2	1	08/01/2019	2020.01	08/01/2019 05:28:34 PM Eastern Daylight Time	08/01/2019 03:37:29 PM Eastern Daylight Time	08/01/2019 12:19:43 PM Eastern Daylight Time			08/06/2019 11:44:51 AM Eastern Daylight Time	"CATHOLIC SPECIAL NEEDS PLAN, LLC"	ArchCare Advantage	www.ArchCareAdvantage.org	ArchCare Community Choice (HMO D-SNP)	1	1		1			H1777	14	0	2020	"NYC,West,Put,Or,Ul,Sull,Dutch"		2	216	2			1	3		1		1	www.archcareadvantage.org	www.archcareadvantage.org	http://www.archcareadvantage.org/provider_directory.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H1787	1	0	1	1	1	H1787_001_0	5	1		1	08/01/2019	2020.01	08/01/2019 11:55:09 AM Central Daylight Time	08/01/2019 01:15:48 PM Central Daylight Time	07/31/2019 04:02:13 PM Central Daylight Time			08/05/2019 04:36:39 PM Central Daylight Time	"GOOD SAMARITAN INSURANCE PLAN OF SOUTH DAKOTA, INC"	Great Plains Medicare Advantage	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage (HMO I-SNP)	1	1		1			H1787	1	0	2020	South Dakota (partial)		2	5061	2			1	1	3				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1787	2	0	1	1	1	H1787_002_0	7	1		1	07/19/2019	2020.01	07/19/2019 03:35:45 PM Central Daylight Time	08/01/2019 11:13:05 AM Central Daylight Time	07/31/2019 04:04:58 PM Central Daylight Time			08/05/2019 04:36:39 PM Central Daylight Time	"GOOD SAMARITAN INSURANCE PLAN OF SOUTH DAKOTA, INC"	Great Plains Medicare Advantage	www.greatplainsmedicareadvantage.com	Great Plain Medicare Advantage Gold (HMO I-SNP)	1	1		1			H1787	2	0	2020	South Dakota (partial)		2	562	2			1	1	3				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1846	4	0	1	4	1	H1846_004_0	5	1			07/18/2019	2020.01	07/18/2019 01:01:28 PM Eastern Daylight Time	07/31/2019 12:32:32 PM Eastern Daylight Time	07/31/2019 03:47:02 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	MediGold Flexible Choice (PPO)	1	4		1			H1846	4	0	2020	Select Ohio Counties		2		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			
H1846	801	0	1	4	1	H1846_801_0	1	1			06/01/2019	2020.01	06/01/2019 10:07:49 AM Eastern Daylight Time					06/02/2019 03:35:07 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	EGWP MediGold Network Choice (PPO)	1	4		1			H1846	801	0	2020	Greater Central Ohio and Dayton Area		1	12	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	1a;1b;2;8a;9a1;9b;10a;11a;11b;11c;15;	2		1									
H1846	802	0	1	4	1	H1846_802_0	1	1			06/01/2019	2020.01	06/01/2019 10:10:01 AM Eastern Daylight Time					06/02/2019 03:35:07 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.MediGold.com	EGWP MediGold Network Choice Medical Only (PPO)	1	4		1			H1846	802	0	2020	Greater Central Ohio and Dayton Area		1	12	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	1a;1b;2;8a;9a1;9b;10a;11a;11b;11c;15;	2		1									
H1889	1	0	1	4	1	H1889_001_0	2	1	2	1	07/24/2019	2020.01	07/24/2019 01:51:19 PM Central Daylight Time	08/02/2019 11:10:19 AM Central Daylight Time	07/30/2019 06:54:55 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	"UNITEDHEALTHCARE OF FLORIDA, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Choice (PPO D-SNP)	1	4		1			H1889	1	0	2020	Select Counties in Florida		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1894	1	0	1	1	1	H1894_001_0	10	1			08/01/2019	2020.01	08/01/2019 09:03:03 AM Pacific Daylight Time	08/05/2019 06:57:02 AM Pacific Daylight Time	07/30/2019 04:31:47 PM Pacific Daylight Time			08/05/2019 02:28:05 PM Pacific Daylight Time	"AMERIGROUP WASHINGTON, INC."	AMERIGROUP	https://shop.amerigroup.com/medicare/	Amerivantage Classic (HMO)	1	1		1			H1894	1	0	2020	Select counties in Washington		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(866)805-4589		(866)805-4589		(844)288-5923		(844)288-5923		(866)805-4589		(866)805-4589		(844)288-7618		(844)288-7618		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1894	2	0	1	1	1	H1894_002_0	8	1	2	1	07/25/2019	2020.01	07/25/2019 12:35:35 PM Pacific Daylight Time	08/05/2019 06:57:02 AM Pacific Daylight Time	07/30/2019 04:32:25 PM Pacific Daylight Time			08/05/2019 02:28:05 PM Pacific Daylight Time	"AMERIGROUP WASHINGTON, INC."	AMERIGROUP	https://shop.amerigroup.com/medicare/	Amerivantage Dual Coordination (HMO D-SNP)	1	1		1			H1894	2	0	2020	Select counties in Washington		2		2			1	3		2		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(844)812-2275		(844)812-2275		(844)288-5923		(844)288-5923		(844)812-2275		(844)812-2275		(844)288-7618		(844)288-7618		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1904	1	0	1	20	8	H1904_001_0	1	1			05/30/2019	2020.01	05/30/2019 10:39:03 AM Central Daylight Time		05/30/2019 09:50:03 AM Central Daylight Time			05/30/2019 10:58:44 AM Central Daylight Time	PACE GREATER NEW ORLEANS	Pace Greater New Orleans	http://pacegno.org/	PACE Greater New Orleans (PACE)	8	20		1			H1904	1	0	2020	PACE Greater New Orleans		2		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	2	0	1	20	8	H1904_002_0	1	1			05/30/2019	2020.01	05/30/2019 10:40:08 AM Central Daylight Time		05/30/2019 09:49:20 AM Central Daylight Time			05/30/2019 10:58:44 AM Central Daylight Time	PACE GREATER NEW ORLEANS	Pace Greater New Orleans	http://pacegno.org/	PACE Greater New Orleans (PACE)	8	20		1			H1904	2	0	2020	PACE Greater New Orleans		2		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																
H1914	1	0	1	4	1	H1914_001_0	8	1			07/12/2019	2020.01	07/12/2019 11:10:14 AM Eastern Daylight Time	08/02/2019 05:50:19 AM Eastern Daylight Time	07/30/2019 10:17:11 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF CONNECTICUT	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H1914	1	0	2020	Select counties in CT		2	9463	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H1924	1	0		7	2	H1924_001_0	4	2			05/20/2019	2020.01	05/20/2019 08:30:38 AM Eastern Daylight Time			05/30/2019 06:20:11 PM Eastern Daylight Time		05/30/2019 06:26:40 PM Eastern Daylight Time	"PORT HOLDINGS, INC."	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare (MSA)	2	7	2				H1924	1	0	2020	Lasso Healthcare Region 1		2	100106	1	1		2									(866)766-2583		(866)766-2583		(866)766-2583		(866)766-2583										(711)-		(711)-		(711)-		(711)-																								
H1924	2	0		7	2	H1924_002_0	4	2			05/16/2019	2020.01	05/16/2019 08:19:38 AM Eastern Daylight Time			05/30/2019 06:20:11 PM Eastern Daylight Time		05/30/2019 06:26:40 PM Eastern Daylight Time	"PORT HOLDINGS, INC."	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare (MSA)	2	7	2				H1924	2	0	2020	Lasso Healthcare Region 2		2	9778	1	1		2									(866)766-2583		(866)766-2583		(866)766-2583		(866)766-2583										(711)-		(711)-		(711)-		(711)-																								
H1924	3	0		7	2	H1924_003_0	4	2			05/16/2019	2020.01	05/16/2019 08:20:11 AM Eastern Daylight Time			05/30/2019 06:20:11 PM Eastern Daylight Time		05/30/2019 06:26:40 PM Eastern Daylight Time	"PORT HOLDINGS, INC."	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare (MSA)	2	7	2				H1924	3	0	2020	Lasso Healthcare Region 3		2	61958	1	1		2									(866)766-2583		(866)766-2583		(866)766-2583		(866)766-2583										(711)-		(711)-		(711)-		(711)-																								
H1924	803	0		7	2	H1924_803_0	2	2			05/20/2019	2020.01	05/20/2019 02:12:23 PM Eastern Daylight Time					05/30/2019 06:26:40 PM Eastern Daylight Time	"PORT HOLDINGS, INC."	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare Employer Group 200 (MSA)	2	7	2				H1924	803	0	2020	National Employer Group 200		1	22400	1	1		2									(866)766-2583		(866)766-2583		(866)766-2583		(866)766-2583										(711)-		(711)-		(711)-		(711)-																								
H1924	804	0		7	2	H1924_804_0	2	2			05/20/2019	2020.01	05/20/2019 02:14:27 PM Eastern Daylight Time					05/30/2019 06:26:40 PM Eastern Daylight Time	"PORT HOLDINGS, INC."	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare Employer Group 220 (MSA)	2	7	2				H1924	804	0	2020	National Employer Group 220		1	22400	1	1		2									(866)766-2583		(866)766-2583		(866)766-2583		(866)766-2583										(711)-		(711)-		(711)-		(711)-																								
H1924	805	0		7	2	H1924_805_0	2	2			05/20/2019	2020.01	05/20/2019 02:15:49 PM Eastern Daylight Time					05/30/2019 06:26:40 PM Eastern Daylight Time	"PORT HOLDINGS, INC."	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare Employer Group 250 (MSA)	2	7	2				H1924	805	0	2020	National Employer Group 250		1	22400	1	1		2									(866)766-2583		(866)766-2583		(866)766-2583		(866)766-2583										(711)-		(711)-		(711)-		(711)-																								
H1924	806	0		7	2	H1924_806_0	2	2			05/20/2019	2020.01	05/20/2019 02:17:29 PM Eastern Daylight Time					05/30/2019 06:26:40 PM Eastern Daylight Time	"PORT HOLDINGS, INC."	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare Employer Group 270 (MSA)	2	7	2				H1924	806	0	2020	National Employer Group 270		1	22400	1	1		2									(866)766-2583		(866)766-2583		(866)766-2583		(866)766-2583										(711)-		(711)-		(711)-		(711)-																								
H1924	807	0		7	2	H1924_807_0	2	2			05/20/2019	2020.01	05/20/2019 02:18:27 PM Eastern Daylight Time					05/30/2019 06:26:40 PM Eastern Daylight Time	"PORT HOLDINGS, INC."	Lasso Healthcare	lassohealthcare.com	Lasso Healthcare Employer Group 300 (MSA)	2	7	2				H1924	807	0	2020	National Employer Group 300		1	22400	1	1		2									(866)766-2583		(866)766-2583		(866)766-2583		(866)766-2583										(711)-		(711)-		(711)-		(711)-																								
H1944	1	0	1	1	1	H1944_001_0	4	1			08/02/2019	2020.01	08/02/2019 10:41:57 AM Central Daylight Time	08/02/2019 10:28:52 AM Central Daylight Time	07/30/2019 06:55:29 PM Central Daylight Time			08/06/2019 09:59:12 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H1944	1	0	2020	Middlesex and Suffolk counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	4	0	1	1	1	H1944_004_0	3	1			08/02/2019	2020.01	08/02/2019 10:41:43 AM Central Daylight Time	08/02/2019 10:29:15 AM Central Daylight Time	07/30/2019 06:56:00 PM Central Daylight Time			08/06/2019 09:59:12 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H1944	4	0	2020	Middlesex and Suffolk counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	5	0	1	1	1	H1944_005_0	4	1			08/05/2019	2020.01	08/05/2019 09:55:33 AM Central Daylight Time	08/02/2019 10:29:38 AM Central Daylight Time	07/30/2019 06:56:33 PM Central Daylight Time			08/06/2019 09:59:12 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H1944	5	0	2020	Select Counties in Massachusetts		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	6	0	1	1	1	H1944_006_0	3	1			08/05/2019	2020.01	08/05/2019 10:11:31 AM Central Daylight Time	08/02/2019 10:30:01 AM Central Daylight Time	07/30/2019 06:57:06 PM Central Daylight Time			08/06/2019 09:59:12 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H1944	6	0	2020	Select Counties in Massachusetts		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	9	0	1	1	1	H1944_009_0	3	1			08/02/2019	2020.01	08/02/2019 09:13:35 AM Central Daylight Time	08/02/2019 10:30:24 AM Central Daylight Time	07/30/2019 06:57:40 PM Central Daylight Time			08/06/2019 12:04:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H1944	9	0	2020	"Bucks, Chester and Philadelphia Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	10	0	1	1	1	H1944_010_0	5	1			08/02/2019	2020.01	08/02/2019 09:14:26 AM Central Daylight Time	08/02/2019 10:30:47 AM Central Daylight Time	07/30/2019 06:58:15 PM Central Daylight Time			08/06/2019 12:04:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H1944	10	0	2020	West Pennsylvania		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	11	0	1	1	1	H1944_011_0	4	1			08/02/2019	2020.01	08/02/2019 09:15:16 AM Central Daylight Time	08/02/2019 10:31:11 AM Central Daylight Time	07/30/2019 06:58:50 PM Central Daylight Time			08/06/2019 12:04:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H1944	11	0	2020	West Pennsylvania		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	14	0	1	2	1	H1944_014_0	3	1			08/02/2019	2020.01	08/02/2019 10:43:07 AM Central Daylight Time	08/02/2019 10:31:34 AM Central Daylight Time	07/30/2019 06:59:20 PM Central Daylight Time			08/06/2019 09:59:12 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	1	2		1			H1944	14	0	2020	State of Rhode Island		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	15	0	1	2	1	H1944_015_0	5	1			08/05/2019	2020.01	08/05/2019 10:13:14 AM Central Daylight Time	07/17/2019 10:20:08 AM Central Daylight Time				08/07/2019 10:23:47 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Essential (HMO-POS)	1	2		1			H1944	15	0	2020	State of Rhode Island		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1944	16	0	1	2	1	H1944_016_0	3	1			08/02/2019	2020.01	08/02/2019 10:52:10 AM Central Daylight Time	08/02/2019 10:32:22 AM Central Daylight Time	07/30/2019 06:59:55 PM Central Daylight Time			08/06/2019 10:27:36 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H1944	16	0	2020	State of Rhode Island		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	17	0	1	1	1	H1944_017_0	3	1			08/02/2019	2020.01	08/02/2019 09:16:01 AM Central Daylight Time	08/02/2019 10:32:45 AM Central Daylight Time	07/30/2019 07:00:42 PM Central Daylight Time			08/06/2019 12:04:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H1944	17	0	2020	Select counties in New Hampshire		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	18	0	1	1	1	H1944_018_0	3	1			08/02/2019	2020.01	08/02/2019 09:16:44 AM Central Daylight Time	08/02/2019 10:33:08 AM Central Daylight Time	07/30/2019 07:01:20 PM Central Daylight Time			08/06/2019 12:04:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H1944	18	0	2020	Select counties in Vermont		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	19	0	1	1	1	H1944_019_0	3	1			08/02/2019	2020.01	08/02/2019 09:17:29 AM Central Daylight Time	08/02/2019 10:33:31 AM Central Daylight Time	07/30/2019 07:01:58 PM Central Daylight Time			08/06/2019 12:04:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	1	1		1			H1944	19	0	2020	Select counties in New Hampshire		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	20	0	1	2	1	H1944_020_0	3	1			08/02/2019	2020.01	08/02/2019 10:52:30 AM Central Daylight Time	08/02/2019 10:33:54 AM Central Daylight Time	07/30/2019 07:02:29 PM Central Daylight Time			08/06/2019 10:27:36 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO-POS)	1	2		1			H1944	20	0	2020	State of Rhode Island		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	21	0	1	1	1	H1944_021_0	3	1			08/02/2019	2020.01	08/02/2019 10:52:52 AM Central Daylight Time	08/02/2019 10:34:17 AM Central Daylight Time	07/30/2019 07:03:01 PM Central Daylight Time			08/06/2019 10:27:36 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	1	1		1			H1944	21	0	2020	Middlesex and Suffolk counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	22	0	1	1	1	H1944_022_0	3	1			08/02/2019	2020.01	08/02/2019 10:53:35 AM Central Daylight Time	08/02/2019 10:34:40 AM Central Daylight Time	07/30/2019 07:03:40 PM Central Daylight Time			08/06/2019 10:27:36 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	1	1		1			H1944	22	0	2020	Select Counties in Massachusetts		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	24	0	1	1	1	H1944_024_0	3	1			07/11/2019	2020.01	07/11/2019 02:39:28 PM Central Daylight Time	08/02/2019 10:35:04 AM Central Daylight Time	07/30/2019 07:04:13 PM Central Daylight Time			08/06/2019 12:04:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H1944	24	0	2020	Philadelphia Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	25	0	1	1	1	H1944_025_0	3	1			08/02/2019	2020.01	08/02/2019 09:21:39 AM Central Daylight Time	08/02/2019 10:35:26 AM Central Daylight Time	07/30/2019 07:04:47 PM Central Daylight Time			08/06/2019 12:04:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	1	1		1			H1944	25	0	2020	West Pennsylvania		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	28	0	1	1	1	H1944_028_0	4	1			08/09/2019	2020.01	08/09/2019 08:20:55 AM Central Daylight Time	08/02/2019 10:35:50 AM Central Daylight Time	07/30/2019 07:05:22 PM Central Daylight Time			08/09/2019 08:32:41 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H1944	28	0	2020	Select Counties in Vermont		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	30	0	1	1	1	H1944_030_0	3	1			07/11/2019	2020.01	07/11/2019 02:42:16 PM Central Daylight Time	05/31/2019 12:39:13 PM Central Daylight Time				07/12/2019 12:51:19 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Essential (HMO)	1	1		1			H1944	30	0	2020	West Pennsylvania		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1944	31	0	1	1	1	H1944_031_0	3	1			08/02/2019	2020.01	08/02/2019 09:25:39 AM Central Daylight Time	08/02/2019 10:36:37 AM Central Daylight Time	07/30/2019 07:05:56 PM Central Daylight Time			08/06/2019 12:04:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Plan 4 (HMO)	1	1		1			H1944	31	0	2020	Select counties in New Hampshire		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	32	0	1	1	1	H1944_032_0	3	1			08/02/2019	2020.01	08/02/2019 09:27:31 AM Central Daylight Time	08/02/2019 10:37:01 AM Central Daylight Time	07/30/2019 07:06:28 PM Central Daylight Time			08/06/2019 12:04:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Plan 3 (HMO)	1	1		1			H1944	32	0	2020	Select counties in Vermont		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1944	805	0	1	1	1	H1944_805_0	1	1			05/14/2019	2020.01	05/14/2019 08:23:48 PM Pacific Daylight Time					06/02/2019 03:22:13 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H1944	805	0	2020	"Select counties in MA, NH, PA, RI, VT"		1	8292	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H1944	806	0	1	1	1	H1944_806_0	1	1			05/09/2019	2020.01	05/09/2019 11:33:25 PM Central Daylight Time					06/02/2019 03:22:13 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H1944	806	0	2020	"Select counties in MA, NH, PA, RI, VT"		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H1944	807	0	1	1	1	H1944_807_0	1	1			05/09/2019	2020.01	05/09/2019 11:35:12 PM Central Daylight Time					06/02/2019 03:22:13 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW ENGLAND, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H1944	807	0	2020	"Select counties in MA, NH, PA, RI, VT"		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H1947	1	0	1	1	1	H1947_001_0	8	1	2	1	07/31/2019	2020.01	07/31/2019 09:52:51 PM Eastern Daylight Time	08/05/2019 09:57:02 AM Eastern Daylight Time	07/30/2019 07:33:02 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC."	Healthy Blue	https://shop.anthem.com/medicare	Healthy Blue Dual Advantage (HMO D-SNP)	1	1		1			H1947	1	0	2020	Select Parishes in Louisiana		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare			(844)879-3611				(844)373-7111		(844)879-3611		(844)879-3611		(844)373-7110		(844)373-7110		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	13	0	1	1	1	H1951_013_0	4	1			08/01/2019	2020.01	08/01/2019 01:02:21 PM Eastern Daylight Time	08/03/2019 11:59:40 AM Eastern Daylight Time	08/02/2019 01:18:09 PM Eastern Daylight Time			08/05/2019 11:40:46 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1951-013 (HMO)	1	1		1			H1951	13	0	2020	Shreveport Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	24	0	1	1	1	H1951_024_0	4	1			08/01/2019	2020.01	08/01/2019 06:54:53 PM Eastern Daylight Time	08/03/2019 10:34:35 AM Eastern Daylight Time	08/02/2019 01:18:10 PM Eastern Daylight Time			08/05/2019 11:40:46 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1951-024 (HMO)	1	1		1			H1951	24	0	2020	Tangipahoa Parish		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	28	0	1	1	1	H1951_028_0	4	1			07/15/2019	2020.01	07/15/2019 03:34:22 PM Eastern Daylight Time	08/03/2019 10:40:09 AM Eastern Daylight Time	08/02/2019 01:18:10 PM Eastern Daylight Time			08/05/2019 11:40:46 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1951-028 (HMO)	1	1		1			H1951	28	0	2020	Washington and St. Tammany Parishes		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	30	0	1	1	1	H1951_030_0	3	1			07/15/2019	2020.01	07/15/2019 03:35:48 PM Eastern Daylight Time	06/01/2019 09:30:30 AM Eastern Daylight Time				07/16/2019 05:12:39 PM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1951-030 (HMO)	1	1		1			H1951	30	0	2020	Baton Rouge Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1951	32	0	1	1	1	H1951_032_0	3	1	2	1	05/31/2019	2020.01	05/31/2019 12:25:01 PM Eastern Daylight Time	08/03/2019 10:49:15 AM Eastern Daylight Time	08/02/2019 01:18:10 PM Eastern Daylight Time			08/05/2019 11:40:46 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-032 (HMO D-SNP)	1	1		1			H1951	32	0	2020	Baton Rouge Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	33	0	1	1	1	H1951_033_0	6	1	2	1	07/19/2019	2020.01	07/19/2019 04:40:08 PM Eastern Daylight Time	08/03/2019 10:46:55 AM Eastern Daylight Time	08/02/2019 01:18:10 PM Eastern Daylight Time			08/05/2019 11:40:46 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-033 (HMO D-SNP)	1	1		1			H1951	33	0	2020	New Orleans Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	34	0	1	1	1	H1951_034_0	4	1	2	1	05/31/2019	2020.01	05/31/2019 12:14:38 PM Eastern Daylight Time	08/03/2019 10:44:45 AM Eastern Daylight Time	08/02/2019 01:18:10 PM Eastern Daylight Time			08/05/2019 12:14:58 PM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-034 (HMO D-SNP)	1	1		1			H1951	34	0	2020	Washington and St. Tammany Parishes		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	38	0	1	1	1	H1951_038_0	3	1			05/31/2019	2020.01	05/31/2019 12:27:26 PM Eastern Daylight Time	08/03/2019 10:53:47 AM Eastern Daylight Time	08/02/2019 01:18:10 PM Eastern Daylight Time			08/05/2019 11:40:46 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana-Ochsner Network H1951-038 (HMO)	1	1		1			H1951	38	0	2020	New Orleans Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	39	0	1	1	1	H1951_039_0	3	1			05/31/2019	2020.01	05/31/2019 12:29:40 PM Eastern Daylight Time	08/03/2019 10:51:36 AM Eastern Daylight Time	08/02/2019 01:18:10 PM Eastern Daylight Time			08/05/2019 11:40:46 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana-Ochsner Network H1951-039 (HMO)	1	1		1			H1951	39	0	2020	Baton Rouge Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	41	0	1	1	1	H1951_041_0	4	1	2	1	05/31/2019	2020.01	05/31/2019 12:30:28 PM Eastern Daylight Time	08/03/2019 11:07:32 AM Eastern Daylight Time	08/02/2019 01:18:10 PM Eastern Daylight Time			08/05/2019 11:40:46 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H1951-041 (HMO D-SNP)	1	1		1			H1951	41	0	2020	Select Louisiana Parishes		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	44	0	1	1	1	H1951_044_0	3	1		1	08/01/2019	2020.01	08/01/2019 01:08:54 PM Eastern Daylight Time	08/03/2019 11:00:01 AM Eastern Daylight Time	08/02/2019 01:18:10 PM Eastern Daylight Time			08/05/2019 11:40:46 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart H1951-044 (HMO C-SNP)	1	1		1			H1951	44	0	2020	Jefferson and Orleans Parishes		2		2			1	4			10		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	47	1	1	1	1	H1951_047_1	4	1			08/01/2019	2020.01	08/01/2019 01:11:17 PM Eastern Daylight Time	08/03/2019 11:17:55 AM Eastern Daylight Time	08/02/2019 01:18:11 PM Eastern Daylight Time			08/05/2019 11:40:46 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1951-047 (HMO)	1	1		1			H1951	47	1	2020	New Orleans Area	"Jefferson, Orleans, and St. Charles Parishes"	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	47	2	1	1	1	H1951_047_2	4	1			07/15/2019	2020.01	07/15/2019 03:38:15 PM Eastern Daylight Time	08/03/2019 11:15:57 AM Eastern Daylight Time	08/02/2019 01:18:11 PM Eastern Daylight Time			08/05/2019 11:43:56 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1951-047 (HMO)	1	1		1			H1951	47	2	2020	New Orleans Area	Select Louisiana Parishes	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	48	1	1	1	1	H1951_048_1	4	1			08/01/2019	2020.01	08/01/2019 01:13:09 PM Eastern Daylight Time	08/03/2019 11:13:46 AM Eastern Daylight Time	08/02/2019 01:18:11 PM Eastern Daylight Time			08/05/2019 11:43:56 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1951-048 (HMO)	1	1		1			H1951	48	1	2020	Baton Rouge Area	Baton Rouge Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	48	2	1	1	1	H1951_048_2	4	1			08/01/2019	2020.01	08/01/2019 01:14:38 PM Eastern Daylight Time	08/03/2019 11:11:40 AM Eastern Daylight Time	08/02/2019 01:18:11 PM Eastern Daylight Time			08/05/2019 11:43:56 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1951-048 (HMO)	1	1		1			H1951	48	2	2020	Baton Rouge Area	Select Louisiana Parishes	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	49	1	1	1	1	H1951_049_1	4	1			08/01/2019	2020.01	08/01/2019 01:16:03 PM Eastern Daylight Time	08/03/2019 11:27:57 AM Eastern Daylight Time	08/02/2019 01:18:11 PM Eastern Daylight Time			08/05/2019 11:43:56 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1951-049 (HMO)	1	1		1			H1951	49	1	2020	Select Louisiana Parishes	Select Louisiana Parishes	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	49	2	1	1	1	H1951_049_2	4	1			08/01/2019	2020.01	08/01/2019 01:17:32 PM Eastern Daylight Time	08/03/2019 11:35:49 AM Eastern Daylight Time	08/02/2019 01:18:11 PM Eastern Daylight Time			08/05/2019 11:43:56 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1951-049 (HMO)	1	1		1			H1951	49	2	2020	Select Louisiana Parishes	Select Louisiana Parishes	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	49	3	1	1	1	H1951_049_3	4	1			08/01/2019	2020.01	08/01/2019 01:19:34 PM Eastern Daylight Time	08/03/2019 11:37:55 AM Eastern Daylight Time	08/02/2019 01:18:11 PM Eastern Daylight Time			08/05/2019 11:43:56 AM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1951-049 (HMO)	1	1		1			H1951	49	3	2020	Select Louisiana Parishes	Select Louisiana Parishes	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H1951	50	0	1	1	1	H1951_050_0	4	1			05/31/2019	2020.01	05/31/2019 12:18:00 PM Eastern Daylight Time	08/03/2019 11:55:31 AM Eastern Daylight Time	08/02/2019 01:18:11 PM Eastern Daylight Time			08/05/2019 12:14:58 PM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H1951-050 (HMO)	1	1		1			H1951	50	0	2020	New Orleans Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools			(502)580-1000				(502)580-1000		(800)475-0480		(502)580-1000		(800)475-0480		(502)580-1000		(800)475-0480		(800)475-0480		(800)475-0480		(800)475-0480		(800)475-0480		(800)475-0480		(800)475-0480		(800)475-0480		2					2					2	2			
H1951	801	0	1	1	1	H1951_801_0	1	1			05/29/2019	2020.01	05/29/2019 10:36:52 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1951	801	0	2020	Select parishes in Louisiana		1	87992	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1951	804	0	1	1	1	H1951_804_0	1	1			05/29/2019	2020.01	05/29/2019 10:37:45 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1951	804	0	2020	Select parishes in Louisiana		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H1951	807	0	1	1	1	H1951_807_0	1	1			05/29/2019	2020.01	05/29/2019 12:23:45 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1951	807	0	2020	Select parishes in Louisiana		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1951	808	0	1	1	1	H1951_808_0	1	1			05/29/2019	2020.01	05/29/2019 12:25:07 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H1951	808	0	2020	Select parishes in Louisiana		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H1961	3	0	1	1	1	H1961_003_0	4	1	2	1	08/02/2019	2020.01	08/02/2019 11:32:43 AM Central Daylight Time	08/02/2019 10:12:50 AM Central Daylight Time	07/30/2019 07:07:02 PM Central Daylight Time			08/05/2019 06:10:28 PM Central Daylight Time	"PEOPLES HEALTH, INC."	Peoples Health	www.peopleshealth.com	Peoples Health Secure Health (HMO D-SNP)	1	1		1			H1961	3	0	2020	South Louisiana		2	250743	2			1	3		2		2	www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(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	2			
H1961	11	0	1	1	1	H1961_011_0	4	1	2	1	06/03/2019	2020.01	06/03/2019 02:26:21 PM Central Daylight Time	08/02/2019 10:13:20 AM Central Daylight Time	07/30/2019 07:07:38 PM Central Daylight Time			08/06/2019 03:07:06 PM Central Daylight Time	"PEOPLES HEALTH, INC."	Peoples Health	www.peopleshealth.com	Peoples Health Secure Choice #011 (HMO D-SNP)	1	1		1			H1961	11	0	2020	North and Central Louisiana		2	481	2			1	3		2		2	www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(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	2			
H1961	14	1	1	1	1	H1961_014_1	5	1			08/02/2019	2020.01	08/02/2019 11:33:39 AM Central Daylight Time	08/02/2019 10:13:50 AM Central Daylight Time	07/30/2019 07:08:12 PM Central Daylight Time			08/05/2019 06:10:28 PM Central Daylight Time	"PEOPLES HEALTH, INC."	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 #14 (HMO)	1	1		1			H1961	14	1	2020	New Orleans Metro Area and Northshore	Southeast Louisiana	2	443209	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(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	2			
H1961	14	2	1	1	1	H1961_014_2	5	1			08/02/2019	2020.01	08/02/2019 11:34:28 AM Central Daylight Time	08/02/2019 10:14:20 AM Central Daylight Time	07/30/2019 07:08:44 PM Central Daylight Time			08/05/2019 06:10:28 PM Central Daylight Time	"PEOPLES HEALTH, INC."	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 #14 (HMO)	1	1		1			H1961	14	2	2020	New Orleans Metro Area and Northshore	Northshore	2	85905	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(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	2			
H1961	17	0	1	2	1	H1961_017_0	5	1			08/02/2019	2020.01	08/02/2019 11:34:57 AM Central Daylight Time	08/02/2019 10:14:51 AM Central Daylight Time	07/30/2019 07:09:16 PM Central Daylight Time			08/05/2019 06:10:28 PM Central Daylight Time	"PEOPLES HEALTH, INC."	Peoples Health	www.peopleshealth.com	Peoples Health Choices Gold (HMO-POS)	1	2		1			H1961	17	0	2020	Southwest and North Louisiana		2	16037	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(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	2			
H1961	18	0	1	1	1	H1961_018_0	6	1			08/02/2019	2020.01	08/02/2019 11:36:06 AM Central Daylight Time	08/02/2019 10:15:21 AM Central Daylight Time	07/30/2019 07:09:53 PM Central Daylight Time			08/05/2019 06:10:28 PM Central Daylight Time	"PEOPLES HEALTH, INC."	Peoples Health	www.peopleshealth.com	Peoples Health Choices Value (HMO)	1	1		1			H1961	18	0	2020	Southwest and North Louisiana		2		2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	https://www.peopleshealth.com/2018-search/physician/	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(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	2			
H1961	801	0	1	2	1	H1961_801_0	1	1			05/09/2019	2020.01	05/09/2019 11:36:23 PM Central Daylight Time					06/02/2019 03:25:54 PM Central Daylight Time	"PEOPLES HEALTH, INC."	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO-POS)	1	2		1			H1961	801	0	2020	Nationwide		1	0	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(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		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1	2		2		1				
H1961	802	0	1	2	1	H1961_802_0	1	1			05/09/2019	2020.01	05/09/2019 11:36:53 PM Central Daylight Time					06/02/2019 03:25:54 PM Central Daylight Time	"PEOPLES HEALTH, INC."	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO-POS)	1	2		1			H1961	802	0	2020	Nationwide		1	0	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(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		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1	2		2		1				
H1961	803	0	1	1	1	H1961_803_0	1	1			05/09/2019	2020.01	05/09/2019 11:37:37 PM Central Daylight Time					06/02/2019 03:25:54 PM Central Daylight Time	"PEOPLES HEALTH, INC."	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO)	1	1		1			H1961	803	0	2020	Nationwide		1	0	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(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		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H1961	804	0	1	1	1	H1961_804_0	1	1			05/09/2019	2020.01	05/09/2019 11:38:04 PM Central Daylight Time					06/02/2019 03:25:54 PM Central Daylight Time	"PEOPLES HEALTH, INC."	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO)	1	1		1			H1961	804	0	2020	Nationwide		1	0	2			2						www.peopleshealth.com/pharmacies	www.peopleshealth.com/formulary	www.peopleshealth.com/physicians	(800)222-8600		(504)849-4685		(866)301-8865		(504)712-7504		(800)222-8600		(504)849-4685		(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		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H1969	2	0	1	1	1	H1969_002_0	10	1			05/29/2019	2020.01	05/29/2019 01:20:38 PM Mountain Daylight Time	08/05/2019 10:13:10 AM Mountain Daylight Time	07/31/2019 10:36:21 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence Blue MedAdvantage HMO (HMO)	1	1		1			H1969	2	0	2020	Ada and Canyon Counties		2	14542	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	2			
H1969	4	0	1	1	1	H1969_004_0	10	1			05/29/2019	2020.01	05/29/2019 01:20:47 PM Mountain Daylight Time	08/05/2019 10:14:17 AM Mountain Daylight Time	07/31/2019 10:38:50 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence Blue MedAdvantage HMO Plus (HMO)	1	1		1			H1969	4	0	2020	Ada and Canyon Counties		2	7538	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	2			
H1969	6	0	1	1	1	H1969_006_0	9	1			05/29/2019	2020.01	05/29/2019 01:20:56 PM Mountain Daylight Time	07/05/2019 02:18:18 PM Mountain Daylight Time				07/10/2019 11:17:56 AM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence St. Luke's Health Partners AlignBlue No Rx (HMO)	1	1		1			H1969	6	0	2020	Select Counties in Idaho		2	1608	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1969	7	3	1	1	1	H1969_007_3	10	1			05/29/2019	2020.01	05/29/2019 01:21:02 PM Mountain Daylight Time	08/05/2019 10:16:41 AM Mountain Daylight Time	07/31/2019 10:41:21 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence St. Luke's Health Partners AlignBlue (HMO)	1	1		1			H1969	7	3	2020	Select Counties in Idaho	Select Counties in Idaho	2	18984	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	2			
H1969	7	4	1	1	1	H1969_007_4	11	1			05/29/2019	2020.01	05/29/2019 01:23:40 PM Mountain Daylight Time	08/05/2019 10:17:51 AM Mountain Daylight Time	07/31/2019 10:43:52 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence St. Luke's Health Partners AlignBlue (HMO)	1	1		1			H1969	7	4	2020	Select Counties in Idaho	Select Counties in Idaho	2	5694	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	2			
H1969	8	1	1	1	1	H1969_008_1	10	1			06/03/2019	2020.01	06/03/2019 04:27:51 PM Mountain Daylight Time	08/05/2019 10:19:19 AM Mountain Daylight Time	07/31/2019 10:46:21 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence St. Luke's Health Partners AlignBlue Plus (HMO)	1	1		1			H1969	8	1	2020	Select Counties in Idaho	Select Counties in Idaho	2	7302	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	2			
H1969	8	2	1	1	1	H1969_008_2	10	1			06/03/2019	2020.01	06/03/2019 04:28:01 PM Mountain Daylight Time	08/05/2019 10:20:34 AM Mountain Daylight Time	07/31/2019 10:49:03 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence St. Luke's Health Partners AlignBlue Plus (HMO)	1	1		1			H1969	8	2	2020	Select Counties in Idaho	Select Counties in Idaho	2	1410	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	2			
H1977	1	0	1	48	5	H1977_001_0	1	1			05/29/2019	2020.01	05/29/2019 12:28:23 PM Eastern Daylight Time					05/30/2019 11:37:26 AM Eastern Daylight Time	"UPPER PENINSULA HEALTH PLAN, LLC"	Upper Peninsula Health Plan (UPHP) MI Health Link	www.uphp.com/medicare	Upper Peninsula Health Plan MI Health Link (Medicare-Medicaid Plan)	5	48		1			H1977	1	0	2020	Upper Peninsula of Michigan		2	55200	2			2						www.uphp.com/pharmacy	www.uphp.com/medicare/uphp-mi-health-link/formulary	www.uphp.com/medicare/providers	(877)349-9324		(877)349-9324		(877)349-9324		(877)349-9324		(855)380-0275		(855)380-0275		(877)349-9324		(877)349-9324		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H1994	1	0	1	1	1	H1994_001_0	4	1			07/12/2019	2020.01	07/12/2019 11:15:10 AM Mountain Daylight Time	08/02/2019 01:51:02 PM Mountain Daylight Time	07/31/2019 04:24:14 PM Mountain Daylight Time			08/05/2019 05:26:00 PM Mountain Daylight Time	"SELECTHEALTH, INC."	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage Essential (HMO)	1	1		1			H1994	1	0	2020	Urban and Northern Utah		2		2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	2			
H1994	2	0	1	1	1	H1994_002_0	4	1			07/10/2019	2020.01	07/10/2019 12:14:13 PM Mountain Daylight Time	08/02/2019 01:51:42 PM Mountain Daylight Time	07/31/2019 04:24:42 PM Mountain Daylight Time			08/05/2019 05:26:00 PM Mountain Daylight Time	"SELECTHEALTH, INC."	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage (HMO)	1	1		1			H1994	2	0	2020	"Gar, Iron, Jua, Mil, Piu, San, Sev, Wash, Wayne Co"		2	69338	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	2			
H1994	3	0	1	1	1	H1994_003_0	4	1			07/10/2019	2020.01	07/10/2019 12:14:35 PM Mountain Daylight Time	08/02/2019 01:52:22 PM Mountain Daylight Time	07/31/2019 04:25:08 PM Mountain Daylight Time			08/05/2019 05:26:00 PM Mountain Daylight Time	"SELECTHEALTH, INC."	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage Essential (HMO)	1	1		1			H1994	3	0	2020	Southwest Idaho		2		2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	2			
H1994	4	0	1	1	1	H1994_004_0	4	1			07/10/2019	2020.01	07/10/2019 12:14:55 PM Mountain Daylight Time	08/02/2019 01:53:02 PM Mountain Daylight Time	07/31/2019 04:25:36 PM Mountain Daylight Time			08/05/2019 05:26:00 PM Mountain Daylight Time	"SELECTHEALTH, INC."	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage (HMO)	1	1		1			H1994	4	0	2020	"Bla, Cas, Goo, Jer, Min, Twi"		2		2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	2			
H1994	7	0	1	1	1	H1994_007_0	4	1			07/10/2019	2020.01	07/10/2019 12:15:29 PM Mountain Daylight Time	08/02/2019 01:53:34 PM Mountain Daylight Time	07/31/2019 04:26:04 PM Mountain Daylight Time			08/05/2019 05:26:00 PM Mountain Daylight Time	"SELECTHEALTH, INC."	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage Enhanced (HMO)	1	1		1			H1994	7	0	2020	Urban and Northern Utah		2	15742	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	2			
H1994	8	0	1	1	1	H1994_008_0	4	1			07/10/2019	2020.01	07/10/2019 12:15:53 PM Mountain Daylight Time	08/02/2019 02:16:58 PM Mountain Daylight Time	07/31/2019 04:26:44 PM Mountain Daylight Time			08/05/2019 05:26:00 PM Mountain Daylight Time	"SELECTHEALTH, INC."	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage Enhanced (HMO)	1	1		1			H1994	8	0	2020	Southwest Idaho		2		2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		2					2					2	2			
H1994	9	0	1	1	1	H1994_009_0	4	1			07/10/2019	2020.01	07/10/2019 12:16:09 PM Mountain Daylight Time	08/02/2019 01:58:42 PM Mountain Daylight Time	07/31/2019 04:27:12 PM Mountain Daylight Time			08/05/2019 05:26:00 PM Mountain Daylight Time	"SELECTHEALTH, INC."	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage Essential (HMO)	1	1		1			H1994	9	0	2020	Clark County Nevada		2		2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	2			
H1994	10	0	1	1	1	H1994_010_0	4	1		1	07/10/2019	2020.01	07/10/2019 12:16:27 PM Mountain Daylight Time	08/02/2019 01:59:22 PM Mountain Daylight Time	07/31/2019 04:27:40 PM Mountain Daylight Time			08/05/2019 05:26:00 PM Mountain Daylight Time	"SELECTHEALTH, INC."	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage - Diabetes and Heart Care (HMO C-SNP)	1	1		1			H1994	10	0	2020	Clark County Nevada		2		2			1	4			10		www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	2			
H1994	11	0	1	1	1	H1994_011_0	4	1		1	07/10/2019	2020.01	07/10/2019 12:16:43 PM Mountain Daylight Time	08/02/2019 02:00:02 PM Mountain Daylight Time	07/31/2019 04:28:08 PM Mountain Daylight Time			08/05/2019 05:26:00 PM Mountain Daylight Time	"SELECTHEALTH, INC."	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage - Lung Care (HMO C-SNP)	1	1		1			H1994	11	0	2020	Clark County Nevada		2		2			1	4			100000000		www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	2			
H1994	801	0	1	1	1	H1994_801_0	1	1			05/31/2019	2020.01	05/31/2019 10:28:43 AM Mountain Daylight Time					06/03/2019 10:09:54 PM Mountain Daylight Time	"SELECTHEALTH, INC."	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage (HMO)	1	1		1			H1994	801	0	2020	"Utah and Idaho, and Clark and Nye Counties Nevada"		1	300	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	2		2		1					1				
H1994	802	0	1	1	1	H1994_802_0	1	1			05/31/2019	2020.01	05/31/2019 10:28:48 AM Mountain Daylight Time					06/03/2019 10:09:54 PM Mountain Daylight Time	"SELECTHEALTH, INC."	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage (HMO)	1	1		1			H1994	802	0	2020	"Utah and Idaho, and Clark and Nye Counties Nevada"		1	300	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1				
H1994	803	0	1	1	1	H1994_803_0	1	1			05/31/2019	2020.01	05/31/2019 10:28:54 AM Mountain Daylight Time					06/03/2019 10:09:54 PM Mountain Daylight Time	"SELECTHEALTH, INC."	SelectHealth	www.selecthealth.org/medicare	SelectHealth Advantage (HMO)	1	1		1			H1994	803	0	2020	"Utah and Idaho, and Clark and Nye Counties Nevada"		1	300	2			2						www.selecthealth.org/medicare	www.selecthealth.org/medicare	www.selecthealth.org/medicare	(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	2		2		1					1				
H1997	2	0	1	1	1	H1997_002_0	11	1			07/01/2019	2020.01	07/01/2019 12:54:23 PM Mountain Daylight Time	08/05/2019 10:21:53 AM Mountain Daylight Time	07/31/2019 10:51:47 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO Plus (HMO)	1	1		1			H1997	2	0	2020	"King, Kitsap, Pierce, Snohomish counties"		2	23961	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	2			
H1997	8	0	1	1	1	H1997_008_0	10	1			07/01/2019	2020.01	07/01/2019 12:54:41 PM Mountain Daylight Time	07/05/2019 02:24:57 PM Mountain Daylight Time				07/10/2019 11:17:56 AM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO No Rx (HMO)	1	1		1			H1997	8	0	2020	"King, Kitsap, Pierce, Snohomish, Whatcom counties"		2	2023	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H1997	9	0	1	1	1	H1997_009_0	11	1			07/01/2019	2020.01	07/01/2019 12:54:56 PM Mountain Daylight Time	08/05/2019 10:24:30 AM Mountain Daylight Time	07/31/2019 10:54:27 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	1	1		1			H1997	9	0	2020	"King, Kitsap, Pierce, Snohomish counties"		2	9139	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	2			
H1997	10	0	1	1	1	H1997_010_0	11	1			07/01/2019	2020.01	07/01/2019 12:55:22 PM Mountain Daylight Time	08/05/2019 10:25:41 AM Mountain Daylight Time	07/31/2019 10:57:05 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence AlignBlue (HMO)	1	1		1			H1997	10	0	2020	Whatcom		2	8719	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	2			
H1997	11	0	1	1	1	H1997_011_0	11	1			07/01/2019	2020.01	07/01/2019 12:55:43 PM Mountain Daylight Time	08/05/2019 10:26:53 AM Mountain Daylight Time	07/31/2019 10:59:40 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence AlignBlue Plus (HMO)	1	1		1			H1997	11	0	2020	Whatcom		2	4531	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	2			
H2001	1	0	1	4	1	H2001_001_0	3	1			08/02/2019	2020.01	08/02/2019 09:31:59 AM Central Daylight Time	08/02/2019 10:17:53 AM Central Daylight Time	07/30/2019 07:10:29 PM Central Daylight Time			08/06/2019 12:09:48 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	1	4		1			H2001	1	0	2020	Southwest Maine		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2001	10	0	1	4	1	H2001_010_0	3	1			08/02/2019	2020.01	08/02/2019 09:32:19 AM Central Daylight Time	08/02/2019 10:18:27 AM Central Daylight Time	07/30/2019 07:11:03 PM Central Daylight Time			08/06/2019 12:09:48 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	1	4		1			H2001	10	0	2020	Southwest Maine		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2001	17	0	1	4	1	H2001_017_0	3	1			08/02/2019	2020.01	08/02/2019 11:07:21 AM Central Daylight Time	08/02/2019 10:18:59 AM Central Daylight Time	07/30/2019 07:11:37 PM Central Daylight Time			08/06/2019 09:22:27 AM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice (PPO)	1	4		1			H2001	17	0	2020	Washington County		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2001	816	0	1	4	1	H2001_816_0	1	1			05/23/2019	2020.01	05/23/2019 02:59:02 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	816	0	2020	National Service Area		1	6586680	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	817	0	1	4	1	H2001_817_0	1	1			05/09/2019	2020.01	05/09/2019 11:39:37 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	817	0	2020	National Service Area		1	6834684	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	818	0	1	4	1	H2001_818_0	1	1			05/09/2019	2020.01	05/09/2019 11:40:19 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	818	0	2020	National Service Area		1	2436	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	819	0	2	4	1	H2001_819_0	1	1			05/09/2019	2020.01	05/09/2019 11:41:08 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2001	819	0	2020	National Service Area		1	10212	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	820	0	2	4	1	H2001_820_0	1	1			05/09/2019	2020.01	05/09/2019 11:41:56 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2001	820	0	2020	National Service Area		1	28320	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	821	0	2	4	1	H2001_821_0	1	1			05/09/2019	2020.01	05/09/2019 11:42:23 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2001	821	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2001	822	0	1	4	1	H2001_822_0	1	1			06/01/2019	2020.01	06/01/2019 03:32:10 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	822	0	2020	Select Counties		1	3372	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	823	0	1	4	1	H2001_823_0	1	1			06/02/2019	2020.01	06/02/2019 07:45:36 AM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	823	0	2020	Select Counties		1	624	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	824	0	1	4	1	H2001_824_0	1	1			05/09/2019	2020.01	05/09/2019 01:47:28 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	824	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;17a;18a;	2		1									
H2001	825	0	1	4	1	H2001_825_0	1	1			05/09/2019	2020.01	05/09/2019 02:05:01 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	825	0	2020	Select Counties		1	40956	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	826	0	1	4	1	H2001_826_0	1	1			06/01/2019	2020.01	06/01/2019 03:32:23 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	826	0	2020	Select Counties		1	50388	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	827	0	1	4	1	H2001_827_0	1	1			05/09/2019	2020.01	05/09/2019 03:41:31 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	827	0	2020	National Service Area		1	1850928	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;18a;	2		1									
H2001	828	0	1	4	1	H2001_828_0	1	1			05/09/2019	2020.01	05/09/2019 04:17:05 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	828	0	2020	National Service Area		1	552	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;18a;	2		1									
H2001	829	0	1	4	1	H2001_829_0	1	1			05/09/2019	2020.01	05/09/2019 04:20:38 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	829	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;18a;	2		1									
H2001	830	0	1	4	1	H2001_830_0	1	1			05/09/2019	2020.01	05/09/2019 04:27:19 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	830	0	2020	National Service Area		1	528	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;	2		1									
H2001	831	0	1	4	1	H2001_831_0	1	1			05/09/2019	2020.01	05/09/2019 11:45:02 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	831	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	832	0	2	4	1	H2001_832_0	1	1			05/09/2019	2020.01	05/09/2019 11:49:43 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2001	832	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	833	0	2	4	1	H2001_833_0	1	1			05/09/2019	2020.01	05/09/2019 11:57:11 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2001	833	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	834	0	2	4	1	H2001_834_0	1	1			05/13/2019	2020.01	05/13/2019 06:47:51 PM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2001	834	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	835	0	1	4	1	H2001_835_0	1	1			05/10/2019	2020.01	05/10/2019 12:01:41 AM Central Daylight Time					06/02/2019 03:27:39 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	835	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	836	0	1	4	1	H2001_836_0	1	1			05/10/2019	2020.01	05/10/2019 11:58:52 AM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	836	0	2020	Nationwide		1	97164	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	837	0	1	4	1	H2001_837_0	1	1			05/13/2019	2020.01	05/13/2019 06:33:44 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	837	0	2020	Nationwide		1	2568	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	838	0	1	4	1	H2001_838_0	1	1			05/13/2019	2020.01	05/13/2019 06:39:44 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	838	0	2020	Nationwide		1	636900	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	839	0	1	4	1	H2001_839_0	1	1			05/13/2019	2020.01	05/13/2019 06:47:12 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	839	0	2020	Nationwide		1	249	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	840	0	1	4	1	H2001_840_0	1	1			05/13/2019	2020.01	05/13/2019 06:52:04 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	840	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	841	0	1	4	1	H2001_841_0	1	1			05/13/2019	2020.01	05/13/2019 07:02:56 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	841	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	842	0	1	4	1	H2001_842_0	1	1			05/13/2019	2020.01	05/13/2019 07:11:09 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	842	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	843	0	1	4	1	H2001_843_0	1	1			05/13/2019	2020.01	05/13/2019 07:14:31 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	843	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	844	0	1	4	1	H2001_844_0	1	1			05/13/2019	2020.01	05/13/2019 07:17:04 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	844	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	845	0	1	4	1	H2001_845_0	1	1			05/13/2019	2020.01	05/13/2019 07:19:22 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	845	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	846	0	1	4	1	H2001_846_0	2	1			06/02/2019	2020.01	06/02/2019 03:56:26 PM Central Daylight Time					06/02/2019 03:56:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	846	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	847	0	1	4	1	H2001_847_0	1	1			05/09/2019	2020.01	05/09/2019 11:29:32 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	847	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	848	0	1	4	1	H2001_848_0	1	1			05/09/2019	2020.01	05/09/2019 11:21:05 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	848	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	849	0	1	4	1	H2001_849_0	1	1			05/09/2019	2020.01	05/09/2019 11:22:42 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	849	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	850	0	1	4	1	H2001_850_0	1	1			05/09/2019	2020.01	05/09/2019 11:23:36 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	850	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	851	0	1	4	1	H2001_851_0	1	1			05/09/2019	2020.01	05/09/2019 11:24:18 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	851	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	852	0	1	4	1	H2001_852_0	1	1			05/09/2019	2020.01	05/09/2019 11:25:03 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	852	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	853	0	1	4	1	H2001_853_0	1	1			05/09/2019	2020.01	05/09/2019 11:25:53 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	853	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	854	0	1	4	1	H2001_854_0	1	1			05/09/2019	2020.01	05/09/2019 11:26:29 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	854	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2001	855	0	1	4	1	H2001_855_0	1	1			05/09/2019	2020.01	05/09/2019 11:27:04 PM Central Daylight Time					06/02/2019 03:29:38 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2001	855	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2011	1	0	1	1	1	H2011_001_0	6	1			06/01/2019	2020.01	06/01/2019 11:41:00 AM Central Daylight Time	08/02/2019 04:25:27 PM Central Daylight Time	08/02/2019 04:57:57 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF TENNESSEE	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Choice (HMO)	1	1		1			H2011	1	0	2020	Nashville Metro Area		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2011	2	0	1	1	1	H2011_002_0	6	1			06/01/2019	2020.01	06/01/2019 06:12:00 PM Central Daylight Time	08/02/2019 04:24:16 PM Central Daylight Time	08/02/2019 04:57:34 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF TENNESSEE	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Plus (HMO)	1	1		1			H2011	2	0	2020	Nashville Metro Area		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(844)202-4025		(844)202-4025		(844)713-0100		(844)713-0100		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2011	3	0	1	1	1	H2011_003_0	6	1			06/06/2019	2020.01	06/06/2019 09:03:26 AM Central Daylight Time	08/02/2019 04:23:29 PM Central Daylight Time	08/02/2019 04:56:47 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF TENNESSEE	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage (HMO)	1	1		1			H2011	3	0	2020	"Fayette, Haywood, and Shelby Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-5489		(844)221-5489		(833)412-7710		(833)412-7710		(844)221-5489		(844)221-5489		(833)412-7710		(833)412-7710		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2011	4	0	1	1	1	H2011_004_0	6	1			06/02/2019	2020.01	06/02/2019 12:22:41 PM Central Daylight Time	08/02/2019 04:23:24 PM Central Daylight Time	08/02/2019 04:56:00 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF TENNESSEE	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Plus (HMO)	1	1		1			H2011	4	0	2020	"Fayette, Haywood, and Shelby Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-5489		(844)221-5489		(833)412-7710		(833)412-7710		(844)221-5489		(844)221-5489		(833)412-7710		(833)412-7710		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2020	1	0	1	4	1	H2020_001_0	5	1			07/03/2019	2020.01	07/03/2019 11:32:59 AM Central Daylight Time	08/06/2019 02:11:16 PM Central Daylight Time	08/06/2019 02:11:21 PM Central Daylight Time			08/06/2019 02:39:04 PM Central Daylight Time	DELAWARE LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (PPO)	1	4		1			H2020	1	0	2020	North Central Colorado		2	8202	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)384-1241		(877)384-1241		(877)384-1241		(877)384-1241		(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2020	2	0	1	4	1	H2020_002_0	6	1			07/03/2019	2020.01	07/03/2019 11:25:53 AM Central Daylight Time	08/06/2019 02:11:19 PM Central Daylight Time	08/06/2019 02:11:22 PM Central Daylight Time			08/06/2019 02:39:04 PM Central Daylight Time	DELAWARE LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (PPO)	1	4		1			H2020	2	0	2020	Southeast Virginia		2	8202	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)384-1241		(877)384-1241		(877)384-1241		(877)384-1241		(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2020	3	0	1	4	1	H2020_003_0	6	1			07/03/2019	2020.01	07/03/2019 11:14:25 AM Central Daylight Time	08/06/2019 02:11:19 PM Central Daylight Time	08/06/2019 02:11:23 PM Central Daylight Time			08/06/2019 02:39:04 PM Central Daylight Time	DELAWARE LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (PPO)	1	4		1			H2020	3	0	2020	Robeson and Scotland Counties		2	4220	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)384-1241		(877)384-1241		(877)384-1241		(877)384-1241		(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2020	4	0	1	4	1	H2020_004_0	6	1			07/03/2019	2020.01	07/03/2019 11:15:37 AM Central Daylight Time	08/06/2019 02:11:19 PM Central Daylight Time	08/06/2019 02:11:23 PM Central Daylight Time			08/06/2019 02:39:04 PM Central Daylight Time	DELAWARE LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential Plus (PPO)	1	4		1			H2020	4	0	2020	North Central Colorado		2	2797	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)384-1241		(877)384-1241		(877)384-1241		(877)384-1241		(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2020	5	0	1	4	1	H2020_005_0	6	1			07/03/2019	2020.01	07/03/2019 10:59:55 AM Central Daylight Time	08/06/2019 02:11:20 PM Central Daylight Time	08/06/2019 02:11:23 PM Central Daylight Time			08/06/2019 02:39:04 PM Central Daylight Time	DELAWARE LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential Plus (PPO)	1	4		1			H2020	5	0	2020	Robeson and Scotland Counties		2	1305	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)384-1241		(877)384-1241		(877)384-1241		(877)384-1241		(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2029	1	0	1	4	1	H2029_001_0	3	1			07/15/2019	2020.01	07/15/2019 03:29:19 PM Eastern Daylight Time	08/04/2019 12:01:55 PM Eastern Daylight Time	08/02/2019 01:18:12 PM Eastern Daylight Time			08/05/2019 11:10:38 AM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	HumanaChoice Value H2029-001 (PPO)	1	4		1			H2029	1	0	2020	Puerto Rico Island Wide		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(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			
H2029	801	0	1	4	1	H2029_801_0	1	1			05/29/2019	2020.01	05/29/2019 08:01:11 AM Eastern Daylight Time					05/29/2019 08:20:30 AM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H2029	801	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	802	0	1	4	1	H2029_802_0	1	1			05/29/2019	2020.01	05/29/2019 08:05:58 AM Eastern Daylight Time					05/29/2019 08:20:30 AM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H2029	802	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	805	0	2	4	1	H2029_805_0	1	1			05/29/2019	2020.01	05/29/2019 08:09:23 AM Eastern Daylight Time					05/29/2019 08:20:30 AM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		2	1		H2029	805	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	806	0	1	4	1	H2029_806_0	1	1			05/29/2019	2020.01	05/29/2019 08:10:37 AM Eastern Daylight Time					05/29/2019 08:20:30 AM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H2029	806	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	809	0	1	4	1	H2029_809_0	1	1			05/29/2019	2020.01	05/29/2019 08:12:06 AM Eastern Daylight Time					05/29/2019 08:20:30 AM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H2029	809	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	810	0	1	4	1	H2029_810_0	1	1			05/29/2019	2020.01	05/29/2019 08:13:08 AM Eastern Daylight Time					05/29/2019 08:20:30 AM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H2029	810	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	811	0	1	4	1	H2029_811_0	1	1			05/29/2019	2020.01	05/29/2019 08:14:06 AM Eastern Daylight Time					05/29/2019 08:20:30 AM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H2029	811	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	812	0	1	4	1	H2029_812_0	1	1			05/29/2019	2020.01	05/29/2019 08:14:54 AM Eastern Daylight Time					05/29/2019 08:20:30 AM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H2029	812	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	813	0	1	4	1	H2029_813_0	1	1			05/29/2019	2020.01	05/29/2019 08:15:45 AM Eastern Daylight Time					05/29/2019 08:20:30 AM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H2029	813	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2029	814	0	1	4	1	H2029_814_0	1	1			05/29/2019	2020.01	05/29/2019 08:16:54 AM Eastern Daylight Time					05/29/2019 08:20:30 AM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H2029	814	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2032	1	0	1	4	1	H2032_001_0	5	1			06/17/2019	2020.01	06/17/2019 09:19:11 AM Central Daylight Time	08/05/2019 02:52:48 PM Central Daylight Time	07/31/2019 11:54:22 AM Central Daylight Time			08/06/2019 05:10:23 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage (PPO)	1	4		1			H2032	1	0	2020	Dallas/Ft. Worth Metro Area		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2032	2	0	1	4	1	H2032_002_0	5	1			06/06/2019	2020.01	06/06/2019 01:47:14 PM Central Daylight Time	08/05/2019 02:52:16 PM Central Daylight Time	07/31/2019 11:55:02 AM Central Daylight Time			08/06/2019 05:10:23 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage Basic (PPO)	1	4		1			H2032	2	0	2020	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2032	3	0	1	4	1	H2032_003_0	5	1			05/29/2019	2020.01	05/29/2019 01:45:24 PM Central Daylight Time	08/05/2019 03:00:36 PM Central Daylight Time	07/31/2019 12:01:04 PM Central Daylight Time			08/06/2019 05:10:23 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage Platinum (PPO)	1	4		1			H2032	3	0	2020	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2032	801	0	1	4	1	H2032_801_0	3	1			05/28/2019	2020.01	05/28/2019 05:35:35 PM Central Daylight Time					06/03/2019 05:56:39 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage EGWP CY Rx (PPO)	1	4		1			H2032	801	0	2020	North and Central Texas		1	1200	2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7e;7g;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;9d;10a;11a;11b;12;15;	2		1									
H2032	802	0	1	4	1	H2032_802_0	3	1			05/28/2019	2020.01	05/28/2019 05:53:07 PM Central Daylight Time					06/03/2019 05:56:39 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage EGWP CY (PPO)	1	4		1			H2032	802	0	2020	North and Central Texas		1	1200	2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7e;7g;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;9d;10a;11a;11b;12;15;	2		1									
H2032	803	0	1	4	1	H2032_803_0	3	1			05/28/2019	2020.01	05/28/2019 06:14:50 PM Central Daylight Time					06/03/2019 05:56:39 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage EGWP FY Rx (PPO)	1	4		1			H2032	803	0	2020	North and Central Texas		1	1200	2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7e;7g;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;9d;10a;11a;11b;12;15;	2		1									
H2032	804	0	1	4	1	H2032_804_0	3	1			05/28/2019	2020.01	05/28/2019 06:28:04 PM Central Daylight Time					06/03/2019 05:56:39 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage EGWP FY (PPO)	1	4		1			H2032	804	0	2020	North and Central Texas		1	1200	2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7e;7g;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;9d;10a;11a;11b;12;15;	2		1									
H2034	1	0	1	1	1	H2034_001_0	3	1	2	1	08/05/2019	2020.01	08/05/2019 08:34:32 AM Central Daylight Time	08/06/2019 12:07:35 PM Central Daylight Time	08/06/2019 12:07:20 PM Central Daylight Time			08/06/2019 12:10:58 PM Central Daylight Time	"COMMUNITY CARE HEALTH PLAN, INC."	Community Care	www.communitycareinc.org	Community Care's  Partnership Program (HMO D-SNP)	1	1		1			H2034	1	0	2020	Eastern Wisconsin		2	5498	2			1	3		1		1	www.communitycareinc.org	www.communitycareinc.org	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	2			
H2056	1	0	1	1	1	H2056_001_0	4	1			07/31/2019	2020.01	07/31/2019 03:44:55 PM Eastern Daylight Time	08/01/2019 06:42:27 PM Eastern Daylight Time	07/30/2019 09:52:34 PM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	1	1		1			H2056	1	0	2020	Treasure Valley		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2056	2	0	1	1	1	H2056_002_0	3	1			07/31/2019	2020.01	07/31/2019 03:45:10 PM Eastern Daylight Time	08/01/2019 09:45:57 PM Eastern Daylight Time	07/30/2019 09:53:46 PM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H2056	2	0	2020	Treasure Valley		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2056	3	0	1	1	1	H2056_003_0	3	1			07/31/2019	2020.01	07/31/2019 03:45:34 PM Eastern Daylight Time	08/01/2019 09:48:04 PM Eastern Daylight Time	07/30/2019 09:54:56 PM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	1	1		1			H2056	3	0	2020	Greater Portland Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2056	4	0	1	1	1	H2056_004_0	3	1			07/31/2019	2020.01	07/31/2019 03:45:56 PM Eastern Daylight Time	08/01/2019 10:06:11 PM Eastern Daylight Time	07/30/2019 09:56:06 PM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H2056	4	0	2020	Greater Portland Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2056	801	0	1	1	1	H2056_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:37:09 AM Eastern Daylight Time					05/30/2019 05:55:12 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H2056	801	0	2020	Idaho and Oregon		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H2056	802	0	1	1	1	H2056_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:37:21 AM Eastern Daylight Time					05/30/2019 05:55:12 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H2056	802	0	2020	Idaho and Oregon		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H2056	803	0	1	1	1	H2056_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:37:35 AM Eastern Daylight Time					05/30/2019 05:55:12 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H2056	803	0	2020	Idaho and Oregon		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H2064	1	0	1	20	8	H2064_001_0	1	1			05/31/2019	2020.01	05/31/2019 11:52:46 AM Eastern Daylight Time		05/31/2019 03:15:10 PM Eastern Daylight Time			05/31/2019 03:17:26 PM Eastern Daylight Time	GEISINGER COMMUNITY HEALTH SERVICES	LIFE Geisinger	www.lifegeisinger.org	LIFE Geisinger (PACE)	8	20		1			H2064	1	0	2020	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	2	0	1	20	8	H2064_002_0	1	1			05/31/2019	2020.01	05/31/2019 11:53:03 AM Eastern Daylight Time		05/31/2019 03:14:15 PM Eastern Daylight Time			05/31/2019 03:17:26 PM Eastern Daylight Time	GEISINGER COMMUNITY HEALTH SERVICES	LIFE Geisinger	www.lifegeisinger.org	LIFE Geisinger (PACE)	8	20		1			H2064	2	0	2020	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	1	0	1	1	1	H2108_001_0	5	1	2	1	07/08/2019	2020.01	07/08/2019 04:39:22 PM Central Daylight Time	07/31/2019 04:55:04 PM Central Daylight Time	07/30/2019 04:11:48 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH MID-ATLANTIC, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H2108	1	0	2020	"Maryland, Washington DC and Delaware"		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H2108	20	0	1	1	1	H2108_020_0	4	1		1	07/08/2019	2020.01	07/08/2019 04:40:06 PM Central Daylight Time	07/31/2019 04:55:26 PM Central Daylight Time	07/30/2019 04:12:03 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH MID-ATLANTIC, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Traditions (HMO I-SNP)	1	1		1			H2108	20	0	2020	"Maryland, Washington DC and Delaware"		2		2			1	1	1				www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H2108	22	0	1	1	1	H2108_022_0	4	1			07/08/2019	2020.01	07/08/2019 04:40:51 PM Central Daylight Time	07/31/2019 04:55:47 PM Central Daylight Time	07/30/2019 04:12:16 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH MID-ATLANTIC, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H2108	22	0	2020	Baltimore Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H2108	28	0	1	1	1	H2108_028_0	4	1			07/08/2019	2020.01	07/08/2019 04:41:34 PM Central Daylight Time	07/31/2019 04:56:08 PM Central Daylight Time	07/30/2019 04:12:30 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH MID-ATLANTIC, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H2108	28	0	2020	Washington DC and Delaware		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H2108	29	0	1	1	1	H2108_029_0	5	1		1	07/08/2019	2020.01	07/08/2019 04:42:19 PM Central Daylight Time	07/31/2019 04:56:30 PM Central Daylight Time	07/30/2019 04:12:43 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH MID-ATLANTIC, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Achieve (HMO C-SNP)	1	1		1			H2108	29	0	2020	Washington DC and Delaware		2		2			1	4			1E+13		www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H2108	30	0	1	1	1	H2108_030_0	5	1		1	07/08/2019	2020.01	07/08/2019 04:43:06 PM Central Daylight Time	07/31/2019 04:56:51 PM Central Daylight Time	07/30/2019 04:12:56 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH MID-ATLANTIC, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Achieve (HMO C-SNP)	1	1		1			H2108	30	0	2020	Baltimore Area		2		2			1	4			1E+13		www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H2108	34	0	1	1	1	H2108_034_0	5	1			07/08/2019	2020.01	07/08/2019 04:43:49 PM Central Daylight Time	07/31/2019 04:57:13 PM Central Daylight Time	07/30/2019 04:13:11 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH MID-ATLANTIC, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H2108	34	0	2020	Maryland DC Suburbs		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H2108	35	0	1	1	1	H2108_035_0	6	1	2	1	07/08/2019	2020.01	07/08/2019 04:44:31 PM Central Daylight Time	07/31/2019 04:57:35 PM Central Daylight Time	07/30/2019 04:13:25 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH MID-ATLANTIC, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare Plus (HMO D-SNP)	1	1		1			H2108	35	0	2020	Washington DC and Delaware		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H2108	801	0	1	1	1	H2108_801_0	2	1			04/18/2019	2020.01	04/18/2019 12:13:50 PM Central Daylight Time					05/30/2019 05:00:36 PM Central Daylight Time	"BRAVO HEALTH MID-ATLANTIC, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	1	1		1			H2108	801	0	2020	"Statewide MD, DC and DE"		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2109	1	0	1	20	8	H2109_001_0	2	1			05/20/2019	2020.01	05/20/2019 01:05:17 PM Eastern Daylight Time		05/30/2019 01:09:21 PM Eastern Daylight Time			05/30/2019 01:13:22 PM Eastern Daylight Time	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	Hopkins ElderPlus	www.hopkinsbayview.org/hopkinselderplus	The Johns Hopkins Health System Corporation. (PACE)	8	20		1			H2109	1	0	2020	"Parts of Baltimore City and County, Maryland"		2	1998	2			2						http://www.hopkinsbayview.org/hopkinselderplus	http://www.hopkinsbayview.org/hopkinselderplus												(410)550-7044				(410)550-7044												(410)550-0316				(410)550-0316																
H2109	2	0	1	20	8	H2109_002_0	2	1			05/20/2019	2020.01	05/20/2019 01:05:27 PM Eastern Daylight Time		05/30/2019 01:09:06 PM Eastern Daylight Time			05/30/2019 01:13:22 PM Eastern Daylight Time	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	Hopkins ElderPlus	www.hopkinsbayview.org/hopkinselderplus	The Johns Hopkins Health System Corporation (PACE)	8	20		1			H2109	2	0	2020	"Parts of Baltimore City and County, Maryland"		2		2			2						http://www.hopkinsbayview.org/hopkinselderplus	http://www.hopkinsbayview.org/hopkinselderplus												(410)550-7044				(410)550-7044												(410)550-0316				(410)550-0316																
H2120	1	0	1	1	1	H2120_001_0	5	1		1	08/02/2019	2020.01	08/02/2019 09:03:41 AM Eastern Daylight Time	08/05/2019 03:18:44 PM Eastern Daylight Time	08/05/2019 03:19:20 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"SECURITYCARE OF TENNESSEE, INC."	BlueEssential	bcbstmedicare.com	BlueEssential (HMO C-SNP)	1	1		1			H2120	1	0	2020	West Tennessee		2		2			1	4			1E+13		bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(888)851-2583		(888)851-2583		(888)665-5678		(888)665-5678		(888)851-2583		(888)851-2583		(888)665-5678		(888)665-5678		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2120	2	0	1	1	1	H2120_002_0	5	1		1	08/02/2019	2020.01	08/02/2019 09:04:01 AM Eastern Daylight Time	08/05/2019 03:18:45 PM Eastern Daylight Time	08/05/2019 03:19:21 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"SECURITYCARE OF TENNESSEE, INC."	BlueEssential	bcbstmedicare.com	BlueEssential (HMO C-SNP)	1	1		1			H2120	2	0	2020	Middle Tennessee		2		2			1	4			1E+13		bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(888)851-2583		(888)851-2583		(888)665-5678		(888)665-5678		(888)851-2583		(888)851-2583		(888)665-5678		(888)665-5678		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2120	3	0	1	1	1	H2120_003_0	5	1		1	08/02/2019	2020.01	08/02/2019 09:04:01 AM Eastern Daylight Time	08/05/2019 03:18:45 PM Eastern Daylight Time	08/05/2019 03:19:21 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"SECURITYCARE OF TENNESSEE, INC."	BlueEssential	bcbstmedicare.com	BlueEssential (HMO C-SNP)	1	1		1			H2120	3	0	2020	Southeast Tennessee		2		2			1	4			1E+13		bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(888)851-2583		(888)851-2583		(888)665-5678		(888)665-5678		(888)851-2583		(888)851-2583		(888)665-5678		(888)665-5678		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2120	4	0	1	1	1	H2120_004_0	5	1		1	08/02/2019	2020.01	08/02/2019 09:04:01 AM Eastern Daylight Time	08/05/2019 03:18:46 PM Eastern Daylight Time	08/05/2019 03:19:22 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"SECURITYCARE OF TENNESSEE, INC."	BlueEssential	bcbstmedicare.com	BlueEssential (HMO C-SNP)	1	1		1			H2120	4	0	2020	Northeast Tennessee		2		2			1	4			1E+13		bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(888)851-2583		(888)851-2583		(888)665-5678		(888)665-5678		(888)851-2583		(888)851-2583		(888)665-5678		(888)665-5678		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2134	1	0	1	1	1	H2134_001_0	3	1	2	1	08/01/2019	2020.01	08/01/2019 01:11:31 PM Eastern Daylight Time	08/05/2019 04:15:59 PM Central Daylight Time	08/05/2019 03:11:16 PM Central Daylight Time			08/06/2019 09:25:24 AM Central Daylight Time	"WESTERN SKY COMMUNITY CARE, INC."	Allwell	allwell.westernskycommunitycare.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H2134	1	0	2020	Western NM Counties		2		2			1	3		1		2	allwell.westernskycommunitycare.com/findadoctor	allwell.westernskycommunitycare.com/formulary	allwell.westernskycommunitycare.com/findadoctor	(844)810-7965		(844)810-7965		(866)445-1088		(866)445-1088		(844)810-7965		(844)810-7965		(866)445-1088		(866)445-1088		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2134	801	0	1	1	1	H2134_801_0	2	1			05/13/2019	2020.01	05/13/2019 02:35:19 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"WESTERN SKY COMMUNITY CARE, INC."	Allwell	allwell.westernskycommunity.com	Allwell Group (HMO)	1	1		1			H2134	801	0	2020	Statewide		1	100	2			2						allwell.westernskycommunity.com/findadoctor	allwell.westernskycommunity.com/formulary	allwell.westernskycommunity.com/findadoctor	(844)810-7965		(844)810-7965		(866)445-1088		(866)445-1088		(844)810-7965		(844)810-7965		(866)445-1088		(866)445-1088		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2134	802	0	1	1	1	H2134_802_0	2	1			05/03/2019	2020.01	05/03/2019 12:57:44 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"WESTERN SKY COMMUNITY CARE, INC."	Allwell	allwell.westernskycommunity.com	Allwell Group (HMO)	1	1		1			H2134	802	0	2020	Statewide		1	100	2			2						allwell.westernskycommunity.com/findadoctor	allwell.westernskycommunity.com/formulary	allwell.westernskycommunity.com/findadoctor	(844)810-7965		(844)810-7965		(866)445-1088		(866)445-1088										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2134	803	0	1	1	1	H2134_803_0	2	1			05/03/2019	2020.01	05/03/2019 12:57:58 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"WESTERN SKY COMMUNITY CARE, INC."	Allwell	allwell.westernskycommunity.com	Allwell Group (HMO)	1	1		1			H2134	803	0	2020	Statewide		1	100	2			2						allwell.westernskycommunity.com/findadoctor	allwell.westernskycommunity.com/formulary	allwell.westernskycommunity.com/findadoctor	(844)810-7965		(844)810-7965		(866)445-1088		(866)445-1088		(844)810-7965		(844)810-7965		(866)445-1088		(866)445-1088		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2150	2	0	1	18	6	H2150_002_0	16	1			08/02/2019	2020.01	08/02/2019 06:48:53 AM Eastern Daylight Time		08/01/2019 08:43:35 PM Eastern Daylight Time			08/02/2019 07:07:16 AM 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)	6	18		1			H2150	2	0	2020	"Northern VA Area and MD Counties: CV, CR, FR"		2	43834	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H2150	9	0	1	18	6	H2150_009_0	18	1			08/07/2019	2020.01	08/07/2019 09:35:37 AM Eastern Daylight Time		08/07/2019 09:34:44 AM Eastern Daylight Time			08/07/2019 09:36:11 AM 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)	6	18		1			H2150	9	0	2020	"Northern VA Area and MD Counties: CV, CR, FR"		2	83339	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H2150	17	0	1	18	6	H2150_017_0	7	1			06/01/2019	2020.01	06/01/2019 01:29:37 PM Eastern Daylight Time					06/03/2019 07:45:25 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)	6	18		1			H2150	17	0	2020	"Northern VA Area and MD Counties: CV, CR, FR"		2	648	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2150	21	0	1	18	6	H2150_021_0	8	1			07/05/2019	2020.01	07/05/2019 09:18:44 AM Eastern Daylight Time					07/08/2019 11:12:26 AM 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)	6	18		1			H2150	21	0	2020	"Northern VA Area and MD Counties: CV, CR, FR"		2	937	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2150	22	0	1	18	6	H2150_022_0	8	1			07/05/2019	2020.01	07/05/2019 09:19:12 AM Eastern Daylight Time					07/08/2019 11:12:26 AM 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)	6	18		1			H2150	22	0	2020	"Northern VA Area and MD Counties: CV, CR, FR"		2	2377	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2150	29	0	2	18	6	H2150_029_0	14	1			08/02/2019	2020.01	08/02/2019 06:52:34 AM Eastern Daylight Time		08/01/2019 08:51:17 PM Eastern Daylight Time			08/02/2019 07:07:16 AM 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)	6	18		2	1		H2150	29	0	2020	"Northern VA Area and MD Counties: CV, CR, FR"		2	144	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H2150	30	0	2	18	6	H2150_030_0	7	1			06/01/2019	2020.01	06/01/2019 01:30:22 PM Eastern Daylight Time					06/03/2019 07:45:25 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)	6	18		2	1		H2150	30	0	2020	"Northern VA Area and MD Counties: CV, CR, FR"		2	24	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2150	33	0	1	18	6	H2150_033_0	12	1			08/02/2019	2020.01	08/02/2019 06:53:56 AM Eastern Daylight Time		08/01/2019 08:54:11 PM Eastern Daylight Time			08/02/2019 07:07:16 AM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Basic w/D (AB) (Cost)	6	18		1			H2150	33	0	2020	"Northern VA Area and MD Counties: CV, CR, FR"		2	744	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H2150	34	0	2	18	6	H2150_034_0	12	1			08/02/2019	2020.01	08/02/2019 06:55:00 AM Eastern Daylight Time		08/01/2019 08:56:52 PM Eastern Daylight Time			08/02/2019 07:07:16 AM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Basic w/D (B) (Cost)	6	18		2	1		H2150	34	0	2020	"Northern VA Area and MD Counties: CV, CR, FR"		2	24	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H2150	801	0	1	18	6	H2150_801_0	7	1			05/30/2019	2020.01	05/30/2019 10:50:52 AM Eastern Daylight Time					06/03/2019 07:45:25 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)	6	18		1			H2150	801	0	2020	"Northern VA Area and MD Counties: CV, CR, FR"		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	6	H2150_805_0	7	1			05/29/2019	2020.01	05/29/2019 05:06:51 AM Eastern Daylight Time					06/03/2019 07:45:25 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)	6	18		2	1		H2150	805	0	2020	"Northern VA Area and MD Counties: CV, CR, FR"		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	6	H2150_806_0	7	1			05/29/2019	2020.01	05/29/2019 05:07:00 AM Eastern Daylight Time					06/03/2019 07:45:25 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)	6	18		1			H2150	806	0	2020	"Northern VA Area and MD Counties: CV, CR, FR"		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	6	H2150_807_0	7	1			05/29/2019	2020.01	05/29/2019 05:07:08 AM Eastern Daylight Time					06/03/2019 07:45:25 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)	6	18		2	1		H2150	807	0	2020	"Northern VA Area and MD Counties: CV, CR, FR"		1	0	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2	0	1	1	1	H2161_002_0	7	1			08/01/2019	2020.01	08/01/2019 01:42:34 PM Eastern Daylight Time	08/06/2019 11:42:43 AM Eastern Daylight Time	08/06/2019 11:42:48 AM Eastern Daylight Time			08/06/2019 11:54:32 AM Eastern Daylight Time	"UPPER PENINSULA HEALTH PLAN, LLC"	Upper Peninsula Health Plan	www.uphp.com/medicare	Upper Peninsula Health Plan Advantage (HMO)	1	1		1			H2161	2	0	2020	Upper Peninsula of Michigan		2	3600	2			2						www.uphp.com/pharmacy	www.uphp.com/medicare/upper-peninsula-health-plan-advantage/formulary-advantage/	www.uphp.com/medicare/providers	(877)349-9324		(877)349-9324		(877)349-9324		(877)349-9324		(844)827-0182		(844)827-0182		(877)349-9324		(877)349-9324		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2161	3	0	1	1	1	H2161_003_0	6	1			08/01/2019	2020.01	08/01/2019 01:44:50 PM Eastern Daylight Time	08/06/2019 11:42:36 AM Eastern Daylight Time	08/06/2019 11:42:39 AM Eastern Daylight Time			08/06/2019 11:56:44 AM Eastern Daylight Time	"UPPER PENINSULA HEALTH PLAN, LLC"	Upper Peninsula Health Plan	www.uphp.com/medicare	Upper Peninsula Health Plan Choice (HMO)	1	1		1			H2161	3	0	2020	Upper Peninsula of Michigan		2	8400	2			2						www.uphp.com/pharmacy	www.uphp.com/medicare/upper-peninsula-health-plan-choice/formulary-choice	www.uphp.com/medicare/providers	(877)349-9324		(877)349-9324		(877)349-9324		(877)349-9324		(844)827-0182		(844)827-0182		(877)349-9324		(877)349-9324		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2162	1	0	1	1	1	H2162_001_0	7	1			07/11/2019	2020.01	07/11/2019 01:53:09 PM Eastern Daylight Time	08/02/2019 05:51:54 AM Eastern Daylight Time	07/30/2019 10:17:48 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	"WELLCARE OF NEW HAMPSHIRE, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H2162	1	0	2020	Select counties in NH		2	4300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2162	2	0	1	1	1	H2162_002_0	8	1			07/12/2019	2020.01	07/12/2019 11:24:57 AM Eastern Daylight Time	08/02/2019 05:53:28 AM Eastern Daylight Time	07/30/2019 10:18:24 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	"WELLCARE OF NEW HAMPSHIRE, INC."	WellCare	www.wellcare.com/medicare	WellCare Plus (HMO)	1	1		1			H2162	2	0	2020	Select counties in NH		2	43	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2168	1	0	1	1	1	H2168_001_0	11	1	2	1	08/07/2019	2020.01	08/07/2019 08:01:16 PM Eastern Daylight Time	08/05/2019 10:28:57 AM Eastern Daylight Time	08/05/2019 10:29:00 AM Eastern Daylight Time			08/07/2019 08:02:07 PM Eastern Daylight Time	VILLAGE SENIOR SERVICES CORPORATION	VillageCareMAX	www.villagecaremax.org	VillageCareMAX Medicare Health Advantage (HMO D-SNP)	1	1		1			H2168	1	0	2020	"Bronx, Kings, New York, and Queens counties"		2	12261	2			1	3		2		1	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	2			
H2168	2	0	1	1	1	H2168_002_0	8	1	2	1	07/10/2019	2020.01	07/10/2019 06:40:16 PM Eastern Daylight Time	08/05/2019 10:28:58 AM Eastern Daylight Time	08/05/2019 10:29:02 AM Eastern Daylight Time			08/05/2019 11:11:03 AM Eastern Daylight Time	VILLAGE SENIOR SERVICES CORPORATION	VillageCareMAX	www.villagecaremax.org	VillageCareMAX Medicare Total Advantage (HMO D-SNP)	1	1		1			H2168	2	0	2020	"Bronx, Kings, New York, and Queens counties"		2	28542	2			1	3		1		1	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	2			
H2171	1	0	1	1	1	H2171_001_0	3	1			07/09/2019	2020.01	07/09/2019 01:34:54 PM Eastern Daylight Time	07/31/2019 02:14:26 PM Eastern Daylight Time	07/31/2019 02:23:21 PM Eastern Daylight Time			08/05/2019 04:52:22 PM Eastern Daylight Time	"CARE N' CARE INSURANCE COMPANY, INC."	Care N' Care Insurance Company	www.cnchealthplan.com	Care N' Care Classic (HMO)	1	1		1			H2171	1	0	2020	Dallas Fort Worth Metro Area		2		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	2			
H2171	801	0	1	1	1	H2171_801_0	1	1			05/30/2019	2020.01	05/30/2019 04:22:26 PM Eastern Daylight Time					06/03/2019 12:56:04 PM Eastern Daylight Time	"CARE N' CARE INSURANCE COMPANY, INC."	Care N' Care Insurance Company	www.cnchealthplan.com	Care N' Care Classic CY - MAPD (HMO)	1	1		1			H2171	801	0	2020	Nationwide		1	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)-		2					2					2	2			
H2171	802	0	1	1	1	H2171_802_0	1	1			05/27/2019	2020.01	05/27/2019 06:28:23 PM Eastern Daylight Time					06/03/2019 12:56:04 PM Eastern Daylight Time	"CARE N' CARE INSURANCE COMPANY, INC."	Care N' Care Insurance Company	www.cnchealthplan.com	Care N' Care Classic NCY - MAPD (HMO)	1	1		1			H2171	802	0	2020	Nationwide		1	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)-		2					2					2	2			
H2171	803	0	1	1	1	H2171_803_0	1	1			05/27/2019	2020.01	05/27/2019 06:45:16 PM Eastern Daylight Time					06/03/2019 12:56:04 PM Eastern Daylight Time	"CARE N' CARE INSURANCE COMPANY, INC."	Care N' Care Insurance Company	www.cnchealthplan.com	Care N' Care Classic CY - MA-Only (HMO)	1	1		1			H2171	803	0	2020	Nationwide		1	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)-										2					2					2	2			
H2171	804	0	1	1	1	H2171_804_0	1	1			05/28/2019	2020.01	05/28/2019 01:20:16 PM Eastern Daylight Time					06/03/2019 12:56:04 PM Eastern Daylight Time	"CARE N' CARE INSURANCE COMPANY, INC."	Care N' Care Insurance Company	www.cnchealthplan.com	Care N' Care Classic NCY - MA-Only (HMO)	1	1		1			H2171	804	0	2020	Nationwide		1	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)-										2					2					2	2			
H2172	1	0	1	1	1	H2172_001_0	8	1			07/31/2019	2020.01	07/31/2019 01:16:04 PM Eastern Daylight Time	08/01/2019 06:04:18 PM Eastern Daylight Time	08/01/2019 06:29:27 PM Eastern Daylight Time			08/02/2019 03:09:27 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage High DC (HMO)	1	1		1			H2172	1	0	2020	DC		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H2172	2	0	1	1	1	H2172_002_0	11	1			07/31/2019	2020.01	07/31/2019 01:16:13 PM Eastern Daylight Time	08/01/2019 06:10:56 PM Eastern Daylight Time	08/01/2019 06:34:18 PM Eastern Daylight Time			08/02/2019 03:09:27 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage High MD (HMO)	1	1		1			H2172	2	0	2020	MD		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H2172	3	0	1	1	1	H2172_003_0	8	1			07/31/2019	2020.01	07/31/2019 01:16:25 PM Eastern Daylight Time	08/01/2019 06:06:45 PM Eastern Daylight Time	08/01/2019 06:32:19 PM Eastern Daylight Time			08/02/2019 03:09:27 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Standard DC (HMO)	1	1		1			H2172	3	0	2020	DC		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H2172	4	0	1	1	1	H2172_004_0	8	1			07/31/2019	2020.01	07/31/2019 01:16:34 PM Eastern Daylight Time	08/01/2019 06:12:38 PM Eastern Daylight Time	08/01/2019 06:36:57 PM Eastern Daylight Time			08/02/2019 03:09:27 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Standard MD (HMO)	1	1		1			H2172	4	0	2020	MD		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H2172	5	0	1	1	1	H2172_005_0	7	1			07/19/2019	2020.01	07/19/2019 05:35:29 PM Eastern Daylight Time	07/18/2019 06:18:01 PM Eastern Daylight Time				07/22/2019 12:49:41 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage w/o Part D (HMO)	1	1		1			H2172	5	0	2020	"DC, MD, VA"		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2172	6	0	1	1	1	H2172_006_0	8	1			07/31/2019	2020.01	07/31/2019 01:16:59 PM Eastern Daylight Time	08/01/2019 06:16:13 PM Eastern Daylight Time	08/01/2019 06:40:04 PM Eastern Daylight Time			08/02/2019 03:09:27 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Value (HMO)	1	1		1			H2172	6	0	2020	Baltimore City and Baltimore County		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H2172	8	0	1	1	1	H2172_008_0	8	1			07/31/2019	2020.01	07/31/2019 01:17:12 PM Eastern Daylight Time	08/01/2019 06:19:49 PM Eastern Daylight Time	08/01/2019 06:42:11 PM Eastern Daylight Time			08/02/2019 03:09:27 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage High VA (HMO)	1	1		1			H2172	8	0	2020	Northern Virginia		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H2172	9	0	1	1	1	H2172_009_0	9	1			07/31/2019	2020.01	07/31/2019 01:17:24 PM Eastern Daylight Time	08/01/2019 06:22:23 PM Eastern Daylight Time	08/01/2019 06:44:01 PM Eastern Daylight Time			08/02/2019 03:09:27 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Standard VA (HMO)	1	1		1			H2172	9	0	2020	Northern Virginia		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H2172	10	0	1	1	1	H2172_010_0	8	1			07/31/2019	2020.01	07/31/2019 01:17:36 PM Eastern Daylight Time	08/01/2019 06:24:23 PM Eastern Daylight Time	08/01/2019 06:46:19 PM Eastern Daylight Time			08/02/2019 03:09:27 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Value VA (HMO)	1	1		1			H2172	10	0	2020	Northern Virginia		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H2172	801	0	1	1	1	H2172_801_0	2	1			05/29/2019	2020.01	05/29/2019 05:05:06 AM Eastern Daylight Time					06/03/2019 08:01:45 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage for Groups (HMO)	1	1		1			H2172	801	0	2020	"DC, MD, VA"		1	167348	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;16b;17a;17b;18a;	1					2				
H2172	803	0	1	1	1	H2172_803_0	2	1			05/29/2019	2020.01	05/29/2019 05:05:13 AM Eastern Daylight Time					06/03/2019 08:01:45 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Fed w/Part D (HMO)	1	1		1			H2172	803	0	2020	"DC, MD, VA"		1	147016	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;16b;17a;17b;18a;	1					2				
H2172	804	0	2	1	1	H2172_804_0	2	1			05/29/2019	2020.01	05/29/2019 05:05:20 AM Eastern Daylight Time					06/03/2019 08:01:45 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage Fed B/D (HMO)	1	1		2	1		H2172	804	0	2020	"DC, MD, VA"		1	1428	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;16b;17a;17b;18a;	1					2				
H2172	805	0	1	1	1	H2172_805_0	2	1			05/29/2019	2020.01	05/29/2019 05:05:27 AM Eastern Daylight Time					06/03/2019 08:01:45 PM Eastern Daylight Time	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Advantage GRP w/o D (HMO)	1	1		1			H2172	805	0	2020	"DC, MD, VA"		1	15753	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;16b;17a;17b;18a;	1					2				
H2174	1	0	1	1	1	H2174_001_0	6	1	2	1	08/01/2019	2020.01	08/01/2019 01:13:36 PM Pacific Daylight Time	08/05/2019 03:59:03 PM Central Daylight Time	08/05/2019 03:11:56 PM Central Daylight Time			08/06/2019 09:30:34 AM Central Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Medicare Advantage	trilliumadvantage.com	Trillium Advantage Dual (HMO D-SNP)	1	1		1			H2174	1	0	2020	Lane County		2		2			1	3		2		2	trilliumadvantage.com/findadoctor	trilliumadvantage.com/formulary	trilliumadvantage.com/findadoctor	(844)867-1156		(844)867-1156		(877)826-5519		(877)826-5519		(844)867-1156		(844)867-1156		(877)826-5519		(877)826-5519		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2185	1	0	1	1	1	H2185_001_0	8	1		1	08/01/2019	2020.01	08/01/2019 04:59:15 PM Central Daylight Time	08/01/2019 01:00:57 PM Central Daylight Time	07/31/2019 03:50:35 PM Central Daylight Time			08/05/2019 03:45:39 PM Central Daylight Time	"LIFEWORKS ADVANTAGE, LLC"	LifeWorks Advantage	www.lifeworksadvantage.com	LifeWorks Advantage I-SNP (HMO I-SNP)	1	1		1			H2185	1	0	2020	Virginia (partial)		2	9439	2			1	1	1				www.lifeworksadvantage.com	www.lifeworksadvantage.com	www.lifeworksadvantage.com	(844)854-6883		(844)854-6883		(844)854-6883		(844)854-6883		(844)854-6883		(844)854-6883		(844)854-6883		(844)854-6883		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2218	1	0	1	20	8	H2218_001_0	1	1			06/03/2019	2020.01	06/03/2019 12:35:39 PM Eastern Daylight Time		06/03/2019 11:32:50 AM Eastern Daylight Time			06/03/2019 12:37:46 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)"	8	20		1			H2218	1	0	2020	"Norfolk,Suffolk, Plymouth,Bristol & Middlesex cty"		2		2			2						www.eatonapothecary.com	www.elderserviceplan.org												(617)533-2426				(617)533-2400												(617)533-2404				(617)533-2404																
H2218	2	0	1	20	8	H2218_002_0	1	1			06/03/2019	2020.01	06/03/2019 12:36:22 PM Eastern Daylight Time		06/03/2019 11:33:04 AM Eastern Daylight Time			06/03/2019 12:37:46 PM 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)"	8	20		1			H2218	2	0	2020	"Norfolk,Suffolk,Middlesex,Plymouth & Bristol Cty"		2		2			2						www.eatonapothecary.com	www.elderserviceplan.org												(617)533-2426				(617)533-2400												(617)533-2404				(617)533-2404																
H2219	1	0	1	20	8	H2219_001_0	1	1			06/03/2019	2020.01	06/03/2019 10:34:11 PM Eastern Daylight Time		06/03/2019 10:26:28 PM Eastern Daylight Time			06/03/2019 10:36:26 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Summit ElderCare or Fallon Health	www.fallonhealth.org/summit	Summit ElderCare (PACE)	8	20		1			H2219	1	0	2020	"Full: Worc,Hampden Part: Essex,Hampshire,Middlesex"		2	15777	2			2						Not Applicable	www.fallonhealth.org/summit	www.fallonhealth.org/summit									(800)698-7566		(508)368-9690		(800)698-7566		(508)368-9690										(711)-		(711)-		(711)-		(711)-																
H2219	2	0	1	20	8	H2219_002_0	1	1			06/03/2019	2020.01	06/03/2019 10:34:34 PM Eastern Daylight Time		06/03/2019 10:26:18 PM Eastern Daylight Time			06/03/2019 10:36:26 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Summit ElderCare or Fallon Health	www.fallonhealth.org/summit	Summit ElderCare (PACE)	8	20		1			H2219	2	0	2020	"Full: Worc,Hampden Part: Essex,Hampshire,Middlesex"		2	133	2			2						Not Applicable	www.fallonhealth.org/summit	www.fallonhealth.org/summit									(800)698-7566		(508)368-9690		(800)698-7566		(508)368-9690										(711)-		(711)-		(711)-		(711)-																
H2220	1	0	1	20	8	H2220_001_0	1	1			05/30/2019	2020.01	05/30/2019 10:59:29 AM Eastern Daylight Time		05/30/2019 10:43:27 AM Eastern Daylight Time			05/30/2019 11:02:26 AM Eastern Daylight Time	"UPHAMS CORNER HEALTH COMMITTEE, INC."	"Uphams Corner Health Committee, Inc."	www.uphamselderserviceplan.org	Upham's Corner Health Committee (PACE)	8	20		1			H2220	1	0	2020	"Upham's Elder Service Plan, inner city of Boston"		2	3793	2			2						http://www.uphamscornerhealthctr.com/	http://www.uphamscornerhealthctr.com/										(617)288-0970		(617)288-0970		(617)288-0970		(617)288-0970										(617)287-8000		(617)287-8000		(617)287-8000		(617)287-8000																
H2220	2	0	1	20	8	H2220_002_0	1	1			05/30/2019	2020.01	05/30/2019 11:01:27 AM Eastern Daylight Time		05/30/2019 10:43:16 AM Eastern Daylight Time			05/30/2019 11:02:26 AM Eastern Daylight Time	"UPHAMS CORNER HEALTH COMMITTEE, INC."	"Uphams Corner Health Committee, Inc."	www.uphamselderserviceplan.org	Uphams Corner Health Committee (PACE)	8	20		1			H2220	2	0	2020	"Upham's Elder Service Plan, inner city of Boston"		2	3793	2			2						http://www.uphamscornerhealthctr.com/	http://www.uphamscornerhealthctr.com/										(617)288-0970		(617)288-0970		(617)288-0970		(617)288-0970										(617)287-8000		(617)287-8000		(617)287-8000		(617)287-8000																
H2221	1	0	1	20	8	H2221_001_0	1	1			05/21/2019	2020.01	05/21/2019 10:51:09 AM Eastern Daylight Time		05/21/2019 10:38:59 AM Eastern Daylight Time			05/21/2019 10:54:20 AM Eastern Daylight Time	CAMBRIDGE PUBLIC HEALTH COMMISSION	Elder Service Plan of Cambridge Health Alliance	http://www.challiance.org/esp/elder-service-plan.a	Cambridge Public Health Commission (PACE)	8	20		1			H2221	1	0	2020	Counties: Middlesex and Suffolk		2		2			2						http://www.challiance.org/Services/Pharmacy.aspx	none												(617)575-5850		(617)575-5850		(617)575-5850										(800)439-2370		(711)-		(617)575-5850		(617)575-5850																
H2221	2	0	1	20	8	H2221_002_0	1	1			05/21/2019	2020.01	05/21/2019 10:51:46 AM Eastern Daylight Time		05/21/2019 10:38:59 AM Eastern Daylight Time			05/21/2019 10:54:20 AM Eastern Daylight Time	CAMBRIDGE PUBLIC HEALTH COMMISSION	Elder Service Plan of Cambridge Health Alliance	http://www.challiance.org/esp	Cambridge Public Health Commission (PACE)	8	20		1			H2221	2	0	2020	Counties:  Middlesex and Suffolk		2		2			2						http://www.challiance.org/Services/Pharmacy.aspx	none												(617)575-5850		(617)575-5850		(617)575-5850												(711)-		(617)575-5850		(617)575-5850																
H2222	2	0	1	20	8	H2222_002_0	1	1			05/29/2019	2020.01	05/29/2019 10:24:29 AM Eastern Daylight Time		05/28/2019 08:54:38 AM Eastern Daylight Time			05/29/2019 10:26:37 AM Eastern Daylight Time	"ELEMENT CARE, INC."	"Element Care, Inc"	www.elementcare.org	Element Care (PACE)	8	20		1			H2222	2	0	2020	"Essex, Middlesex counties"		2		2			2						www.eatonapothecary.com	None										(877)803-5564		(781)715-6608		(877)803-5564		(781)715-6608										(711)-		(711)-		(711)-		(711)-																
H2222	3	0	1	20	8	H2222_003_0	1	1			05/29/2019	2020.01	05/29/2019 10:24:53 AM Eastern Daylight Time		05/28/2019 08:55:08 AM Eastern Daylight Time			05/29/2019 10:26:37 AM Eastern Daylight Time	"ELEMENT CARE, INC."	"Element Care, Inc"	www.elementcare.org	Element Care (PACE)	8	20		1			H2222	3	0	2020	"Essex, Middlesex counties"		2		2			2						www.eatonapothecary.com	None										(877)803-5564		(781)715-6608		(877)803-5564		(781)715-6608										(711)-		(711)-		(711)-		(711)-																
H2223	1	0	1	20	8	H2223_001_0	1	1			06/03/2019	2020.01	06/03/2019 01:03:38 PM Eastern Daylight Time		05/30/2019 01:53:20 PM Eastern Daylight Time			06/03/2019 01:06:34 PM Eastern Daylight Time	ELDER SVC PLN/E BOSTON HEALTH CENTER	Neighborhood PACE	www.ebnhc.org/elderservice.php	East Boston Elder Service Plan (PACE)	8	20		1			H2223	1	0	2020	"02108, 02128, 02148 - 02152, 02155, 02176, 02180"		2		2			2						www.neighborhoodpace.org	www.neighborhoodpace.org										(617)568-6377		(617)568-6377		(617)568-6377		(617)568-6377										(800)720-3480		(800)720-3480		(800)720-3480		(800)720-3480																
H2223	2	0	1	20	8	H2223_002_0	1	1			06/03/2019	2020.01	06/03/2019 01:04:30 PM Eastern Daylight Time		06/03/2019 12:49:27 PM Eastern Daylight Time			06/03/2019 01:06:34 PM Eastern Daylight Time	ELDER SVC PLN/E BOSTON HEALTH CENTER	Neighborhood PACE	www.ebnhc.org/elderservice.php	East Boston Elder Service Plan (PACE)	8	20		1			H2223	2	0	2020	"02108, 02128, 02148 - 02152, 02155, 02176, 02180"		2		2			2						www.neighborhoodpace.org	www.neighborhoodpace.org										(617)568-6377		(617)568-6377		(617)568-6377		(617)568-6377										(800)720-3480		(800)720-3480		(800)720-3480		(800)720-3480																
H2224	1	0	1	1	1	H2224_001_0	4	1	2	1	05/30/2019	2020.01	05/30/2019 12:29:51 AM Eastern Daylight Time	08/01/2019 11:45:42 AM Eastern Daylight Time	08/01/2019 10:51:24 AM Eastern Daylight Time			08/05/2019 11:27:37 PM Eastern Daylight Time	"SENIOR WHOLE HEALTH, LLC"	Senior Whole Health	www.seniorwholehealth.com	Senior Whole Health (HMO D-SNP)	1	1		1			H2224	1	0	2020	"Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor"		2	101583	2			1	3		2		1	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	2			
H2224	3	0	1	1	1	H2224_003_0	4	1	2	1	05/30/2019	2020.01	05/30/2019 12:30:13 AM Eastern Daylight Time	08/01/2019 11:41:26 AM Eastern Daylight Time	08/01/2019 10:58:26 AM Eastern Daylight Time			08/05/2019 11:27:37 PM Eastern Daylight Time	"SENIOR WHOLE HEALTH, LLC"	Senior Whole Health	www.seniorwholehealth.com	Senior Whole Health NHC (HMO D-SNP)	1	1		1			H2224	3	0	2020	"Brstl, Essx, Hmpdn, Mdlsx, Nrflk, Plmth, Sflk, Wor"		2	76100	2			1	3		2		1	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	2			
H2225	1	0	1	1	1	H2225_001_0	4	1	2	1	08/05/2019	2020.01	08/05/2019 04:12:09 PM Eastern Daylight Time	08/05/2019 04:06:14 PM Eastern Daylight Time	08/05/2019 04:06:14 PM Eastern Daylight Time			08/05/2019 04:15:16 PM Eastern Daylight Time	"COMMONWEALTH CARE ALLIANCE, INC."	"Commonwealth Care Alliance, Inc."	www.commonwealthcaresco.org	Senior Care Options Program (HMO D-SNP)	1	1		1			H2225	1	0	2020	"BRI, ESS, FRA, HMD, HMP, MID, NOR, PLY, SUF, WOR"		2		2			1	3		1		1	http://www.commonwealthcarealliance.org/members/pharmacy-program	http://www.commonwealthcarealliance.org/members/pharmacy-program/formulary-2019	www.commonwealthcarealliance.org	(866)610-2273		(866)610-2273		(800)225-5222		(800)225-5222		(866)610-2273		(866)610-2273		(800)225-5222		(800)225-5222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2226	1	0	1	1	1	H2226_001_0	3	1	2	1	07/17/2019	2020.01	07/17/2019 02:15:59 PM Central Daylight Time	08/02/2019 10:20:25 AM Central Daylight Time	07/30/2019 07:12:12 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Senior Care Options (HMO D-SNP)	1	1		1			H2226	1	0	2020	"Boston, Springfield and Worcester Metro Areas"		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(888)867-5511		(888)867-5511		(800)555-5757		(800)555-5757		(888)867-5511		(888)867-5511		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2226	3	0	1	1	1	H2226_003_0	2	1	2	1	05/28/2019	2020.01	05/29/2019 09:15:20 AM Central Daylight Time	08/02/2019 10:20:58 AM Central Daylight Time	07/30/2019 07:12:49 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Senior Care Options NHC (HMO D-SNP)	1	1		1			H2226	3	0	2020	"Boston, Springfield and Worcester Metro Areas"		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(888)867-5511		(888)867-5511		(800)555-5757		(800)555-5757		(888)867-5511		(888)867-5511		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2228	2	0	1	4	1	H2228_002_0	3	1		1	08/05/2019	2020.01	08/05/2019 09:02:26 AM Central Daylight Time	08/05/2019 10:50:09 AM Central Daylight Time	07/30/2019 07:13:26 PM Central Daylight Time			08/05/2019 05:09:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	1	4		1			H2228	2	0	2020	State of Rhode Island		2		2			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			
H2228	10	0	1	4	1	H2228_010_0	3	1		1	08/05/2019	2020.01	08/05/2019 09:01:59 AM Central Daylight Time	08/05/2019 12:23:37 PM Central Daylight Time	07/30/2019 07:14:04 PM Central Daylight Time			08/05/2019 05:09:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	1	4		1			H2228	10	0	2020	"Select Counties in Delaware, Maryland and Virginia"		2		2			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			
H2228	11	0	1	4	1	H2228_011_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:43:03 AM Central Daylight Time	08/02/2019 11:25:26 AM Central Daylight Time	07/30/2019 07:14:36 PM Central Daylight Time			08/05/2019 05:09:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	1	4		1			H2228	11	0	2020	Select Counties in Maryland		2		2			1	1	2				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			
H2228	13	0	1	4	1	H2228_013_0	2	1		1	07/02/2019	2020.01	07/02/2019 01:04:54 PM Central Daylight Time	08/02/2019 11:26:19 AM Central Daylight Time	07/30/2019 07:15:12 PM Central Daylight Time			08/05/2019 05:09:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	1	4		1			H2228	13	0	2020	Select Counties in Georgia		2		2			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			
H2228	16	0	1	4	1	H2228_016_0	3	1		1	08/05/2019	2020.01	08/05/2019 09:01:27 AM Central Daylight Time	08/05/2019 10:50:49 AM Central Daylight Time	07/30/2019 07:15:47 PM Central Daylight Time			08/05/2019 05:09:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	1	4		1			H2228	16	0	2020	Select Counties in Oregon		2		2			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			
H2228	17	0	1	4	1	H2228_017_0	3	1		1	07/17/2019	2020.01	07/17/2019 10:05:46 AM Central Daylight Time	08/02/2019 11:28:13 AM Central Daylight Time	07/30/2019 07:16:20 PM Central Daylight Time			08/05/2019 05:09:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan 1 (PPO I-SNP)	1	4		1			H2228	17	0	2020	Select Counties in Oregon		2		2			1	1	2				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			
H2228	18	0	1	4	1	H2228_018_0	3	1			07/11/2019	2020.01	07/11/2019 04:32:35 PM Central Daylight Time	08/02/2019 11:29:12 AM Central Daylight Time	07/30/2019 07:16:51 PM Central Daylight Time			08/05/2019 05:09:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2228	18	0	2020	Select counties in North Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	19	0	1	4	1	H2228_019_0	3	1			08/05/2019	2020.01	08/05/2019 12:48:13 PM Central Daylight Time	08/02/2019 11:30:15 AM Central Daylight Time	07/30/2019 07:17:27 PM Central Daylight Time			08/06/2019 08:00:21 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	1	4		1			H2228	19	0	2020	Northeast Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	20	0	1	4	1	H2228_020_0	5	1			08/02/2019	2020.01	08/02/2019 09:56:36 AM Central Daylight Time	08/02/2019 11:31:09 AM Central Daylight Time	07/30/2019 07:17:58 PM Central Daylight Time			08/06/2019 08:00:21 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (PPO)	1	4		1			H2228	20	0	2020	Fort Wayne area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	21	0	1	4	1	H2228_021_0	3	1			08/02/2019	2020.01	08/02/2019 09:56:57 AM Central Daylight Time	08/02/2019 11:31:59 AM Central Daylight Time	07/30/2019 07:18:33 PM Central Daylight Time			08/06/2019 08:00:21 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	1	4		1			H2228	21	0	2020	Indianapolis and Central Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	22	0	1	4	1	H2228_022_0	3	1			08/02/2019	2020.01	08/02/2019 09:57:18 AM Central Daylight Time	08/02/2019 11:32:51 AM Central Daylight Time	07/30/2019 07:19:06 PM Central Daylight Time			08/06/2019 08:00:21 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2228	22	0	2020	Evansville area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	23	0	1	4	1	H2228_023_0	3	1			08/02/2019	2020.01	08/02/2019 10:10:37 AM Central Daylight Time	08/02/2019 11:33:40 AM Central Daylight Time	07/30/2019 07:19:39 PM Central Daylight Time			08/06/2019 08:00:21 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2228	23	0	2020	El Paso and Southwest New Mexico		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	24	0	1	4	1	H2228_024_0	3	1			08/02/2019	2020.01	08/02/2019 03:11:57 PM Central Daylight Time	08/02/2019 11:34:48 AM Central Daylight Time	07/30/2019 07:20:13 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	1	4		1			H2228	24	0	2020	Honolulu County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757		(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	25	0	1	4	1	H2228_025_0	2	1			07/11/2019	2020.01	07/11/2019 03:30:44 PM Central Daylight Time	05/31/2019 01:37:38 PM Central Daylight Time				07/12/2019 08:56:42 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Essential (PPO)	1	4		1			H2228	25	0	2020	Honolulu County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2228	29	0	1	4	1	H2228_029_0	3	1			07/11/2019	2020.01	07/11/2019 03:30:58 PM Central Daylight Time	08/02/2019 11:36:35 AM Central Daylight Time	07/30/2019 07:20:46 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2228	29	0	2020	"Portland, Salem, and Eugene Metro Areas"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	30	0	1	4	1	H2228_030_0	2	1			08/02/2019	2020.01	08/02/2019 12:01:54 PM Central Daylight Time	08/02/2019 11:37:33 AM Central Daylight Time	07/30/2019 07:21:22 PM Central Daylight Time			08/05/2019 04:04:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	1	4		1			H2228	30	0	2020	St. Louis Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	31	0	1	4	1	H2228_031_0	3	1			08/02/2019	2020.01	08/02/2019 11:10:38 AM Central Daylight Time	08/02/2019 11:38:40 AM Central Daylight Time	07/30/2019 07:21:56 PM Central Daylight Time			08/06/2019 09:22:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	1	4		1			H2228	31	0	2020	Ada and Canyon counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	32	0	1	4	1	H2228_032_0	3	1			08/02/2019	2020.01	08/02/2019 11:11:10 AM Central Daylight Time	08/02/2019 11:39:45 AM Central Daylight Time	07/30/2019 07:22:30 PM Central Daylight Time			08/06/2019 09:22:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	1	4		1			H2228	32	0	2020	Ada and Canyon counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	35	0	1	4	1	H2228_035_0	4	1			08/05/2019	2020.01	08/05/2019 10:49:50 AM Central Daylight Time	08/02/2019 11:40:33 AM Central Daylight Time	07/30/2019 07:23:04 PM Central Daylight Time			08/06/2019 12:41:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	1	4		1			H2228	35	0	2020	Philadelphia Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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			
H2228	36	0	1	4	1	H2228_036_0	4	1			08/02/2019	2020.01	08/02/2019 09:37:23 AM Central Daylight Time	08/02/2019 11:41:38 AM Central Daylight Time	07/30/2019 07:23:35 PM Central Daylight Time			08/06/2019 12:41:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	1	4		1			H2228	36	0	2020	Philadelphia Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	37	0	1	4	1	H2228_037_0	4	1			08/02/2019	2020.01	08/02/2019 09:37:45 AM Central Daylight Time	08/02/2019 11:42:44 AM Central Daylight Time	07/30/2019 07:24:07 PM Central Daylight Time			08/06/2019 12:41:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	1	4		1			H2228	37	0	2020	"Bucks, Chester and Philadelphia counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)393-0993		(800)393-0993		(800)555-5757		(800)555-5757		(800)393-0993		(800)393-0993		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	39	0	1	4	1	H2228_039_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:43:47 AM Central Daylight Time	08/02/2019 11:43:51 AM Central Daylight Time	07/30/2019 07:24:39 PM Central Daylight Time			08/05/2019 05:09:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan 1 (PPO I-SNP)	1	4		1			H2228	39	0	2020	Select Counties in Rhode Island		2		2			1	1	2				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			
H2228	41	0	1	4	1	H2228_041_0	3	1	2	1	07/11/2019	2020.01	07/11/2019 01:50:36 PM Central Daylight Time	08/02/2019 11:44:52 AM Central Daylight Time	07/30/2019 07:25:16 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO D-SNP)	1	4		1			H2228	41	0	2020	El Paso County		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-4983		(866)944-4983		(888)834-3721		(888)834-3721		(866)944-4983		(866)944-4983		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	42	0	1	4	1	H2228_042_0	4	1	2	1	07/11/2019	2020.01	07/11/2019 12:22:31 PM Central Daylight Time	08/02/2019 11:45:50 AM Central Daylight Time	07/30/2019 07:25:52 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO D-SNP)	1	4		1			H2228	42	0	2020	"Dona Ana, Grant, Hidalgo, Luna and Sierra counties"		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)393-0208		(866)393-0208		(888)834-3721		(888)834-3721		(866)393-0208		(866)393-0208		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	43	0	1	4	1	H2228_043_0	2	1	2	1	05/31/2019	2020.01	05/31/2019 01:21:49 PM Central Daylight Time	08/02/2019 11:46:35 AM Central Daylight Time	07/30/2019 07:26:28 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO D-SNP)	1	4		1			H2228	43	0	2020	Honolulu County		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.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						2			
H2228	44	0	1	4	1	H2228_044_0	2	1	2	1	08/06/2019	2020.01	08/06/2019 11:53:35 AM Central Daylight Time	08/02/2019 11:47:30 AM Central Daylight Time	07/30/2019 07:27:01 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO D-SNP)	1	4		1			H2228	44	0	2020	Atlanta and Macon Metro Areas		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	45	0	1	4	1	H2228_045_0	2	1	2	1	05/22/2019	2020.01	05/22/2019 07:16:12 PM Central Daylight Time	08/02/2019 11:48:17 AM Central Daylight Time	07/30/2019 07:27:34 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO D-SNP)	1	4		1			H2228	45	0	2020	"Washington, DC"		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	46	0	1	4	1	H2228_046_0	4	1	2	1	07/11/2019	2020.01	07/11/2019 12:22:56 PM Central Daylight Time	08/02/2019 11:49:11 AM Central Daylight Time	07/30/2019 07:28:07 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO D-SNP)	1	4		1			H2228	46	0	2020	"Bernalillo, Sandoval, Santa Fe, Valencia Counties"		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)393-0208		(866)393-0208		(888)834-3721		(888)834-3721		(866)393-0208		(866)393-0208		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	47	0	1	4	1	H2228_047_0	3	1			07/11/2019	2020.01	07/11/2019 03:31:14 PM Central Daylight Time	08/02/2019 11:50:04 AM Central Daylight Time	07/30/2019 07:28:41 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2228	47	0	2020	Select counties in Albuquerque		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	49	0	1	4	1	H2228_049_0	3	1			07/11/2019	2020.01	07/11/2019 03:31:27 PM Central Daylight Time	08/02/2019 11:50:54 AM Central Daylight Time	07/30/2019 07:29:14 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2228	49	0	2020	Santa Fe Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	64	0	1	4	1	H2228_064_0	3	1			08/02/2019	2020.01	08/02/2019 09:58:40 AM Central Daylight Time	08/02/2019 11:51:47 AM Central Daylight Time	07/30/2019 07:29:51 PM Central Daylight Time			08/06/2019 08:00:21 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2228	64	0	2020	Northwest Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	65	0	1	4	1	H2228_065_0	3	1			08/02/2019	2020.01	08/02/2019 09:59:40 AM Central Daylight Time	08/02/2019 11:52:25 AM Central Daylight Time	07/30/2019 07:30:25 PM Central Daylight Time			08/06/2019 08:00:21 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2228	65	0	2020	Southeast Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	66	0	1	4	1	H2228_066_0	3	1			08/02/2019	2020.01	08/02/2019 10:00:06 AM Central Daylight Time	08/02/2019 11:53:04 AM Central Daylight Time	07/30/2019 07:30:57 PM Central Daylight Time			08/06/2019 08:00:21 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2228	66	0	2020	West Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	67	0	1	4	1	H2228_067_0	3	1			07/11/2019	2020.01	07/11/2019 03:31:42 PM Central Daylight Time	08/02/2019 11:53:42 AM Central Daylight Time	07/30/2019 07:31:27 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	1	4		1			H2228	67	0	2020	Honolulu county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757		(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	68	0	1	4	1	H2228_068_0	3	1			07/11/2019	2020.01	07/11/2019 03:31:58 PM Central Daylight Time	08/02/2019 11:54:37 AM Central Daylight Time	07/30/2019 07:32:01 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2228	68	0	2020	Kauai and Maui Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757		(866)868-1534		(866)868-1534		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	71	0	1	4	1	H2228_071_0	2	1			08/02/2019	2020.01	08/02/2019 12:02:27 PM Central Daylight Time	08/02/2019 11:55:16 AM Central Daylight Time	07/30/2019 07:32:33 PM Central Daylight Time			08/05/2019 04:04:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2228	71	0	2020	Kansas City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	74	0	1	4	1	H2228_074_0	2	1			06/01/2019	2020.01	06/01/2019 02:59:49 PM Central Daylight Time	08/02/2019 11:56:03 AM Central Daylight Time	07/30/2019 07:33:06 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 1 (PPO)	1	4		1			H2228	74	0	2020	Maricopa county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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			
H2228	75	0	1	4	1	H2228_075_0	2	1			08/02/2019	2020.01	08/02/2019 03:12:40 PM Central Daylight Time	08/02/2019 11:56:46 AM Central Daylight Time	07/30/2019 07:33:38 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H2228	75	0	2020	Pima county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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			
H2228	76	0	1	4	1	H2228_076_0	3	1			07/11/2019	2020.01	07/11/2019 03:32:19 PM Central Daylight Time	08/02/2019 11:57:26 AM Central Daylight Time	07/30/2019 07:34:12 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H2228	76	0	2020	"Coconino, Yavapai, and Yuma counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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			
H2228	77	0	1	4	1	H2228_077_0	3	1			07/11/2019	2020.01	07/11/2019 03:32:32 PM Central Daylight Time	08/02/2019 11:58:18 AM Central Daylight Time	07/30/2019 07:34:47 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 2 (PPO)	1	4		1			H2228	77	0	2020	Maricopa county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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			
H2228	79	0	1	4	1	H2228_079_0	4	1			08/02/2019	2020.01	08/02/2019 11:11:56 AM Central Daylight Time	08/02/2019 11:59:00 AM Central Daylight Time	07/30/2019 07:35:18 PM Central Daylight Time			08/06/2019 09:22:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H2228	79	0	2020	Ada and Canyon counties		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	80	0	1	4	1	H2228_080_0	5	1			08/02/2019	2020.01	08/02/2019 10:00:25 AM Central Daylight Time	08/02/2019 11:59:39 AM Central Daylight Time	07/30/2019 07:35:53 PM Central Daylight Time			08/06/2019 08:00:21 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	1	4		1			H2228	80	0	2020	Fort Wayne Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	81	0	1	4	1	H2228_081_0	3	1			08/05/2019	2020.01	08/05/2019 10:21:59 AM Central Daylight Time	08/02/2019 12:00:20 PM Central Daylight Time	07/30/2019 07:36:22 PM Central Daylight Time			08/06/2019 08:00:21 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	1	4		1			H2228	81	0	2020	Indianapolis Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	82	0	1	4	1	H2228_082_0	2	1			08/02/2019	2020.01	08/02/2019 12:04:22 PM Central Daylight Time	08/02/2019 12:01:00 PM Central Daylight Time	07/30/2019 07:36:55 PM Central Daylight Time			08/05/2019 04:04:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2228	82	0	2020	"Bollinger, Scott and Stoddard Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	83	0	1	4	1	H2228_083_0	3	1			08/02/2019	2020.01	08/02/2019 12:04:55 PM Central Daylight Time	08/02/2019 12:01:43 PM Central Daylight Time	07/30/2019 07:37:25 PM Central Daylight Time			08/05/2019 04:04:35 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H2228	83	0	2020	St. Louis Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	84	0	1	4	1	H2228_084_0	4	1			08/05/2019	2020.01	08/05/2019 10:38:40 AM Central Daylight Time	08/02/2019 12:02:21 PM Central Daylight Time	07/30/2019 07:37:55 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H2228	84	0	2020	Select counties in Portland		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2228	85	0	1	4	1	H2228_085_0	5	1			08/02/2019	2020.01	08/02/2019 09:38:06 AM Central Daylight Time	08/02/2019 12:02:58 PM Central Daylight Time	07/30/2019 07:38:30 PM Central Daylight Time			08/06/2019 12:41:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Choice Plan 2 (PPO)	1	4		1			H2228	85	0	2020	Philadelphia Metro Area		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						2			
H2228	86	0	1	4	1	H2228_086_0	6	1			08/02/2019	2020.01	08/02/2019 09:38:24 AM Central Daylight Time	08/05/2019 10:09:17 AM Central Daylight Time	07/30/2019 07:39:01 PM Central Daylight Time			08/06/2019 12:41:45 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Choice Plan 3 (PPO)	1	4		1			H2228	86	0	2020	Philadelphia Metro Area		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						2			
H2228	805	0	1	4	1	H2228_805_0	1	1			05/12/2019	2020.01	05/12/2019 06:21:21 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	805	0	2020	National Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	807	0	1	4	1	H2228_807_0	1	1			05/12/2019	2020.01	05/12/2019 06:23:36 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	807	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	808	0	1	4	1	H2228_808_0	1	1			05/12/2019	2020.01	05/12/2019 06:27:08 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	808	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	809	0	2	4	1	H2228_809_0	1	1			05/12/2019	2020.01	05/12/2019 06:29:26 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2228	809	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	810	0	2	4	1	H2228_810_0	1	1			05/12/2019	2020.01	05/12/2019 06:32:14 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2228	810	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	811	0	2	4	1	H2228_811_0	1	1			05/12/2019	2020.01	05/12/2019 06:34:10 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2228	811	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	812	0	1	4	1	H2228_812_0	1	1			05/12/2019	2020.01	05/12/2019 06:35:59 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	812	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	813	0	1	4	1	H2228_813_0	1	1			05/12/2019	2020.01	05/12/2019 06:37:14 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	813	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	814	0	1	4	1	H2228_814_0	1	1			05/12/2019	2020.01	05/12/2019 06:38:43 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	814	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	815	0	1	4	1	H2228_815_0	1	1			05/12/2019	2020.01	05/12/2019 06:39:53 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	815	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	816	0	1	4	1	H2228_816_0	1	1			05/12/2019	2020.01	05/12/2019 06:40:47 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	816	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	817	0	2	4	1	H2228_817_0	1	1			05/12/2019	2020.01	05/12/2019 06:41:39 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2228	817	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	818	0	2	4	1	H2228_818_0	1	1			05/12/2019	2020.01	05/12/2019 06:42:51 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2228	818	0	2020	Nationwide		1	0	2			2						9999	www.UHCMedicareSolutions.com	610097	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	819	0	2	4	1	H2228_819_0	1	1			05/12/2019	2020.01	05/12/2019 06:43:45 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2228	819	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	820	0	1	4	1	H2228_820_0	1	1			05/12/2019	2020.01	05/12/2019 06:44:25 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	820	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	821	0	1	4	1	H2228_821_0	1	1			05/12/2019	2020.01	05/12/2019 06:45:37 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	821	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	822	0	1	4	1	H2228_822_0	5	1			05/12/2019	2020.01	05/12/2019 06:46:19 PM Central Daylight Time					06/03/2019 08:51:20 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	822	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	823	0	1	4	1	H2228_823_0	1	1			05/12/2019	2020.01	05/12/2019 06:47:04 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	823	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	824	0	1	4	1	H2228_824_0	1	1			05/12/2019	2020.01	05/12/2019 06:48:00 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	824	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	825	0	1	4	1	H2228_825_0	1	1			05/12/2019	2020.01	05/12/2019 06:52:28 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	825	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	826	0	1	4	1	H2228_826_0	1	1			05/12/2019	2020.01	05/12/2019 06:54:24 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	826	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	827	0	2	4	1	H2228_827_0	1	1			05/12/2019	2020.01	05/12/2019 06:56:34 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2228	827	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	828	0	1	4	1	H2228_828_0	1	1			05/12/2019	2020.01	05/12/2019 06:59:59 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	828	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	829	0	2	4	1	H2228_829_0	1	1			05/12/2019	2020.01	05/12/2019 07:00:14 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2228	829	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	830	0	1	4	1	H2228_830_0	1	1			05/12/2019	2020.01	05/12/2019 07:01:00 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	830	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	831	0	1	4	1	H2228_831_0	1	1			05/12/2019	2020.01	05/12/2019 07:01:41 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	831	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	832	0	1	4	1	H2228_832_0	1	1			05/12/2019	2020.01	05/12/2019 07:04:03 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	832	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	833	0	1	4	1	H2228_833_0	1	1			05/12/2019	2020.01	05/12/2019 07:04:40 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	833	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	834	0	1	4	1	H2228_834_0	1	1			05/12/2019	2020.01	05/12/2019 07:06:23 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	834	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2228	835	0	1	4	1	H2228_835_0	1	1			05/12/2019	2020.01	05/12/2019 07:07:25 PM Central Daylight Time					06/02/2019 05:12:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2228	835	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
H2230	2	0	1	4	1	H2230_002_0	6	1			07/10/2019	2020.01	07/10/2019 11:48:12 AM Eastern Daylight Time	08/02/2019 01:48:02 PM Eastern Daylight Time	07/31/2019 12:47:11 PM Eastern Daylight Time			08/05/2019 09:13:52 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue PlusRx (PPO)	1	4		1			H2230	2	0	2020	Massachusetts except Berkshire Dukes and Nantucket		2	74195	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2230	17	0	1	4	1	H2230_017_0	5	1			07/10/2019	2020.01	07/10/2019 11:48:17 AM Eastern Daylight Time	08/02/2019 01:49:00 PM Eastern Daylight Time	07/31/2019 12:47:40 PM Eastern Daylight Time			08/05/2019 09:13:52 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue SaverRx (PPO)	1	4		1			H2230	17	0	2020	Massachusetts except Berkshire Dukes and Nantucket		2	128900	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2230	18	1	1	4	1	H2230_018_1	5	1			07/10/2019	2020.01	07/10/2019 11:48:28 AM Eastern Daylight Time	08/02/2019 01:49:58 PM Eastern Daylight Time	07/31/2019 12:48:09 PM Eastern Daylight Time			08/05/2019 09:13:52 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue ValueRx (PPO)	1	4		1			H2230	18	1	2020	Massachusetts except Berkshire Dukes and Nantucket	"Massachusetts except BER, DUK, NAN, WOR"	2	287823	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2230	18	2	1	4	1	H2230_018_2	5	1			07/10/2019	2020.01	07/10/2019 11:48:49 AM Eastern Daylight Time	08/02/2019 01:50:55 PM Eastern Daylight Time	07/31/2019 12:48:38 PM Eastern Daylight Time			08/05/2019 09:13:52 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue ValueRx (PPO)	1	4		1			H2230	18	2	2020	Massachusetts except Berkshire Dukes and Nantucket	"Worcester, MA"	2	62118	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2230	801	0	1	4	1	H2230_801_0	3	1			06/03/2019	2020.01	06/03/2019 11:12:48 AM Eastern Daylight Time					06/03/2019 11:17:28 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue (PPO)	1	4		1			H2230	801	0	2020	National Network		1	900	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7d;7e;7h;8a;8b1;9a1;9b;9c;10a;11a;15;	2		1									
H2230	809	0	1	4	1	H2230_809_0	3	1			06/03/2019	2020.01	06/03/2019 11:12:52 AM Eastern Daylight Time					06/03/2019 11:17:28 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue (PPO)	1	4		1			H2230	809	0	2020	National Network		1	50	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7d;7e;7h;8a;8b1;9a1;9b;9c;	2		1									
H2235	1	0	1	1	1	H2235_001_0	7	1			08/02/2019	2020.01	08/02/2019 08:30:53 AM Central Daylight Time	08/02/2019 10:28:27 AM Central Daylight Time	08/02/2019 10:28:55 AM Central Daylight Time			08/02/2019 11:59:42 AM Central Daylight Time	"BAYCARE SELECT HEALTH PLANS, INC."	BayCare Health Plans	www.BayCarePlus.org	BayCarePlus Complete (HMO)	1	1		1			H2235	1	0	2020	"Hillsborough, Pasco, Pinellas and Polk counties"		2		2			2						www.BayCarePlus.org	www.BayCarePlus.org	www.BayCarePlus.org	(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2235	2	0	1	1	1	H2235_002_0	6	1			07/31/2019	2020.01	07/31/2019 02:42:03 PM Central Daylight Time	07/31/2019 01:00:25 PM Central Daylight Time	07/31/2019 12:57:59 PM Central Daylight Time			08/02/2019 09:20:52 AM Central Daylight Time	"BAYCARE SELECT HEALTH PLANS, INC."	BayCare Health Plans	www.BayCarePlus.org	BayCarePlus Rewards (HMO)	1	1		1			H2235	2	0	2020	"Hillborough, Pasco, Pinellas and Polk counties"		2		2			2						www.BayCarePlus.org	www.BayCarePlus.org	www.BayCarePlus.org	(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2235	801	0	1	1	1	H2235_801_0	3	1			05/21/2019	2020.01	05/21/2019 03:06:19 PM Central Daylight Time					05/30/2019 03:33:26 PM Central Daylight Time	"BAYCARE SELECT HEALTH PLANS, INC."	BayCare Health Plans	www.BayCarePlus.org	BayCarePlus EGWP MAPD calendar (HMO)	1	1		1			H2235	801	0	2020	"Hillsborough, Pasco, Pinellas and Polk counties"		1	300	2			2						www.BayCarePlus.org	www.BayCarePlus.org	www.BayCarePlus.org	(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;16b;17a;18a;	1					1				
H2235	802	0	1	1	1	H2235_802_0	3	1			05/21/2019	2020.01	05/21/2019 01:33:34 PM Central Daylight Time					05/30/2019 03:33:26 PM Central Daylight Time	"BAYCARE SELECT HEALTH PLANS, INC."	BayCare Health Plans	www.BayCarePlus.org	BayCarePlus EGWP MAPD non calendar (HMO)	1	1		1			H2235	802	0	2020	"Hillsborough, Pasco, Pinellas and Polk counties"		1	300	2			2						www.BayCarePlus.org	www.BayCarePlus.org	www.BayCarePlus.org	(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(866)509-5396		(866)509-5396		(866)947-5820		(866)947-5820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;6;7c;7d;7g;7i;8a;8b1;8b2;8b3;9a1;16b;17a;18a;	1					1				
H2237	1	0	1	1	1	H2237_001_0	5	1	2	1	07/01/2019	2020.01	07/01/2019 03:46:53 PM Central Daylight Time	07/31/2019 04:23:24 PM Central Daylight Time	07/31/2019 04:26:56 PM Central Daylight Time			08/06/2019 12:59:46 PM Central Daylight Time	"INDEPENDENT CARE HEALTH PLAN, INC."	iCare	www.icarehealthplan.org	iCare Medicare Plan (HMO D-SNP)	1	1		1			H2237	1	0	2020	"Eastern, South Central and Western Wisconsin"		2	88053	2			1	3		2		2	www.icarehealthplan.org	www.icarehealthplan.org	www.icarehealthplan.org	(800)777-4376		(414)223-4847		(888)241-9637		(414)223-4847		(800)777-4376		(414)223-4847		(855)689-7690		(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	2			
H2237	7	0	1	1	1	H2237_007_0	5	1	2	1	07/01/2019	2020.01	07/01/2019 03:49:39 PM Central Daylight Time	07/31/2019 04:24:27 PM Central Daylight Time	07/31/2019 04:27:37 PM Central Daylight Time			08/06/2019 12:59:46 PM Central Daylight Time	"INDEPENDENT CARE HEALTH PLAN, INC."	iCare	www.icarehealthplan.org	iCare Family Care Partnership (HMO D-SNP)	1	1		1			H2237	7	0	2020	"Milwaukee, Racine, Kenosha, Dane and Sauk Counties"		2	9057	2			1	3		1		2	www.icarehealthplan.org	www.icarehealthplan.org	www.icarehealthplan.org	(800)777-4376		(414)223-4847		(888)241-9637		(414)223-4847		(800)777-4376		(414)223-4847		(855)689-7690		(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	2			
H2237	9	0	1	1	1	H2237_009_0	5	1	2	1	07/01/2019	2020.01	07/01/2019 03:47:39 PM Central Daylight Time	07/31/2019 04:25:29 PM Central Daylight Time	07/31/2019 04:28:25 PM Central Daylight Time			08/06/2019 12:59:46 PM Central Daylight Time	"INDEPENDENT CARE HEALTH PLAN, INC."	iCare	www.icarehealthplan.org/aurora	Aurora CompleteCare (HMO D-SNP)	1	1		1			H2237	9	0	2020	"Milwaukee, Waukesha and SE Wis. Counties"		2	7225	2			1	3		2		2	www.icarehealthplan.org/aurora	www.icarehealthplan.org/aurora	www.icarehealthplan.org/aurora	(855)818-1129		(414)299-5549		(888)241-9637		(414)299-5549		(855)818-1129		(414)299-5549		(855)689-7690		(414)299-5549		(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	2			
H2237	11	0	1	1	1	H2237_011_0	5	1			07/01/2019	2020.01	07/01/2019 03:48:03 PM Central Daylight Time	07/31/2019 04:49:39 PM Central Daylight Time	07/31/2019 04:50:17 PM Central Daylight Time			08/06/2019 12:59:46 PM Central Daylight Time	"INDEPENDENT CARE HEALTH PLAN, INC."	iCare	www.iCareHealthPlan.org/MAP	iCare Medicare Advantage Plan (HMO)	1	1		1			H2237	11	0	2020	iCare Medicare Advantage Plan		2	542	2			2						www.iCareHealthPlan.org/MAP	www.iCareHealthPlan.org/MAP	www.iCareHealthPlan.org/MAP	(800)777-4376		(414)223-4847		(888)241-9637		(414)223-4847		(800)777-4376		(414)223-4847		(855)689-7690		(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	2			
H2241	7	1	1	1	1	H2241_007_1	7	1			08/05/2019	2020.01	08/05/2019 07:05:48 PM Pacific Daylight Time	08/09/2019 12:58:10 PM Pacific Daylight Time	08/05/2019 06:34:58 PM Pacific Daylight Time			08/09/2019 01:28:50 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care (HMO)	1	1		1			H2241	7	1	2020	Stanislaus and San Luis Obispo Counties	Stanislaus County	2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	7	2	1	1	1	H2241_007_2	7	1			08/05/2019	2020.01	08/05/2019 07:05:55 PM Pacific Daylight Time	08/09/2019 12:58:11 PM Pacific Daylight Time	08/05/2019 06:34:59 PM Pacific Daylight Time			08/09/2019 01:28:50 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care (HMO)	1	1		1			H2241	7	2	2020	Stanislaus and San Luis Obispo Counties	San Luis Obispo County	2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	12	0	1	1	1	H2241_012_0	7	1			08/05/2019	2020.01	08/05/2019 07:06:03 PM Pacific Daylight Time	08/09/2019 12:58:12 PM Pacific Daylight Time	08/05/2019 06:34:59 PM Pacific Daylight Time			08/09/2019 01:28:50 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care (HMO)	1	1		1			H2241	12	0	2020	Los Angeles County		2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	13	0	1	1	1	H2241_013_0	6	1			08/05/2019	2020.01	08/05/2019 07:06:10 PM Pacific Daylight Time	08/09/2019 12:58:13 PM Pacific Daylight Time	08/05/2019 06:34:59 PM Pacific Daylight Time			08/09/2019 01:28:50 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care (HMO)	1	1		1			H2241	13	0	2020	Orange and Riverside Counties		2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	14	0	1	1	1	H2241_014_0	8	1			08/05/2019	2020.01	08/05/2019 07:06:18 PM Pacific Daylight Time	08/09/2019 12:58:13 PM Pacific Daylight Time	08/05/2019 06:35:00 PM Pacific Daylight Time			08/09/2019 01:28:50 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Golden State Senior Health Plan (HMO)	1	1		1			H2241	14	0	2020	San Francisco County		2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	15	0	1	1	1	H2241_015_0	6	1			08/05/2019	2020.01	08/05/2019 07:06:26 PM Pacific Daylight Time	08/09/2019 12:58:14 PM Pacific Daylight Time	08/05/2019 06:35:00 PM Pacific Daylight Time			08/09/2019 01:28:50 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care (HMO)	1	1		1			H2241	15	0	2020	San Joaquin County		2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	16	0	1	1	1	H2241_016_0	6	1			08/05/2019	2020.01	08/05/2019 07:06:33 PM Pacific Daylight Time	08/09/2019 12:58:24 PM Pacific Daylight Time	08/05/2019 06:35:00 PM Pacific Daylight Time			08/09/2019 01:28:50 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care (HMO)	1	1		1			H2241	16	0	2020	San Bernardino County		2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	17	0	1	1	1	H2241_017_0	6	1			08/05/2019	2020.01	08/05/2019 07:06:39 PM Pacific Daylight Time	08/09/2019 12:58:25 PM Pacific Daylight Time	08/05/2019 06:35:01 PM Pacific Daylight Time			08/09/2019 01:28:50 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care (HMO)	1	1		1			H2241	17	0	2020	San Diego County		2		2			2						www.gsmhp.com	www.gsmhp.com	www.gsmhp.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	18	0	1	1	1	H2241_018_0	5	1		1	08/05/2019	2020.01	08/05/2019 07:06:46 PM Pacific Daylight Time	08/05/2019 06:35:37 PM Pacific Daylight Time	08/05/2019 06:35:01 PM Pacific Daylight Time			08/05/2019 07:09:24 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care Select (HMO C-SNP)	1	1		1			H2241	18	0	2020	Los Angeles County		2		2			1	4			10		www.gsmhp.com	www.gsmhp.com	www.gsmhp.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	19	0	1	1	1	H2241_019_0	6	1		1	08/05/2019	2020.01	08/05/2019 07:06:53 PM Pacific Daylight Time	08/09/2019 12:58:26 PM Pacific Daylight Time	08/05/2019 06:35:01 PM Pacific Daylight Time			08/09/2019 01:28:50 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care Select (HMO C-SNP)	1	1		1			H2241	19	0	2020	Orange and Riverside Counties		2		2			1	4			10		www.gsmhp.com	www.gsmhp.com	www.gsmhp.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	20	0	1	1	1	H2241_020_0	6	1		1	08/05/2019	2020.01	08/05/2019 07:07:00 PM Pacific Daylight Time	08/09/2019 12:58:27 PM Pacific Daylight Time	08/05/2019 06:35:02 PM Pacific Daylight Time			08/09/2019 01:28:50 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care Select (HMO C-SNP)	1	1		1			H2241	20	0	2020	San Luis Obispo County		2		2			1	4			10		www.gsmhp.com	www.gsmhp.com	www.gsmhp.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2241	21	0	1	1	1	H2241_021_0	6	1		1	08/05/2019	2020.01	08/05/2019 07:07:08 PM Pacific Daylight Time	08/09/2019 12:58:28 PM Pacific Daylight Time	08/05/2019 06:35:02 PM Pacific Daylight Time			08/09/2019 01:28:50 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State	www.gsmhp.com	Connected Care Select (HMO C-SNP)	1	1		1			H2241	21	0	2020	Stanislaus County		2		2			1	4			10		www.gsmhp.com	www.gsmhp.com	www.gsmhp.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2247	1	0	1	1	1	H2247_001_0	3	1	2	1	08/02/2019	2020.01	08/02/2019 09:05:25 AM Central Daylight Time	08/02/2019 10:22:16 AM Central Daylight Time	07/30/2019 07:39:37 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	"UNITEDHEALTHCARE COMMUNITY PLAN, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H2247	1	0	2020	Select Counties in MI		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-6885		(844)368-6885		(888)834-3721		(888)834-3721		(844)368-6885		(844)368-6885		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2247	2	0	1	1	1	H2247_002_0	3	1	2	1	08/02/2019	2020.01	08/02/2019 09:05:45 AM Central Daylight Time	08/02/2019 10:22:49 AM Central Daylight Time	07/30/2019 07:40:10 PM Central Daylight Time			08/06/2019 12:03:11 PM Central Daylight Time	"UNITEDHEALTHCARE COMMUNITY PLAN, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H2247	2	0	2020	Wayne County		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-6885		(844)368-6885		(888)834-3721		(888)834-3721		(844)368-6885		(844)368-6885		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	1	1	1	1	1	H2256_001_1	8	1			08/05/2019	2020.01	08/05/2019 01:45:51 PM Eastern Daylight Time	08/01/2019 04:26:28 PM Eastern Daylight Time	07/31/2019 02:43:06 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	1	1		1			H2256	1	1	2020	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	1	2	1	1	1	H2256_001_2	8	1			08/05/2019	2020.01	08/05/2019 01:45:57 PM Eastern Daylight Time	08/01/2019 04:24:54 PM Eastern Daylight Time	07/31/2019 02:43:38 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	1	1		1			H2256	1	2	2020	Most of Massachusetts	"BARN, BRIS, MIDD, NORF, PLYM Counties"	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	1	6	1	1	1	H2256_001_6	8	1			08/05/2019	2020.01	08/05/2019 01:46:02 PM Eastern Daylight Time	08/01/2019 04:27:30 PM Eastern Daylight Time	07/31/2019 02:44:10 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	1	1		1			H2256	1	6	2020	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	15	1	1	1	1	H2256_015_1	7	1			08/05/2019	2020.01	08/05/2019 01:46:08 PM Eastern Daylight Time	08/01/2019 04:28:26 PM Eastern Daylight Time	07/31/2019 02:44:44 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	1	1		1			H2256	15	1	2020	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	15	2	1	1	1	H2256_015_2	7	1			08/05/2019	2020.01	08/05/2019 01:46:19 PM Eastern Daylight Time	08/01/2019 04:20:38 PM Eastern Daylight Time	07/31/2019 02:45:16 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	1	1		1			H2256	15	2	2020	Most of Massachusetts	"BARN, BRIS, MIDD, NORF, PLYM Counties"	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	15	6	1	1	1	H2256_015_6	7	1			08/05/2019	2020.01	08/05/2019 01:46:26 PM Eastern Daylight Time	08/01/2019 04:14:48 PM Eastern Daylight Time	07/31/2019 02:45:48 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	1	1		1			H2256	15	6	2020	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	16	1	1	1	1	H2256_016_1	6	1			07/18/2019	2020.01	07/18/2019 04:34:32 PM Eastern Daylight Time	07/18/2019 12:09:06 PM Eastern Daylight Time				07/19/2019 11:35:22 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	1	1		1			H2256	16	1	2020	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	16	2	1	1	1	H2256_016_2	6	1			07/18/2019	2020.01	07/18/2019 04:39:16 PM Eastern Daylight Time	07/18/2019 12:07:18 PM Eastern Daylight Time				07/19/2019 11:35:22 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	1	1		1			H2256	16	2	2020	Most of Massachusetts	"BARN, BRIS, MIDD, NORF, PLYM Counties"	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	18	1	1	1	1	H2256_018_1	7	1			08/05/2019	2020.01	08/05/2019 01:46:49 PM Eastern Daylight Time	08/01/2019 04:10:18 PM Eastern Daylight Time	07/31/2019 02:46:20 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	1	1		1			H2256	18	1	2020	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	18	7	1	1	1	H2256_018_7	7	1			08/05/2019	2020.01	08/05/2019 01:46:55 PM Eastern Daylight Time	08/01/2019 04:09:22 PM Eastern Daylight Time	07/31/2019 02:47:02 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	1	1		1			H2256	18	7	2020	Most of Massachusetts	"BARN, BRIS, MIDD, NORF, PLYM Counties"	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	18	8	1	1	1	H2256_018_8	7	1			08/05/2019	2020.01	08/05/2019 01:47:07 PM Eastern Daylight Time	08/01/2019 04:08:32 PM Eastern Daylight Time	07/31/2019 02:47:34 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	1	1		1			H2256	18	8	2020	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	19	1	1	1	1	H2256_019_1	6	1			07/18/2019	2020.01	07/18/2019 04:48:07 PM Eastern Daylight Time	07/18/2019 12:13:32 PM Eastern Daylight Time				07/19/2019 11:35:22 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	1	1		1			H2256	19	1	2020	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	19	7	1	1	1	H2256_019_7	6	1			07/18/2019	2020.01	07/18/2019 04:48:58 PM Eastern Daylight Time	07/18/2019 11:57:06 AM Eastern Daylight Time				07/19/2019 11:35:22 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	1	1		1			H2256	19	7	2020	Most of Massachusetts	"BARN, BRIS, MIDD, NORF, PLYM Counties"	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	26	1	1	1	1	H2256_026_1	7	1			08/05/2019	2020.01	08/05/2019 01:47:40 PM Eastern Daylight Time	08/01/2019 04:07:36 PM Eastern Daylight Time	07/31/2019 02:48:06 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	1	1		1			H2256	26	1	2020	Most of Massachusetts	Essex and Suffolk Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	26	2	1	1	1	H2256_026_2	7	1			08/05/2019	2020.01	08/05/2019 01:47:48 PM Eastern Daylight Time	08/01/2019 04:06:14 PM Eastern Daylight Time	07/31/2019 02:48:38 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	1	1		1			H2256	26	2	2020	Most of Massachusetts	"BARN, BRIS, MIDD, NORF, PLYM Counties"	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	26	3	1	1	1	H2256_026_3	7	1			08/05/2019	2020.01	08/05/2019 01:47:59 PM Eastern Daylight Time	08/01/2019 04:04:40 PM Eastern Daylight Time	07/31/2019 02:49:10 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	1	1		1			H2256	26	3	2020	Most of Massachusetts	Hampden and Hampshire Counties	2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	28	0	1	1	1	H2256_028_0	7	1			08/05/2019	2020.01	08/05/2019 03:40:16 PM Eastern Daylight Time	08/01/2019 11:43:44 AM Eastern Daylight Time	07/31/2019 02:49:42 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Saver Rx (HMO)	1	1		1			H2256	28	0	2020	Most of Massachusetts		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	29	0	1	1	1	H2256_029_0	8	1	2	1	09/20/2019	2020.01	09/20/2019 08:48:39 AM Eastern Daylight Time	08/01/2019 06:19:38 PM Eastern Daylight Time	07/31/2019 02:24:48 PM Eastern Daylight Time			09/20/2019 08:50:13 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/sco	Tufts Health Plan Senior Care Options (HMO D-SNP)	1	1		1			H2256	29	0	2020	Most of Massachusetts		2		2			1	3		1		1	tufts-sco.prismisp.com	tuftsmedicarepreferred.org/drug-coverage	tufts-sco.prismisp.com	(855)670-5934		(855)670-5934		(855)670-5935		(855)670-5935		(855)670-5934		(855)670-5934		(855)670-5935		(855)670-5935		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	33	0	1	1	1	H2256_033_0	7	1			08/05/2019	2020.01	08/05/2019 01:48:23 PM Eastern Daylight Time	08/01/2019 04:01:10 PM Eastern Daylight Time	07/31/2019 02:50:14 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	1	1		1			H2256	33	0	2020	Worcester County		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	34	0	1	1	1	H2256_034_0	7	1			08/05/2019	2020.01	08/05/2019 01:48:31 PM Eastern Daylight Time	08/01/2019 03:55:02 PM Eastern Daylight Time	07/31/2019 02:50:44 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	1	1		1			H2256	34	0	2020	Worcester County		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	36	0	1	1	1	H2256_036_0	7	1			08/05/2019	2020.01	08/05/2019 01:48:38 PM Eastern Daylight Time	08/01/2019 03:56:48 PM Eastern Daylight Time	07/31/2019 02:51:20 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	1	1		1			H2256	36	0	2020	Worcester County		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	39	0	1	1	1	H2256_039_0	6	1			07/18/2019	2020.01	07/18/2019 05:00:31 PM Eastern Daylight Time	07/18/2019 11:16:42 AM Eastern Daylight Time				07/19/2019 11:35:22 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	1	1		1			H2256	39	0	2020	Worcester County		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	40	0	1	1	1	H2256_040_0	6	1			07/18/2019	2020.01	07/18/2019 05:00:46 PM Eastern Daylight Time	07/18/2019 11:13:26 AM Eastern Daylight Time				07/19/2019 11:35:22 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	1	1		1			H2256	40	0	2020	Worcester County		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	41	0	1	1	1	H2256_041_0	6	1			07/18/2019	2020.01	07/18/2019 05:01:59 PM Eastern Daylight Time	07/18/2019 11:19:00 AM Eastern Daylight Time				07/19/2019 11:35:22 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic No Rx (HMO)	1	1		1			H2256	41	0	2020	Worcester County		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	42	0	1	1	1	H2256_042_0	6	1			07/18/2019	2020.01	07/18/2019 05:02:10 PM Eastern Daylight Time	07/18/2019 11:21:56 AM Eastern Daylight Time				07/19/2019 11:35:22 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic No Rx (HMO)	1	1		1			H2256	42	0	2020	Essex and Suffolk Counties		2		2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	801	0	1	1	1	H2256_801_0	4	1			05/28/2019	2020.01	05/28/2019 12:39:27 PM Eastern Daylight Time					06/03/2019 01:48:26 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred HMO Rx (HMO)	1	1		1			H2256	801	0	2020	Most of Massachusetts		1	94935	2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	802	0	1	1	1	H2256_802_0	4	1			05/28/2019	2020.01	05/28/2019 12:40:09 PM Eastern Daylight Time					06/03/2019 01:48:26 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred HMO (HMO)	1	1		1			H2256	802	0	2020	Most of Massachusetts		1	7687	2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2256	803	0	1	1	1	H2256_803_0	4	1			05/28/2019	2020.01	05/28/2019 12:46:08 PM Eastern Daylight Time					06/03/2019 01:48:26 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred HMO Rx (HMO)	1	1		1			H2256	803	0	2020	Most of Massachusetts		1	0	2			2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2256	808	0	1	1	1	H2256_808_0	4	1			05/28/2019	2020.01	05/28/2019 12:48:11 PM Eastern Daylight Time					06/03/2019 01:48:26 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred HMO (HMO)	1	1		1			H2256	808	0	2020	Most of Massachusetts		1	54747	2			2						tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/drug-coverage	tuftsmedicarepreferred.org/find-doctor	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2261	5	0	1	1	1	H2261_005_0	6	1			08/01/2019	2020.01	08/01/2019 11:53:42 AM Eastern Daylight Time	08/02/2019 01:51:54 PM Eastern Daylight Time	07/31/2019 12:49:07 PM Eastern Daylight Time			08/05/2019 09:13:52 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue PlusRx (HMO)	1	1		1			H2261	5	0	2020	Massachusetts except Berkshire Dukes and Nantucket		2	25313	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2261	22	1	1	1	1	H2261_022_1	5	1			07/10/2019	2020.01	07/10/2019 11:49:14 AM Eastern Daylight Time	08/02/2019 01:52:53 PM Eastern Daylight Time	07/31/2019 12:49:36 PM Eastern Daylight Time			08/05/2019 09:13:52 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue ValueRx (HMO)	1	1		1			H2261	22	1	2020	"Massachusetts except Berkshire, Dukes, Nantucket"	"Massachusetts except BER, DUK, NAN, WOR"	2	54839	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2261	22	2	1	1	1	H2261_022_2	5	1			07/10/2019	2020.01	07/10/2019 11:49:10 AM Eastern Daylight Time	08/02/2019 01:53:48 PM Eastern Daylight Time	07/31/2019 12:50:13 PM Eastern Daylight Time			08/05/2019 09:13:52 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue ValueRx (HMO)	1	1		1			H2261	22	2	2020	"Massachusetts except Berkshire, Dukes, Nantucket"	Worcester county	2	11066	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2261	23	1	1	2	1	H2261_023_1	5	1			07/10/2019	2020.01	07/10/2019 11:49:19 AM Eastern Daylight Time	08/02/2019 01:54:46 PM Eastern Daylight Time	07/31/2019 12:50:42 PM Eastern Daylight Time			08/05/2019 09:13:52 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue FlexRx (HMO-POS)	1	2		1			H2261	23	1	2020	Massachusetts except Berkshire Dukes and Nantucket	"Massachusetts except BER, DUK, NAN, WOR"	2	29151	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2261	23	2	1	2	1	H2261_023_2	5	1			07/10/2019	2020.01	07/10/2019 11:50:06 AM Eastern Daylight Time	08/02/2019 01:55:43 PM Eastern Daylight Time	07/31/2019 12:51:14 PM Eastern Daylight Time			08/05/2019 09:13:52 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue FlexRx (HMO-POS)	1	2		1			H2261	23	2	2020	Massachusetts except Berkshire Dukes and Nantucket	"Worcester, MA"	2	6516	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2261	24	0	1	1	1	H2261_024_0	6	1			08/01/2019	2020.01	08/01/2019 11:53:47 AM Eastern Daylight Time	08/02/2019 01:56:41 PM Eastern Daylight Time	07/31/2019 12:51:50 PM Eastern Daylight Time			08/05/2019 09:13:52 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue SaverRx (HMO)	1	1		1			H2261	24	0	2020	Massachusetts except Berkshire Dukes and Nantucket		2	23798	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2261	801	0	1	1	1	H2261_801_0	3	1			06/03/2019	2020.01	06/03/2019 11:13:31 AM Eastern Daylight Time					06/03/2019 11:17:28 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue (HMO)	1	1		1			H2261	801	0	2020	Massachusetts except Berkshire Dukes and Nantucket		1	16500	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;9a1;9b;9c;10a;11a;12;15;	1	7d;7f;7i;14e3;	1					2				
H2261	809	0	1	1	1	H2261_809_0	3	1			06/03/2019	2020.01	06/03/2019 11:13:36 AM Eastern Daylight Time					06/03/2019 11:17:28 AM Eastern Daylight Time	"BCBS  OF MASSACHUSETTS HMO BLUE, INC."	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue (HMO)	1	1		1			H2261	809	0	2020	Massachusetts except Berkshire Dukes and Nantucket		1	120	2			2						http://www.bluecrossma.com/medicare	http://www.bluecrossma.com/medicare	www.bcbsma.com	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;9a1;9b;9c;10a;11a;12;15;	1	7d;7f;7i;14e3;	1					2				
H2288	1	0	1	1	1	H2288_001_0	7	1			07/16/2019	2020.01	07/16/2019 01:18:50 PM Central Daylight Time	08/02/2019 04:23:23 PM Central Daylight Time	08/02/2019 04:55:37 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage (HMO)	1	1		1			H2288	1	0	2020	"Kings, New York, and Queens Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2288	2	0	1	1	1	H2288_002_0	7	1			07/16/2019	2020.01	07/16/2019 01:20:10 PM Central Daylight Time	08/02/2019 04:23:17 PM Central Daylight Time	08/02/2019 04:54:49 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Plus (HMO)	1	1		1			H2288	2	0	2020	"Kings, New York, and Queens Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2288	3	0	1	1	1	H2288_003_0	8	1	2	1	08/01/2019	2020.01	08/01/2019 02:23:34 PM Central Daylight Time	08/02/2019 04:23:11 PM Central Daylight Time	08/02/2019 04:54:25 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Special Care (HMO D-SNP)	1	1		1			H2288	3	0	2020	New York County		2		2			1	3		1		1	https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4030		(844)202-4030		(844)713-0098		(844)713-0098		(844)202-4030		(844)202-4030		(844)713-0098		(844)713-0098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2288	5	0	1	1	1	H2288_005_0	6	1			07/16/2019	2020.01	07/16/2019 01:21:32 PM Central Daylight Time	08/02/2019 04:23:05 PM Central Daylight Time	08/02/2019 04:53:35 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Assist (HMO)	1	1		1			H2288	5	0	2020	"Kings, New York, and Queens Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2288	8	0	1	1	1	H2288_008_0	8	1			07/16/2019	2020.01	07/16/2019 01:22:48 PM Central Daylight Time	08/02/2019 04:23:00 PM Central Daylight Time	08/05/2019 04:07:24 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Choice (HMO)	1	1		1			H2288	8	0	2020	"Kings, New York, and Queens Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2292	1	0	1	4	1	H2292_001_0	2	1		1	08/02/2019	2020.01	08/02/2019 12:23:55 PM Central Daylight Time	08/02/2019 10:37:10 AM Central Daylight Time	07/30/2019 07:40:47 PM Central Daylight Time			08/05/2019 05:22:41 PM Central Daylight Time	"OXFORD HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	1	4		1			H2292	1	0	2020	Upstate New York		2		2			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			
H2292	2	0	1	4	1	H2292_002_0	2	1		1	06/01/2019	2020.01	06/01/2019 12:03:38 PM Central Daylight Time	08/02/2019 10:37:39 AM Central Daylight Time	07/30/2019 07:41:19 PM Central Daylight Time			08/05/2019 05:22:41 PM Central Daylight Time	"OXFORD HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	1	4		1			H2292	2	0	2020	New York City		2		2			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			
H2292	3	0	1	4	1	H2292_003_0	2	1		1	05/30/2019	2020.01	05/30/2019 10:44:17 AM Central Daylight Time	08/02/2019 10:38:09 AM Central Daylight Time	07/30/2019 07:41:52 PM Central Daylight Time			08/05/2019 05:22:41 PM Central Daylight Time	"OXFORD HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (PPO I-SNP)	1	4		1			H2292	3	0	2020	Select Counties in New York		2		2			1	1	2				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			
H2318	1	0	1	20	8	H2318_001_0	1	1			05/29/2019	2020.01	05/29/2019 02:13:52 PM Eastern Daylight Time		05/29/2019 02:05:15 PM Eastern Daylight Time			05/29/2019 02:15:53 PM Eastern Daylight Time	PACE SOUTHEAST MICHIGAN	PACE Southeast Michigan	www.pacesemi.org	PACE Southeast Michigan (PACE)	8	20		1			H2318	1	0	2020	"Michigan, Macomb, Oakland, Wayne Counties"		2		2			2						www.henryford.com	Milwaukee.PACE@milliman.com										(855)445-4554		(855)445-4554		(855)445-4554		(855)445-4554										(711)-		(711)-		(711)-		(711)-																
H2318	2	0	1	20	8	H2318_002_0	1	1			05/29/2019	2020.01	05/29/2019 02:14:19 PM Eastern Daylight Time		05/29/2019 02:05:03 PM Eastern Daylight Time			05/29/2019 02:15:53 PM Eastern Daylight Time	PACE SOUTHEAST MICHIGAN	PACE Southeast Michigan	www.pacesemi.org	PACE Southeast Michigan (PACE)	8	20		1			H2318	2	0	2020	"Michigan, Macomb, Oakland, Wayne Counties"		2		2			2						www.henryford.com	Milwaukee.PACE@milliman.com										(855)445-4554		(855)445-4554		(855)445-4554		(855)445-4554										(711)-		(711)-		(711)-		(711)-																
H2320	22	1	1	2	1	H2320_022_1	9	1			08/01/2019	2020.01	08/01/2019 01:54:15 PM Eastern Daylight Time	08/02/2019 12:52:06 PM Eastern Daylight Time	07/31/2019 11:39:16 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	1	2		1			H2320	22	1	2020	68 lower peninsula Michigan counties	Region 1	2	33567	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	22	2	1	2	1	H2320_022_2	9	1			08/01/2019	2020.01	08/01/2019 01:55:54 PM Eastern Daylight Time	08/02/2019 12:53:42 PM Eastern Daylight Time	07/31/2019 11:39:48 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	1	2		1			H2320	22	2	2020	68 lower peninsula Michigan counties	Region 2	2	85717	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	22	3	1	2	1	H2320_022_3	9	1			08/01/2019	2020.01	08/01/2019 01:56:16 PM Eastern Daylight Time	08/02/2019 12:55:18 PM Eastern Daylight Time	07/31/2019 11:40:18 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	1	2		1			H2320	22	3	2020	68 lower peninsula Michigan counties	Region 3	2	48278	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	22	4	1	2	1	H2320_022_4	9	1			08/01/2019	2020.01	08/01/2019 01:56:37 PM Eastern Daylight Time	08/02/2019 12:56:52 PM Eastern Daylight Time	07/31/2019 11:40:50 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	1	2		1			H2320	22	4	2020	68 lower peninsula Michigan counties	Region 4	2	34520	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	22	5	1	2	1	H2320_022_5	9	1			08/01/2019	2020.01	08/01/2019 01:57:00 PM Eastern Daylight Time	08/02/2019 12:58:28 PM Eastern Daylight Time	07/31/2019 11:41:20 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Key (HMO-POS)	1	2		1			H2320	22	5	2020	68 lower peninsula Michigan counties	Region 5	2	84205	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	28	1	1	2	1	H2320_028_1	8	1			07/12/2019	2020.01	07/12/2019 02:02:41 PM Eastern Daylight Time	08/02/2019 12:42:34 PM Eastern Daylight Time	07/31/2019 11:41:52 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	1	2		1			H2320	28	1	2020	68 lower peninsula Michigan counties	Region 1	2	135012	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	28	2	1	2	1	H2320_028_2	8	1			07/12/2019	2020.01	07/12/2019 02:06:07 PM Eastern Daylight Time	08/02/2019 12:36:14 PM Eastern Daylight Time	07/31/2019 11:42:24 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	1	2		1			H2320	28	2	2020	68 lower peninsula Michigan counties	Region 2	2	43499	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	28	3	1	2	1	H2320_028_3	9	1			07/12/2019	2020.01	07/12/2019 02:06:07 PM Eastern Daylight Time	08/02/2019 12:37:46 PM Eastern Daylight Time	07/31/2019 11:43:00 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	1	2		1			H2320	28	3	2020	68 lower peninsula Michigan counties	Region 3	2	12664	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	28	4	1	2	1	H2320_028_4	8	1			07/12/2019	2020.01	07/12/2019 02:06:07 PM Eastern Daylight Time	08/02/2019 12:45:44 PM Eastern Daylight Time	07/31/2019 11:43:30 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	1	2		1			H2320	28	4	2020	68 lower peninsula Michigan counties	Region 4	2	4953	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	28	5	1	2	1	H2320_028_5	9	1			07/12/2019	2020.01	07/12/2019 02:06:07 PM Eastern Daylight Time	08/02/2019 12:48:56 PM Eastern Daylight Time	07/31/2019 11:44:02 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	1	2		1			H2320	28	5	2020	68 lower peninsula Michigan counties	Region 5	2	13575	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	29	1	1	2	1	H2320_029_1	9	1			07/12/2019	2020.01	07/12/2019 02:05:01 PM Eastern Daylight Time	08/02/2019 12:44:10 PM Eastern Daylight Time	07/31/2019 11:44:44 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	1	2		1			H2320	29	1	2020	68 lower peninsula Michigan counties	Region 1	2	520968	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	29	2	1	2	1	H2320_029_2	9	1			07/12/2019	2020.01	07/12/2019 02:06:37 PM Eastern Daylight Time	08/02/2019 12:39:24 PM Eastern Daylight Time	07/31/2019 11:45:14 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	1	2		1			H2320	29	2	2020	68 lower peninsula Michigan counties	Region 2	2	178345	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	29	3	1	2	1	H2320_029_3	8	1			07/12/2019	2020.01	07/12/2019 02:06:37 PM Eastern Daylight Time	08/02/2019 12:41:00 PM Eastern Daylight Time	07/31/2019 11:45:42 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	1	2		1			H2320	29	3	2020	68 lower peninsula Michigan counties	Region 3	2	30400	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	29	4	1	2	1	H2320_029_4	8	1			07/12/2019	2020.01	07/12/2019 02:06:37 PM Eastern Daylight Time	08/02/2019 12:47:20 PM Eastern Daylight Time	07/31/2019 11:46:12 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	1	2		1			H2320	29	4	2020	68 lower peninsula Michigan counties	Region 4	2	22702	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	29	5	1	2	1	H2320_029_5	8	1			07/12/2019	2020.01	07/12/2019 02:06:37 PM Eastern Daylight Time	08/02/2019 12:50:32 PM Eastern Daylight Time	07/31/2019 11:46:42 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	1	2		1			H2320	29	5	2020	68 lower peninsula Michigan counties	Region 5	2	42295	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	802	0	1	2	1	H2320_802_0	6	1			07/11/2019	2020.01	07/11/2019 10:11:56 AM Eastern Daylight Time					07/12/2019 05:18:23 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG Non-Calendar Year (HMO-POS)	1	2		1			H2320	802	0	2020	National		1	5530	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	803	0	1	2	1	H2320_803_0	6	1			07/12/2019	2020.01	07/12/2019 12:39:59 PM Eastern Daylight Time					07/12/2019 05:18:23 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG Calendar Year (HMO-POS)	1	2		1			H2320	803	0	2020	National		1	236194	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	804	0	1	1	1	H2320_804_0	6	1			07/11/2019	2020.01	07/11/2019 10:34:55 AM Eastern Daylight Time					07/12/2019 05:18:23 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG HMO w PD Non-Cal Year (HMO)	1	1		1			H2320	804	0	2020	State of Michigan		1	352	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	805	0	1	1	1	H2320_805_0	6	1			07/11/2019	2020.01	07/11/2019 10:35:35 AM Eastern Daylight Time					07/12/2019 05:18:23 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG HMO w PD Cal Year (HMO)	1	1		1			H2320	805	0	2020	State of Michigan		1	6621	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2320	810	0	1	1	1	H2320_810_0	6	1			07/11/2019	2020.01	07/11/2019 10:36:08 AM Eastern Daylight Time					07/12/2019 05:18:23 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG HMO Cal Year (HMO) (HMO)	1	1		1			H2320	810	0	2020	State of Michigan		1	3	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2320	811	0	1	1	1	H2320_811_0	6	1			07/11/2019	2020.01	07/11/2019 10:36:27 AM Eastern Daylight Time					07/12/2019 05:18:23 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG HMO Non-Cal Year (HMO) (HMO)	1	1		1			H2320	811	0	2020	State of Michigan		1	3	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2320	812	0	1	2	1	H2320_812_0	6	1			07/11/2019	2020.01	07/11/2019 10:36:54 AM Eastern Daylight Time					07/12/2019 05:18:23 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare HMO-POS No RX EGWP Calendar (HMO-POS)	1	2		1			H2320	812	0	2020	National		1	3	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2320	813	0	1	2	1	H2320_813_0	6	1			07/11/2019	2020.01	07/11/2019 10:37:21 AM Eastern Daylight Time					07/12/2019 05:18:23 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare HMO-POS No RX EGWP Non-Calendar (HMO-POS)	1	2		1			H2320	813	0	2020	National		1	3	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2322	4	0	1	4	1	H2322_004_0	8	1			08/08/2019	2020.01	08/08/2019 01:10:02 PM Eastern Daylight Time	08/06/2019 01:01:38 PM Eastern Daylight Time	08/06/2019 01:01:38 PM Eastern Daylight Time			08/08/2019 01:11:37 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	HAP Senior Plus (PPO)	www.hap.org/medicare	HAP Senior Plus Option 4 (PPO)	1	4		1			H2322	4	0	2020	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	8	0	1	4	1	H2322_008_0	7	1			07/09/2019	2020.01	07/09/2019 02:46:17 PM Eastern Daylight Time	08/06/2019 01:01:39 PM Eastern Daylight Time	08/06/2019 01:01:40 PM Eastern Daylight Time			08/06/2019 02:16:35 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	HAP Senior Plus (PPO)	www.hap.org/medicare	HAP Senior Plus Option 3 (PPO)	1	4		1			H2322	8	0	2020	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	11	0	1	4	1	H2322_011_0	7	1			08/02/2019	2020.01	08/02/2019 09:38:36 AM Eastern Daylight Time	08/06/2019 01:01:41 PM Eastern Daylight Time	08/06/2019 01:01:42 PM Eastern Daylight Time			08/06/2019 02:16:35 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	HAP Senior Plus (PPO)	www.hap.org/medicare	HAP Senior Plus Option 1 (PPO)	1	4		1			H2322	11	0	2020	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	12	0	1	4	1	H2322_012_0	7	1			07/09/2019	2020.01	07/09/2019 02:47:39 PM Eastern Daylight Time	08/06/2019 01:01:44 PM Eastern Daylight Time	08/06/2019 01:01:44 PM Eastern Daylight Time			08/06/2019 02:16:35 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	HAP Senior Plus (PPO)	www.hap.org/medicare	HAP Senior Plus Option 2 (PPO)	1	4		1			H2322	12	0	2020	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2322	801	0	1	4	1	H2322_801_0	4	1			06/01/2019	2020.01	06/01/2019 12:23:57 AM Eastern Daylight Time					06/01/2019 12:51:42 AM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	HAP Senior Plus (PPO)	www.hap.org/medicare	HAP Senior Plus Group (PPO)	1	4		1			H2322	801	0	2020	United States EG Area		1	0	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(833)923-1630		(833)923-1630										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H2322	803	0	1	4	1	H2322_803_0	4	1			06/01/2019	2020.01	06/01/2019 12:23:28 AM Eastern Daylight Time					06/01/2019 12:51:42 AM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	HAP Senior Plus (PPO)	www.hap.org/medicare	HAP Senior Plus Group (PPO)	1	4		1			H2322	803	0	2020	United States EG Area		1	130	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;	2		1									
H2334	1	0	1	4	1	H2334_001_0	9	1		1	08/02/2019	2020.01	08/02/2019 01:19:01 PM Central Daylight Time	08/05/2019 12:03:25 PM Central Daylight Time	08/05/2019 12:04:22 PM Central Daylight Time			08/05/2019 12:18:43 PM Central Daylight Time	"EON HEALTH, INC. (SC)"	Eon Health	www.eonhealthplan.com	EON GOLD (PPO C-SNP)	1	4		1			H2334	1	0	2020	Select South Carolina Counties		2	917	2			1	4			10		www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2334	3	0	1	4	1	H2334_003_0	9	1			08/02/2019	2020.01	08/02/2019 01:19:32 PM Central Daylight Time	08/05/2019 12:03:25 PM Central Daylight Time	08/05/2019 12:04:22 PM Central Daylight Time			08/05/2019 12:18:43 PM Central Daylight Time	"EON HEALTH, INC. (SC)"	Eon Health	www.eonhealthplan.com	EON CHOICE (PPO)	1	4		1			H2334	3	0	2020	Select South Carolina Counties		2	1107	2			2						www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2354	15	0	1	1	1	H2354_015_0	7	1			08/02/2019	2020.01	08/02/2019 11:42:29 AM Eastern Daylight Time	08/06/2019 01:01:46 PM Eastern Daylight Time	08/06/2019 01:01:46 PM Eastern Daylight Time			08/06/2019 02:16:35 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus (HMO)	1	1		1			H2354	15	0	2020	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	18	0	1	1	1	H2354_018_0	6	1			07/09/2019	2020.01	07/09/2019 02:40:55 PM Eastern Daylight Time	08/06/2019 01:01:47 PM Eastern Daylight Time	08/06/2019 01:01:48 PM Eastern Daylight Time			08/06/2019 02:16:35 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus Henry Ford Tiered Access (HMO)	1	1		1			H2354	18	0	2020	"Wayne, Oakland and Macomb counties"		2	136200	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	3-1;3-2;3-3;5;7a;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7k;8a1;8b1;8b2;8b3;9a1;9a2;9b;9c;11a;11b1;11b2;11c1;11c2;12;16b;17a;18a;	
H2354	19	0	1	1	1	H2354_019_0	5	1			07/09/2019	2020.01	07/09/2019 03:29:30 PM Eastern Daylight Time	05/31/2019 03:36:32 PM Eastern Daylight Time				07/09/2019 04:12:04 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus Medical Only (HMO)	1	1		1			H2354	19	0	2020	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(833)923-1630		(833)923-1630										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2354	21	0	1	2	1	H2354_021_0	6	1			08/05/2019	2020.01	08/05/2019 01:36:52 PM Eastern Daylight Time	08/06/2019 01:01:50 PM Eastern Daylight Time	08/06/2019 01:01:53 PM Eastern Daylight Time			08/06/2019 02:16:35 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus Option 1 (HMO-POS)	1	2		1			H2354	21	0	2020	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	22	0	1	2	1	H2354_022_0	6	1			07/09/2019	2020.01	07/09/2019 03:31:28 PM Eastern Daylight Time	08/06/2019 01:01:51 PM Eastern Daylight Time	08/06/2019 01:01:52 PM Eastern Daylight Time			08/06/2019 02:16:35 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus Option 2 (HMO-POS)	1	2		1			H2354	22	0	2020	Mid and Southeast Michigan Counties		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	24	0	1	1	1	H2354_024_0	6	1			08/02/2019	2020.01	08/02/2019 09:31:46 AM Eastern Daylight Time	08/06/2019 01:01:54 PM Eastern Daylight Time	08/06/2019 01:01:54 PM Eastern Daylight Time			08/06/2019 02:16:35 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Primary Choice Medicare (HMO)	1	1		1			H2354	24	0	2020	"Counties: HIL, JAC, LIV, MAC, OAK, WAS, WAY"		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(866)766-4714		(313)664-0444		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(800)868-3153		(313)664-0444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	25	0	1	1	1	H2354_025_0	7	1	2	1	08/02/2019	2020.01	08/02/2019 09:36:06 AM Eastern Daylight Time	08/06/2019 01:01:56 PM Eastern Daylight Time	08/06/2019 01:01:57 PM Eastern Daylight Time			08/06/2019 02:16:35 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Empowered Duals (HMO D-SNP)	1	1		1			H2354	25	0	2020	Genesee County		2		2			1	3		1		1	www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)848-4844		(810)230-2046		(833)923-1630		(833)923-1630		(844)818-9036		(844)818-9036		(800)868-3153		(810)230-2046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	26	0	1	1	1	H2354_026_0	6	1			08/02/2019	2020.01	08/02/2019 09:33:04 AM Eastern Daylight Time	08/06/2019 01:01:58 PM Eastern Daylight Time	08/06/2019 01:01:58 PM Eastern Daylight Time			08/06/2019 02:16:35 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Choice Medicare - Option 1 (HMO)	1	1		1			H2354	26	0	2020	"Counties:  KEN, MUS, OCE, OTT"		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(866)766-4714		(313)664-0444		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(800)868-3153		(313)664-0444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	27	0	1	1	1	H2354_027_0	6	1			07/09/2019	2020.01	07/09/2019 03:38:18 PM Eastern Daylight Time	08/06/2019 01:02:00 PM Eastern Daylight Time	08/06/2019 01:02:00 PM Eastern Daylight Time			08/06/2019 02:16:35 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Choice Medicare - Option 2 (HMO)	1	1		1			H2354	27	0	2020	"Counties:  KEN, MUS, OCE, OTT"		2		2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(866)766-4714		(313)664-0444		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(800)868-3153		(313)664-0444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2354	801	0	1	1	1	H2354_801_0	4	1			06/01/2019	2020.01	06/01/2019 12:24:31 AM Eastern Daylight Time					06/01/2019 12:51:42 AM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus Group (HMO)	1	1		1			H2354	801	0	2020	United States EG Area		1	315931	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(833)923-1630		(833)923-1630										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2354	802	0	1	2	1	H2354_802_0	4	1			06/01/2019	2020.01	06/01/2019 12:46:00 AM Eastern Daylight Time					06/01/2019 12:51:42 AM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/medicare	HAP Senior Plus Group (HMO-POS)	1	2		1			H2354	802	0	2020	United States EG Area		1	28519	2			2						www.hap.org/medicare	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(833)923-1630		(833)923-1630		(877)797-9697		(877)797-9697		(800)868-3153		(800)868-3153		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1				
H2386	1	0	1	20	8	H2386_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:07:14 PM Eastern Daylight Time		05/20/2019 12:32:11 PM Eastern Daylight Time			05/22/2019 01:13:53 PM Eastern Daylight Time	"APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC."	"Appalachian Agency for Senior Citizens, Inc,"	www.allcareforseniors.org	AllCARE for Seniors - Duals (PACE)	8	20		1			H2386	1	0	2020	"Counties:  Buchanan, Dickenson, Russell, Tazewell"		2		2			2						www.seniorscript.com	www.aasc.org										(866)828-7723		(276)964-7176		(866)828-7723		(276)964-7176										(800)656-2272		(276)964-5765		(800)656-2272		(276)964-5765																
H2386	2	0	1	20	8	H2386_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:08:59 PM Eastern Daylight Time		05/20/2019 12:32:00 PM Eastern Daylight Time			05/22/2019 01:13:53 PM Eastern Daylight Time	"APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC."	"Appalachian Agency for Senior Citizens, Inc,"	www.allcareforseniors.org	AllCARE for Seniors - Medicare only (PACE)	8	20		1			H2386	2	0	2020	"Counties:  Buchanan, Dickenson, Russell, Tazewell"		2		2			2						www.seniorscript.com	www.aasc.org										(866)828-7723		(276)964-7176		(866)828-7723		(276)964-7176										(800)656-2272		(276)964-5765		(800)656-2272		(276)964-5765																
H2392	1	0	1	1	1	H2392_001_0	3	1		1	08/05/2019	2020.01	08/05/2019 04:41:09 PM Central Daylight Time	08/01/2019 02:16:50 PM Central Daylight Time	07/30/2019 05:10:06 PM Central Daylight Time			08/05/2019 04:51:13 PM Central Daylight Time	"KANSAS SUPERIOR SELECT, INC."	Kansas Health Advantage	www.kansashealthadvantage.com	Kansas Health Advantage (HMO I-SNP)	1	1		1			H2392	1	0	2020	Central and East Kansas		2	7256	2			1	1	3				www.kansashealthadvantage.com	www.kansashealthadvantage.com	www.kansashealthadvantage.com	(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2	2			
H2392	2	0	1	1	1	H2392_002_0	3	1		1	05/31/2019	2020.01	05/31/2019 03:51:12 PM Central Daylight Time	08/01/2019 02:17:40 PM Central Daylight Time	07/30/2019 05:10:43 PM Central Daylight Time			08/05/2019 04:51:13 PM Central Daylight Time	"KANSAS SUPERIOR SELECT, INC."	Kansas Health Advantage	www.kansashealthadvantage.com	Kansas Health Advantage Plus (HMO I-SNP)	1	1		1			H2392	2	0	2020	Topeka and Wichita Areas		2	700	2			1	1	3				www.kansashealthadvantage.com	www.kansashealthadvantage.com	www.kansashealthadvantage.com	(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(800)399-7524		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2	2			
H2400	1	0	1	1	1	H2400_001_0	5	1		1	08/01/2019	2020.01	08/01/2019 11:38:05 AM Central Daylight Time	08/04/2019 10:06:24 PM Central Daylight Time	08/01/2019 08:47:03 PM Central Daylight Time			08/05/2019 02:03:16 PM Central Daylight Time	"SIGNATURE ADVANTAGE, LLC"	Signature Advantage (HMO SNP)	www.signatureadvantageplan.com	Signature Advantage (HMO I-SNP)	1	1		1			H2400	1	0	2020	KY (partial)		2	8298	2			1	1	1				www.signatureadvantageplan.com	www.signatureadvantageplan.com	www.signatureadvantageplan.com	(844)214-8633		(844)214-8633		(844)214-8633		(844)214-8633		(844)214-8633		(844)214-8633		(844)214-8633		(844)214-8633		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2400	2	0	1	1	1	H2400_002_0	6	1		1	08/01/2019	2020.01	08/01/2019 11:38:22 AM Central Daylight Time	08/01/2019 05:12:03 PM Central Daylight Time	08/01/2019 08:48:40 PM Central Daylight Time			08/05/2019 02:03:16 PM Central Daylight Time	"SIGNATURE ADVANTAGE, LLC"	Signature Advantage (HMO SNP)	www.signatureadvantageplan.com	Signature Advantage Community (HMO I-SNP)	1	1		1			H2400	2	0	2020	KY (partial)		2		2			1	1	2				www.signatureadvantageplan.com	www.signatureadvantageplan.com	www.signatureadvantageplan.com			(844)214-8633				(844)214-8633		(844)214-8633		(844)214-8633		(844)214-8633		(844)214-8633		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2406	1	0	1	4	1	H2406_001_0	2	1		1	08/02/2019	2020.01	08/02/2019 12:32:44 PM Central Daylight Time	08/02/2019 10:50:52 AM Central Daylight Time	07/30/2019 07:42:26 PM Central Daylight Time			08/05/2019 05:22:41 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (PPO I-SNP)	1	4		1			H2406	1	0	2020	Select Counties in Ohio		2		2			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			
H2406	8	0	1	4	1	H2406_008_0	2	1			08/05/2019	2020.01	08/05/2019 01:32:30 PM Central Daylight Time	08/02/2019 10:51:22 AM Central Daylight Time	07/30/2019 07:42:57 PM Central Daylight Time			08/06/2019 10:42:48 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2406	8	0	2020	Select Counties in the Pan Handle of Florida		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	9	0	1	4	1	H2406_009_0	2	1			08/05/2019	2020.01	08/05/2019 12:57:39 PM Central Daylight Time	08/02/2019 10:51:51 AM Central Daylight Time	07/30/2019 07:43:30 PM Central Daylight Time			08/06/2019 10:42:48 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2406	9	0	2020	Select counties in Southwest Florida		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	10	0	1	4	1	H2406_010_0	2	1			08/05/2019	2020.01	08/05/2019 12:57:52 PM Central Daylight Time	08/02/2019 10:52:21 AM Central Daylight Time	07/30/2019 07:44:01 PM Central Daylight Time			08/06/2019 10:42:48 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2406	10	0	2020	"Brevard, Orange, Osceola, and Seminole counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	11	0	1	4	1	H2406_011_0	2	1			08/05/2019	2020.01	08/05/2019 12:58:04 PM Central Daylight Time	08/02/2019 10:52:51 AM Central Daylight Time	07/30/2019 07:44:33 PM Central Daylight Time			08/06/2019 10:42:48 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2406	11	0	2020	Select counties in Tampa		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	12	0	1	4	1	H2406_012_0	3	1			08/05/2019	2020.01	08/05/2019 01:47:11 PM Central Daylight Time	08/02/2019 10:53:20 AM Central Daylight Time	07/30/2019 07:45:05 PM Central Daylight Time			08/06/2019 10:42:48 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2406	12	0	2020	Select Counties in Tallahassee		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	13	0	1	4	1	H2406_013_0	2	1			08/05/2019	2020.01	08/05/2019 12:59:35 PM Central Daylight Time	08/02/2019 10:53:50 AM Central Daylight Time	07/30/2019 07:45:39 PM Central Daylight Time			08/06/2019 10:42:48 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2406	13	0	2020	Select Counties in Jacksonville		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	14	0	1	4	1	H2406_014_0	2	1			08/05/2019	2020.01	08/05/2019 10:53:06 AM Central Daylight Time	08/02/2019 10:54:20 AM Central Daylight Time	07/30/2019 07:46:12 PM Central Daylight Time			08/06/2019 10:52:33 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2406	14	0	2020	Select Counties in Gainesville		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	15	0	1	4	1	H2406_015_0	2	1			08/02/2019	2020.01	08/02/2019 12:31:39 PM Central Daylight Time	08/02/2019 10:54:50 AM Central Daylight Time	07/30/2019 07:46:46 PM Central Daylight Time			08/06/2019 10:52:33 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2406	15	0	2020	Citrus and Levy Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	16	0	1	4	1	H2406_016_0	3	1			08/05/2019	2020.01	08/05/2019 10:53:32 AM Central Daylight Time	08/06/2019 11:27:32 AM Central Daylight Time	07/30/2019 07:47:20 PM Central Daylight Time			08/06/2019 12:07:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2406	16	0	2020	"Lake, Marion, and Sumter Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	17	0	1	4	1	H2406_017_0	2	1			08/05/2019	2020.01	08/05/2019 10:53:45 AM Central Daylight Time	08/02/2019 10:55:50 AM Central Daylight Time	07/30/2019 07:47:52 PM Central Daylight Time			08/06/2019 10:52:33 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2406	17	0	2020	Select Counties in St. Lucie		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	18	0	1	4	1	H2406_018_0	4	1			08/05/2019	2020.01	08/05/2019 10:54:05 AM Central Daylight Time	08/02/2019 10:56:20 AM Central Daylight Time	07/30/2019 07:48:23 PM Central Daylight Time			08/06/2019 10:52:33 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2406	18	0	2020	"Broward, Miami-Dade, and Palm Beach Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	19	0	1	4	1	H2406_019_0	3	1			08/05/2019	2020.01	08/05/2019 03:16:41 PM Central Daylight Time	08/02/2019 10:56:50 AM Central Daylight Time	07/30/2019 07:48:57 PM Central Daylight Time			08/06/2019 12:16:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2406	19	0	2020	"DeSoto, Hardee, and Highlands Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	20	0	1	4	1	H2406_020_0	3	1			08/02/2019	2020.01	08/02/2019 12:33:22 PM Central Daylight Time	08/02/2019 10:57:21 AM Central Daylight Time	07/30/2019 07:49:31 PM Central Daylight Time			08/06/2019 12:16:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Sync (PPO)	1	4		1			H2406	20	0	2020	Palm Beach County		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)876-6177		(844)876-6177		(800)555-5757		(800)555-5757		(844)876-6177		(844)876-6177		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2406	805	0	1	4	1	H2406_805_0	1	1			05/11/2019	2020.01	05/11/2019 09:47:56 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	805	0	2020	Nationwide		1	33948	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	806	0	1	4	1	H2406_806_0	1	1			05/22/2019	2020.01	05/22/2019 09:13:48 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	806	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	807	0	1	4	1	H2406_807_0	1	1			05/11/2019	2020.01	05/11/2019 10:15:17 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	807	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	808	0	2	4	1	H2406_808_0	1	1			05/11/2019	2020.01	05/11/2019 10:15:47 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2406	808	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	809	0	2	4	1	H2406_809_0	1	1			05/11/2019	2020.01	05/11/2019 10:16:06 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2406	809	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	810	0	2	4	1	H2406_810_0	1	1			05/11/2019	2020.01	05/11/2019 10:16:21 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2406	810	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	811	0	1	4	1	H2406_811_0	1	1			05/11/2019	2020.01	05/11/2019 10:16:39 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	811	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	812	0	1	4	1	H2406_812_0	1	1			05/11/2019	2020.01	05/11/2019 10:16:57 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	812	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	813	0	1	4	1	H2406_813_0	1	1			05/11/2019	2020.01	05/11/2019 10:17:15 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	813	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	814	0	1	4	1	H2406_814_0	1	1			05/11/2019	2020.01	05/11/2019 10:17:33 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	814	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	815	0	1	4	1	H2406_815_0	1	1			05/11/2019	2020.01	05/11/2019 10:17:54 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	815	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	816	0	2	4	1	H2406_816_0	1	1			05/11/2019	2020.01	05/11/2019 10:18:13 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2406	816	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	817	0	2	4	1	H2406_817_0	1	1			05/11/2019	2020.01	05/11/2019 10:18:34 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2406	817	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	818	0	2	4	1	H2406_818_0	1	1			05/11/2019	2020.01	05/11/2019 10:18:51 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2406	818	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	819	0	1	4	1	H2406_819_0	1	1			05/11/2019	2020.01	05/11/2019 10:19:13 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	819	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	820	0	1	4	1	H2406_820_0	1	1			05/11/2019	2020.01	05/11/2019 10:19:29 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	820	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	821	0	1	4	1	H2406_821_0	1	1			05/11/2019	2020.01	05/11/2019 10:19:47 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	821	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	822	0	1	4	1	H2406_822_0	1	1			05/11/2019	2020.01	05/11/2019 10:20:04 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	822	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	823	0	1	4	1	H2406_823_0	1	1			05/11/2019	2020.01	05/11/2019 10:20:22 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	823	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	824	0	1	4	1	H2406_824_0	1	1			05/11/2019	2020.01	05/11/2019 10:20:47 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	824	0	2020	Select Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	825	0	1	4	1	H2406_825_0	1	1			05/11/2019	2020.01	05/11/2019 10:21:40 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	825	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	826	0	1	4	1	H2406_826_0	1	1			05/11/2019	2020.01	05/11/2019 10:21:57 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	826	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	827	0	1	4	1	H2406_827_0	1	1			05/11/2019	2020.01	05/11/2019 10:22:32 AM Eastern Daylight Time					06/03/2019 07:30:53 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	827	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	828	0	2	4	1	H2406_828_0	1	1			05/11/2019	2020.01	05/11/2019 10:22:48 AM Eastern Daylight Time					06/03/2019 07:34:51 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		2	2		H2406	828	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	829	0	1	4	1	H2406_829_0	1	1			05/11/2019	2020.01	05/11/2019 10:23:13 AM Eastern Daylight Time					06/03/2019 07:34:51 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	829	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	830	0	1	4	1	H2406_830_0	1	1			05/11/2019	2020.01	05/11/2019 10:23:32 AM Eastern Daylight Time					06/03/2019 07:34:51 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	830	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	831	0	1	4	1	H2406_831_0	1	1			05/11/2019	2020.01	05/11/2019 10:23:52 AM Eastern Daylight Time					06/03/2019 07:34:51 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	831	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	832	0	1	4	1	H2406_832_0	1	1			05/11/2019	2020.01	05/11/2019 10:24:11 AM Eastern Daylight Time					06/03/2019 07:34:51 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	832	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	833	0	1	4	1	H2406_833_0	1	1			05/11/2019	2020.01	05/11/2019 10:24:40 AM Eastern Daylight Time					06/03/2019 07:34:51 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	833	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	834	0	1	4	1	H2406_834_0	1	1			05/11/2019	2020.01	05/11/2019 10:24:58 AM Eastern Daylight Time					06/03/2019 07:34:51 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	834	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2406	835	0	1	4	1	H2406_835_0	1	1			06/03/2019	2020.01	06/03/2019 08:04:30 AM Eastern Daylight Time					06/03/2019 08:05:30 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (PPO)	1	4		1			H2406	835	0	2020	Nationwide		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1									
H2416	1	0	1	1	1	H2416_001_0	6	1	2	1	09/18/2019	2020.01	09/18/2019 10:14:39 AM Central Daylight Time	09/18/2019 10:57:22 AM Central Daylight Time	09/18/2019 11:04:32 AM Central Daylight Time			09/18/2019 11:10:54 AM Central Daylight Time	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	PrimeWest Health	www.primewest.org/pwshc	PrimeWest Senior Health Complete (HMO D-SNP)	1	1		1			H2416	1	0	2020	"Northern, west central, and southwestern Minnesota"		2	23136	2			1	3		1		1	https://primewest.org/drug-search	https://primewest.org/pharmacy-search	https://www.primewest.org/find-a-health-care-provider	(800)366-2906		(320)335-5243		(800)366-2906		(320)335-5243		(800)366-2906		(320)335-5243		(800)366-2906		(320)335-5243		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H2417	1	0	1	1	1	H2417_001_0	3	1	2	1	05/31/2019	2020.01	05/31/2019 01:46:43 PM Central Daylight Time	08/05/2019 04:50:50 PM Central Daylight Time	08/05/2019 04:41:42 PM Central Daylight Time			08/05/2019 04:54:50 PM Central Daylight Time	ITASCA MEDICAL CARE	Itasca Medical Care/IMCare Classic	www.imcare.org	IMCare Classic (HMO D-SNP)	1	1		1			H2417	1	0	2020	Itasca County		2	5520	2			1	3		1		1	http://www.caremark.com/wps/portal	http://www.imcare.org	http://www.imcare.org	(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	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7f;7g;7h;7i;9b;9c;9d;10a;11a;11b;11c;12;18a;	1	1b;2;5;6;7c;7d;7e;7f;7g;7h;7i;9b;9c;9d;12;18a;	1					1				
H2419	1	0	1	1	1	H2419_001_0	5	1	2	1	07/11/2019	2020.01	07/11/2019 04:55:05 PM Central Daylight Time	07/31/2019 11:12:34 AM Central Daylight Time	07/31/2019 11:20:40 AM Central Daylight Time			07/31/2019 11:28:27 AM Central Daylight Time	SOUTH COUNTRY HEALTH ALLIANCE	South Country Health Alliance	www.mnscha.org	SeniorCare Complete (HMO D-SNP)	1	1		1			H2419	1	0	2020	Select Counties in Minnesota		2	20494	1	1		1	3		1		1	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	2			
H2422	2	0	1	1	1	H2422_002_0	7	1	2	1	08/06/2019	2020.01	08/06/2019 03:49:16 PM Central Daylight Time	08/06/2019 02:44:58 PM Central Daylight Time	08/06/2019 02:24:16 PM Central Daylight Time			08/06/2019 03:50:25 PM Central Daylight Time	"HEALTHPARTNERS, INC."	HealthPartners	healthpartners.com/msho	HealthPartners Minnesota Senior Health Options (HMO D-SNP)	1	1		1			H2422	2	0	2020	Minneapolis/St. Paul Metro Area		2	48408	2			1	3		1		1	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2425	1	0	1	1	1	H2425_001_0	8	1	2	1	09/13/2019	2020.01	09/13/2019 03:14:21 PM Central Daylight Time	09/12/2019 12:19:34 PM Central Daylight Time	07/30/2019 04:43:00 PM Central Daylight Time			09/13/2019 03:15:07 PM Central Daylight Time	BLUE PLUS	Blue Plus	www.bluecrossmn.com/secureblue	SecureBlue (HMO D-SNP)	1	1		1			H2425	1	0	2020	62 Counties within the State of Minnesota		2	94640	2			1	3		1		1	www.myprime.com	www.myprime.com	www.bluecrossmn.com/secureblue			(888)740-6013				(866)477-1584		(888)877-6424		(888)877-6424		(866)477-1584		(866)477-1584		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2446	1	0	1	2	1	H2446_001_0	3	1			06/01/2019	2020.01	06/01/2019 07:24:19 AM Central Daylight Time	07/31/2019 01:09:12 PM Central Daylight Time	07/30/2019 04:43:38 PM Central Daylight Time			08/01/2019 01:32:44 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Strive Medicare Advantage Choice (HMO-POS)	1	2		1			H2446	1	0	2020	Eight County Metro		2	731	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(855)373-2583		(651)662-0407		(855)579-7658		(651)662-9949		(855)373-2583		(855)373-2583		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2446	2	0	1	2	1	H2446_002_0	3	1			06/01/2019	2020.01	06/01/2019 07:26:54 AM Central Daylight Time	07/31/2019 01:14:14 PM Central Daylight Time	07/30/2019 04:44:18 PM Central Daylight Time			08/01/2019 01:32:44 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Strive Medicare Advantage Complete (HMO-POS)	1	2		1			H2446	2	0	2020	Eight County Metro		2	443	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(855)373-2583		(651)662-0407		(855)579-7658		(651)662-9949		(855)373-2583		(855)373-2583		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	1	0	1	18	6	H2450_001_0	6	1			07/12/2019	2020.01	07/12/2019 03:55:46 PM Central Daylight Time		08/05/2019 03:55:14 PM Central Daylight Time			08/05/2019 04:23:56 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Basic w/Rx 2 (Cost)	6	18		1			H2450	1	0	2020	Select Counties in MN		2	18540	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	2	0	1	18	6	H2450_002_0	7	1			07/12/2019	2020.01	07/12/2019 03:56:08 PM Central Daylight Time		08/05/2019 03:55:14 PM Central Daylight Time			08/05/2019 04:23:56 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Enhanced w/Rx 2 (Cost)	6	18		1			H2450	2	0	2020	Select Counties in MN		2	15120	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	7	0	1	18	6	H2450_007_0	6	1			05/29/2019	2020.01	05/29/2019 11:51:36 AM Central Daylight Time		08/05/2019 03:55:15 PM Central Daylight Time			08/05/2019 04:23:56 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Thrift w/Rx (Cost)	6	18		1			H2450	7	0	2020	"All of SD, select MN, ND, and WI counties"		2	4188	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	16	0	1	18	6	H2450_016_0	7	1			07/12/2019	2020.01	07/12/2019 03:56:28 PM Central Daylight Time		08/05/2019 03:55:15 PM Central Daylight Time			08/05/2019 04:23:56 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Basic w/Rx (Cost)	6	18		1			H2450	16	0	2020	Select Counties in MN		2	35700	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	17	0	1	18	6	H2450_017_0	7	1			07/12/2019	2020.01	07/12/2019 03:56:56 PM Central Daylight Time		08/05/2019 03:55:15 PM Central Daylight Time			08/05/2019 04:23:56 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Enhanced w/Rx (Cost)	6	18		1			H2450	17	0	2020	Select Counties in MN		2	9096	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	22	0	1	18	6	H2450_022_0	7	1			07/12/2019	2020.01	07/12/2019 03:57:19 PM Central Daylight Time		08/05/2019 03:55:16 PM Central Daylight Time			08/05/2019 04:23:56 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Value w/Rx (Cost)	6	18		1			H2450	22	0	2020	Select Counties in MN		2	5496	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	30	0	1	18	6	H2450_030_0	2	1			05/24/2019	2020.01	05/24/2019 09:44:21 AM Central Daylight Time					05/28/2019 03:27:21 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Thrift (Cost)	6	18		1			H2450	30	0	2020	"All of SD, select MN, ND, WI, IA, and NE counties"		2	7392	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	31	0	1	18	6	H2450_031_0	3	1			07/12/2019	2020.01	07/12/2019 03:57:53 PM Central Daylight Time					07/12/2019 04:17:51 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Value (Cost)	6	18		1			H2450	31	0	2020	Select Counties in MN		2	5784	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	32	0	1	18	6	H2450_032_0	3	1			07/12/2019	2020.01	07/12/2019 03:58:12 PM Central Daylight Time					07/12/2019 04:17:51 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Basic (Cost)	6	18		1			H2450	32	0	2020	Select Counties in MN		2	35388	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	33	0	1	18	6	H2450_033_0	3	1			07/12/2019	2020.01	07/12/2019 03:58:39 PM Central Daylight Time					07/12/2019 04:17:51 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Enhanced (Cost)	6	18		1			H2450	33	0	2020	Select Counties in MN		2	16272	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	34	0	1	18	6	H2450_034_0	3	1			07/12/2019	2020.01	07/12/2019 03:58:55 PM Central Daylight Time					07/12/2019 04:17:51 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core (Cost)	6	18		1			H2450	34	0	2020	"All of SD, plus select counties in ND"		2	314472	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	35	0	1	18	6	H2450_035_0	7	1			07/12/2019	2020.01	07/12/2019 03:59:23 PM Central Daylight Time		08/05/2019 03:55:16 PM Central Daylight Time			08/05/2019 04:23:56 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core w/Rx (Cost)	6	18		1			H2450	35	0	2020	"All of SD, plus select counties in ND"		2	51720	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	36	0	1	18	6	H2450_036_0	3	1			07/12/2019	2020.01	07/12/2019 03:59:46 PM Central Daylight Time					07/12/2019 04:17:51 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier (Cost)	6	18		1			H2450	36	0	2020	"All of SD, plus select counties in ND"		2	120012	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	37	0	1	18	6	H2450_037_0	7	1			07/12/2019	2020.01	07/12/2019 04:00:07 PM Central Daylight Time		08/05/2019 03:55:17 PM Central Daylight Time			08/05/2019 04:23:56 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier w/Rx (Cost)	6	18		1			H2450	37	0	2020	"All of SD, plus select counties in ND"		2	13476	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	38	0	1	18	6	H2450_038_0	3	1			07/12/2019	2020.01	07/12/2019 04:00:25 PM Central Daylight Time					07/12/2019 04:17:51 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Focus (Cost)	6	18		1			H2450	38	0	2020	Select counties in WI		2	156276	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	39	0	1	18	6	H2450_039_0	7	1			07/12/2019	2020.01	07/12/2019 04:00:49 PM Central Daylight Time		08/05/2019 03:55:17 PM Central Daylight Time			08/05/2019 04:23:56 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Focus w/Rx (Cost)	6	18		1			H2450	39	0	2020	Select counties in WI		2	83604	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	40	0	1	18	6	H2450_040_0	3	1			07/12/2019	2020.01	07/12/2019 04:01:07 PM Central Daylight Time					07/12/2019 04:17:51 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Total (Cost)	6	18		1			H2450	40	0	2020	Select counties in WI		2	29796	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	41	0	1	18	6	H2450_041_0	7	1			07/12/2019	2020.01	07/12/2019 04:01:40 PM Central Daylight Time		08/05/2019 03:55:18 PM Central Daylight Time			08/05/2019 04:23:56 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Total w/Rx (Cost)	6	18		1			H2450	41	0	2020	Select counties in WI		2	22488	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2450	42	0	1	18	6	H2450_042_0	3	1			07/12/2019	2020.01	07/12/2019 04:02:06 PM Central Daylight Time					07/12/2019 04:17:51 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier (Cost)	6	18		1			H2450	42	0	2020	Select counties in Iowa		2	540	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	43	0	1	18	6	H2450_043_0	3	1			07/12/2019	2020.01	07/12/2019 04:02:31 PM Central Daylight Time					07/12/2019 04:17:51 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Premier (Cost)	6	18		1			H2450	43	0	2020	Select counties in Nebraska		2	480	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	44	0	1	18	6	H2450_044_0	3	1			07/12/2019	2020.01	07/12/2019 04:02:52 PM Central Daylight Time					07/12/2019 04:17:51 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Standard (Cost)	6	18		1			H2450	44	0	2020	Select counties in MN		2	204	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	45	0	1	18	6	H2450_045_0	3	1			07/12/2019	2020.01	07/12/2019 04:03:18 PM Central Daylight Time					07/12/2019 04:17:51 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core (Cost)	6	18		1			H2450	45	0	2020	Select counties in IA		2	600	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	46	0	1	18	6	H2450_046_0	2	1			07/12/2019	2020.01	07/12/2019 04:03:48 PM Central Daylight Time					07/12/2019 04:17:51 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Prime Solution Core (Cost)	6	18		1			H2450	46	0	2020	Select counties in NE		2	600	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2450	801	0	1	18	6	H2450_801_0	2	1			05/22/2019	2020.01	05/22/2019 09:37:50 AM Central Daylight Time					05/28/2019 03:27:21 PM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica	medica.com	Medica Group Prime Solution w/Rx (Cost)	6	18		1			H2450	801	0	2020	"All of SD, select MN, ND, WI, IA, and NE counties"		1	16836	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)575-2330		(952)992-2330		(800)906-5432		(952)992-2345		(800)575-2330		(952)992-2330		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2456	2	0	1	1	1	H2456_002_0	6	1	2	1	08/12/2019	2020.01	08/12/2019 11:42:36 AM Central Daylight Time	08/06/2019 11:18:01 AM Central Daylight Time	07/31/2019 10:15:55 AM Central Daylight Time			08/12/2019 11:43:26 AM Central Daylight Time	UCARE MINNESOTA	UCare's MSHO	www.ucare.org	UCare's Minnesota Senior Health Options (HMO D-SNP)	1	1		1			H2456	2	0	2020	Twin Cities Metropolitan area and Greater MN		2		2			1	3		1		1	www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2458	2	0	1	1	1	H2458_002_0	13	1	2	1	09/18/2019	2020.01	09/18/2019 08:11:31 AM Central Daylight Time	09/12/2019 09:45:09 AM Central Daylight Time	08/01/2019 09:48:46 AM Central Daylight Time			09/18/2019 11:08:49 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica DUAL Solution (HMO D-SNP)	1	1		1			H2458	2	0	2020	Specific Minnesota counties		2		2			1	3		1		1	medica.com/Members	medica.com/Members	medica.com/Members	(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2459	1	0	1	2	1	H2459_001_0	3	1			05/30/2019	2020.01	05/30/2019 04:37:58 PM Central Daylight Time	06/03/2019 04:19:50 PM Central Daylight Time				06/03/2019 05:10:10 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Value (HMO-POS)	1	2		1			H2459	1	0	2020	State of Minnesota		2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2459	20	0	1	2	1	H2459_020_0	3	1			08/05/2019	2020.01	08/05/2019 05:19:46 PM Central Daylight Time	08/06/2019 02:11:08 PM Central Daylight Time	07/31/2019 10:28:39 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Prime (HMO-POS)	1	2		1			H2459	20	0	2020	Twin Cities Metropolitan Area		2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2459	21	1	1	2	1	H2459_021_1	5	1			08/05/2019	2020.01	08/05/2019 05:32:17 PM Central Daylight Time	08/06/2019 02:43:12 PM Central Daylight Time	07/31/2019 10:38:11 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Classic (HMO-POS)	1	2		1			H2459	21	1	2020	44 Counties	Twin Cities Metropolitan Area	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2459	21	2	1	2	1	H2459_021_2	4	1			08/05/2019	2020.01	08/05/2019 05:31:30 PM Central Daylight Time	08/06/2019 02:26:05 PM Central Daylight Time	07/31/2019 10:37:12 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Classic (HMO-POS)	1	2		1			H2459	21	2	2020	44 Counties	Northern Minnesota	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2459	21	3	1	2	1	H2459_021_3	5	1			08/05/2019	2020.01	08/05/2019 05:33:53 PM Central Daylight Time	08/06/2019 02:31:22 PM Central Daylight Time	07/31/2019 10:35:48 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Classic (HMO-POS)	1	2		1			H2459	21	3	2020	44 Counties	Southern Minnesota	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2459	23	1	1	2	1	H2459_023_1	4	1			08/05/2019	2020.01	08/05/2019 05:28:10 PM Central Daylight Time	08/06/2019 02:35:41 PM Central Daylight Time	07/31/2019 10:40:16 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Essentials Rx (HMO-POS)	1	2		1			H2459	23	1	2020	46 Counties	Twin Cities Metropolitan Area	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2459	23	2	1	2	1	H2459_023_2	4	1			08/05/2019	2020.01	08/05/2019 05:28:49 PM Central Daylight Time	08/06/2019 02:40:04 PM Central Daylight Time	07/31/2019 10:39:14 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Essentials Rx (HMO-POS)	1	2		1			H2459	23	2	2020	46 Counties	Northern Minnesota	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2459	24	0	1	2	1	H2459_024_0	3	1			08/05/2019	2020.01	08/05/2019 05:21:40 PM Central Daylight Time	08/06/2019 01:49:10 PM Central Daylight Time	07/31/2019 10:30:21 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Standard (HMO-POS)	1	2		1			H2459	24	0	2020	Southern Minnesota		2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2459	25	1	1	2	1	H2459_025_1	4	1			05/30/2019	2020.01	05/30/2019 02:28:55 PM Central Daylight Time	08/05/2019 05:02:36 PM Central Daylight Time	07/31/2019 10:25:16 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Total (HMO-POS)	1	2		1			H2459	25	1	2020	State of Minnesota	Twin Cities Metropolitan Area	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2459	25	2	1	2	1	H2459_025_2	4	1			05/30/2019	2020.01	05/30/2019 02:29:10 PM Central Daylight Time	08/05/2019 05:05:07 PM Central Daylight Time	07/31/2019 10:24:14 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Total (HMO-POS)	1	2		1			H2459	25	2	2020	State of Minnesota	Northern Minnesota	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2459	25	3	1	2	1	H2459_025_3	4	1			05/30/2019	2020.01	05/30/2019 02:29:22 PM Central Daylight Time	08/05/2019 05:07:20 PM Central Daylight Time	07/31/2019 10:23:02 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Total (HMO-POS)	1	2		1			H2459	25	3	2020	State of Minnesota	Southern Minnesota	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2459	26	1	1	2	1	H2459_026_1	3	1			08/05/2019	2020.01	08/05/2019 05:24:30 PM Central Daylight Time	08/06/2019 02:37:20 PM Central Daylight Time	07/31/2019 10:27:36 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Complete (HMO-POS)	1	2		1			H2459	26	1	2020	State of Minnesota	Twin Cities Metropolitan Area	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2459	26	3	1	2	1	H2459_026_3	4	1			08/05/2019	2020.01	08/05/2019 05:25:02 PM Central Daylight Time	08/06/2019 02:43:26 PM Central Daylight Time	07/31/2019 10:26:23 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Complete (HMO-POS)	1	2		1			H2459	26	3	2020	State of Minnesota	Greater Minnesota	2		2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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	2			
H2459	801	0	1	2	1	H2459_801_0	1	1			06/03/2019	2020.01	06/03/2019 11:54:00 AM Central Daylight Time					06/03/2019 11:54:52 AM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	Group UCare (HMO-POS)	1	2		1			H2459	801	0	2020	Minnesota and 26 Wisconsin Counties		1	71196	2			2						www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(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		2					2					2	2			
H2461	5	0	1	18	6	H2461_005_0	2	1			08/26/2019	2020.01	08/26/2019 07:32:17 AM Central Daylight Time					08/26/2019 09:20:11 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Core Plan (Cost)	6	18		1			H2461	5	0	2020	21 County region		2	12382	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2461	6	0	1	18	6	H2461_006_0	2	1			08/26/2019	2020.01	08/26/2019 07:33:07 AM Central Daylight Time					08/26/2019 09:20:11 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Choice Plan (Cost)	6	18		1			H2461	6	0	2020	21 County Region		2	137862	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2461	7	0	1	18	6	H2461_007_0	3	1			08/26/2019	2020.01	08/26/2019 07:33:49 AM Central Daylight Time					08/26/2019 09:20:11 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Complete Plan (Cost)	6	18		1			H2461	7	0	2020	21 County region		2	214424	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2461	8	0	1	18	6	H2461_008_0	4	1			08/26/2019	2020.01	08/26/2019 07:32:45 AM Central Daylight Time		07/30/2019 04:44:56 PM Central Daylight Time			08/26/2019 09:26:15 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Core Plan with Rx (Cost)	6	18		1			H2461	8	0	2020	21 County Region		2	5219	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.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	2			
H2461	9	0	1	18	6	H2461_009_0	4	1			08/26/2019	2020.01	08/26/2019 07:33:29 AM Central Daylight Time		07/30/2019 04:45:32 PM Central Daylight Time			08/26/2019 09:26:15 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Choice Plan with Rx (Cost)	6	18		1			H2461	9	0	2020	21 County Region		2	76147	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.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	2			
H2461	10	0	1	18	6	H2461_010_0	6	1			08/26/2019	2020.01	08/26/2019 07:34:08 AM Central Daylight Time		07/30/2019 04:46:08 PM Central Daylight Time			08/26/2019 09:26:15 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmnonline.com	Platinum Blue Complete Plan with Rx (Cost)	6	18		1			H2461	10	0	2020	21 County Region		2	58548	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.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	2			
H2462	4	0	1	18	6	H2462_004_0	6	1			07/17/2019	2020.01	07/17/2019 05:29:04 PM Central Daylight Time					07/18/2019 11:45:59 AM Central Daylight Time	"GROUP HEALTH PLAN, INC. (MN)"	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Basic (Cost)	6	18		1			H2462	4	0	2020	"Select MN Counties, Duluth Area & Western WI"		2	480	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	10	0	1	18	6	H2462_010_0	8	1			07/17/2019	2020.01	07/17/2019 05:29:23 PM Central Daylight Time					07/18/2019 11:45:59 AM Central Daylight Time	"GROUP HEALTH PLAN, INC. (MN)"	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Ultimate (Cost)	6	18		1			H2462	10	0	2020	Select MN Counties Including the Duluth Area		2	2364	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	16	0	1	18	6	H2462_016_0	6	1			07/17/2019	2020.01	07/17/2019 05:31:38 PM Central Daylight Time					07/18/2019 11:45:59 AM Central Daylight Time	"GROUP HEALTH PLAN, INC. (MN)"	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Balance (Cost)	6	18		1			H2462	16	0	2020	"Select MN Counties, Duluth Area & Western WI"		2	29760	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	18	0	1	18	6	H2462_018_0	5	1			07/17/2019	2020.01	07/17/2019 05:30:58 PM Central Daylight Time					07/18/2019 11:45:59 AM Central Daylight Time	"GROUP HEALTH PLAN, INC. (MN)"	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Vital (Cost)	6	18		1			H2462	18	0	2020	"Select MN Counties, Duluth Area & Western WI"		2	16596	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	22	0	1	18	6	H2462_022_0	6	1			07/17/2019	2020.01	07/17/2019 05:32:16 PM Central Daylight Time					07/18/2019 11:45:59 AM Central Daylight Time	"GROUP HEALTH PLAN, INC. (MN)"	HealthPartners	healthpartners.com/medicare	HealthPartners Sanford Basic (Cost)	6	18		1			H2462	22	0	2020	"Sioux Falls, Watertown, Fargo, Jamestown, Bismarck"		2	36	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(800)233-9645		(800)247-7015		(800)247-7015										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	23	0	1	18	6	H2462_023_0	5	1			07/17/2019	2020.01	07/17/2019 05:32:39 PM Central Daylight Time					07/18/2019 11:45:59 AM Central Daylight Time	"GROUP HEALTH PLAN, INC. (MN)"	HealthPartners	healthpartners.com/medicare	HealthPartners Sanford Vital (Cost)	6	18		1			H2462	23	0	2020	"Sioux Falls, Watertown, Fargo, Jamestown, Bismarck"		2	6354	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(800)233-9645		(800)247-7015		(800)247-7015										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	24	0	1	18	6	H2462_024_0	5	1			07/17/2019	2020.01	07/17/2019 05:32:59 PM Central Daylight Time					07/18/2019 11:45:59 AM Central Daylight Time	"GROUP HEALTH PLAN, INC. (MN)"	HealthPartners	healthpartners.com/medicare	HealthPartners Sanford Active (Cost)	6	18		1			H2462	24	0	2020	"Sioux Falls, Watertown, Fargo, Jamestown, Bismarck"		2	6012	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(800)233-9645		(800)247-7015		(800)247-7015										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	25	0	1	18	6	H2462_025_0	6	1			08/06/2019	2020.01	08/06/2019 01:09:15 PM Central Daylight Time					08/07/2019 07:18:42 AM Central Daylight Time	"GROUP HEALTH PLAN, INC. (MN)"	HealthPartners	healthpartners.com/medicare	HealthPartners Sanford Ultimate (Cost)	6	18		1			H2462	25	0	2020	"Sioux Falls, Watertown, Fargo, Jamestown, Bismarck"		2	912	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(800)233-9645		(800)247-7015		(800)247-7015										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2462	801	0	1	18	6	H2462_801_0	2	1			05/29/2019	2020.01	05/29/2019 05:07:57 PM Central Daylight Time					05/31/2019 07:16:21 AM Central Daylight Time	"GROUP HEALTH PLAN, INC. (MN)"	HealthPartners	healthpartners.com/medicare	HealthPartners Retiree Group Calendar Year (Cost)	6	18		1			H2462	801	0	2020	"Select Counties in MN, WI, ND, and SD"		1	16848	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2462	802	0	1	18	6	H2462_802_0	2	1			05/29/2019	2020.01	05/29/2019 05:08:31 PM Central Daylight Time					05/31/2019 07:16:21 AM Central Daylight Time	"GROUP HEALTH PLAN, INC. (MN)"	HealthPartners	healthpartners.com/medicare	HealthPartners Retiree Group Non-Calendar Year (Cost)	6	18		1			H2462	802	0	2020	"Select Counties in MN, WI, ND, and SD"		1	0	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2463	1	0	1	1	1	H2463_001_0	3	1			08/01/2019	2020.01	08/01/2019 03:09:58 PM Eastern Daylight Time	08/04/2019 11:45:44 AM Eastern Daylight Time	08/02/2019 01:18:12 PM Eastern Daylight Time			08/05/2019 11:34:30 AM Eastern Daylight Time	"HUMANA HEALTH PLAN OF TEXAS, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H2463-001 (HMO)	1	1		1			H2463	1	0	2020	Pinal County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2463	2	0	1	1	1	H2463_002_0	3	1			05/21/2019	2020.01	05/21/2019 06:02:58 PM Eastern Daylight Time	08/04/2019 11:04:05 AM Eastern Daylight Time	08/02/2019 01:18:12 PM Eastern Daylight Time			08/05/2019 11:34:30 AM Eastern Daylight Time	"HUMANA HEALTH PLAN OF TEXAS, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H2463-002 (HMO)	1	1		1			H2463	2	0	2020	Yuma County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2463	801	0	1	1	1	H2463_801_0	1	1			05/29/2019	2020.01	05/29/2019 10:38:36 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH PLAN OF TEXAS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H2463	801	0	2020	Select counties in Arizona		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2463	802	0	1	1	1	H2463_802_0	1	1			05/29/2019	2020.01	05/29/2019 10:39:12 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH PLAN OF TEXAS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H2463	802	0	2020	Select counties in Arizona		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2463	803	0	1	1	1	H2463_803_0	1	1			05/29/2019	2020.01	05/29/2019 12:26:51 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH PLAN OF TEXAS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H2463	803	0	2020	Select counties in Arizona		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H2463	804	0	1	1	1	H2463_804_0	1	1			05/29/2019	2020.01	05/29/2019 12:28:09 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH PLAN OF TEXAS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H2463	804	0	2020	Select counties in Arizona		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H2486	3	0	1	1	1	H2486_003_0	5	1			08/01/2019	2020.01	08/01/2019 07:08:22 PM Eastern Daylight Time	08/04/2019 04:41:20 PM Eastern Daylight Time	08/02/2019 01:18:12 PM Eastern Daylight Time			08/05/2019 12:13:05 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF UTAH, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H2486-003 (HMO)	1	1		1			H2486	3	0	2020	"Davis, Salt Lake, Utah and Weber counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2486	801	0	1	1	1	H2486_801_0	1	1			05/29/2019	2020.01	05/29/2019 10:44:35 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF UTAH, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H2486	801	0	2020	Select counties in Utah		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2486	802	0	1	1	1	H2486_802_0	1	1			05/29/2019	2020.01	05/29/2019 10:45:17 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF UTAH, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H2486	802	0	2020	Select counties in Utah		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2486	805	0	1	1	1	H2486_805_0	1	1			05/29/2019	2020.01	05/29/2019 12:29:59 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF UTAH, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H2486	805	0	2020	Select counties in Utah		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H2486	806	0	1	1	1	H2486_806_0	1	1			05/29/2019	2020.01	05/29/2019 12:31:15 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF UTAH, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H2486	806	0	2020	Select counties in Utah		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H2491	4	0	1	1	1	H2491_004_0	5	1	2	1	07/11/2019	2020.01	07/11/2019 02:14:46 PM Eastern Daylight Time	08/02/2019 03:07:58 PM Eastern Daylight Time	07/30/2019 10:19:00 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	'Ohana Liberty (HMO D-SNP)	1	1		1			H2491	4	0	2020	Select counties in Hawaii		2	55611	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)457-7621		(877)457-7621		(800)265-8171		(800)265-8171		(877)457-7621		(877)457-7621		(800)265-8171		(800)265-8171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	6	0	1	1	1	H2491_006_0	7	1	2	1	07/16/2019	2020.01	07/16/2019 01:02:42 PM Eastern Daylight Time	08/02/2019 03:09:53 PM Eastern Daylight Time	07/30/2019 10:19:37 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H2491	6	0	2020	Select Counties in LA		2	55511	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	7	0	1	1	1	H2491_007_0	6	1			07/12/2019	2020.01	07/12/2019 12:33:09 PM Eastern Daylight Time	08/02/2019 05:58:29 AM Eastern Daylight Time	07/30/2019 10:20:12 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H2491	7	0	2020	Select Counties in LA		2	45954	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	8	0	1	1	1	H2491_008_0	7	1	2	1	07/11/2019	2020.01	07/11/2019 02:21:07 PM Eastern Daylight Time	08/02/2019 03:11:42 PM Eastern Daylight Time	07/30/2019 10:20:48 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H2491	8	0	2020	Select Counties in LA		2	27921	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	9	0	1	1	1	H2491_009_0	6	1			05/29/2019	2020.01	05/29/2019 10:38:41 AM Eastern Daylight Time	08/02/2019 06:01:47 AM Eastern Daylight Time	07/30/2019 10:21:24 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	'Ohana Value (HMO)	1	1		1			H2491	9	0	2020	Select counties in Hawaii		2	19534	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(888)505-1201		(888)505-1201		(800)265-8171		(800)265-8171		(888)505-1201		(888)505-1201		(800)265-8171		(800)265-8171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7a;7c;7d;7f;7g;7i;7k;8b3;16b;17a;18a;	
H2491	10	0	1	1	1	H2491_010_0	6	1			07/12/2019	2020.01	07/12/2019 12:33:44 PM Eastern Daylight Time	08/02/2019 06:03:29 AM Eastern Daylight Time	07/30/2019 10:22:00 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Compass (HMO)	1	1		1			H2491	10	0	2020	Selected Counties		2	22856	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	11	0	1	1	1	H2491_011_0	5	1	2	1	07/16/2019	2020.01	07/16/2019 01:21:49 PM Eastern Daylight Time	08/02/2019 03:13:29 PM Eastern Daylight Time	07/30/2019 10:22:36 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Freedom (HMO D-SNP)	1	1		1			H2491	11	0	2020	Select counties in LA		2	16300	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	12	0	1	1	1	H2491_012_0	6	1	2	1	07/16/2019	2020.01	07/16/2019 01:23:06 PM Eastern Daylight Time	08/02/2019 03:15:16 PM Eastern Daylight Time	07/30/2019 10:23:12 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Pinnacle (HMO D-SNP)	1	1		1			H2491	12	0	2020	Select counties in LA		2	16086	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	13	0	1	1	1	H2491_013_0	5	1			05/29/2019	2020.01	05/29/2019 07:52:38 PM Eastern Daylight Time	08/02/2019 03:16:45 PM Eastern Daylight Time	07/30/2019 10:23:47 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	'Ohana Plus (HMO)	1	1		1			H2491	13	0	2020	Select counties in Hawaii		2	78	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)457-7621		(877)457-7621		(800)265-8171		(800)265-8171		(877)457-7621		(877)457-7621		(800)265-8171		(800)265-8171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2491	14	0	1	1	1	H2491_014_0	6	1			07/17/2019	2020.01	07/17/2019 10:38:27 AM Eastern Daylight Time	08/02/2019 06:10:08 AM Eastern Daylight Time	07/30/2019 10:24:23 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Baton Rouge Preferred (HMO)	1	1		1			H2491	14	0	2020	Select counties in LA		2	7576	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7a;7c;7d;7f;7g;7i;8a1;8b1;9a1;9a2;9b;14e3;14e5;16b;17a;18a;	
H2506	1	0	1	48	5	H2506_001_0	3	1			08/07/2019	2020.01	08/07/2019 07:26:08 AM Central Daylight Time					08/07/2019 07:27:41 AM Central Daylight Time	"AETNA BETTER HEALTH, INC. (IL)"	Aetna Better Health Premier Plan	www.aetnabetterhealth.com/illinois	Aetna Better Health Premier Plan (Medicare-Medicaid Plan)	5	48		1			H2506	1	0	2020	Metro Chicago Area		2	86700	2			2						http://www.aetnabetterhealth.com/illinois	http://www.aetnabetterhealth.com/illinois	http://www.aetnabetterhealth.com/illinois	(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)-																
H2531	1	0	1	48	5	H2531_001_0	5	1			08/21/2019	2020.01	08/21/2019 04:37:08 PM Eastern Daylight Time					08/21/2019 04:58:18 PM Eastern Daylight Time	"UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC."	UnitedHealthcare Community Plan	www.uhccommunityplan.com	UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan)	5	48		1			H2531	1	0	2020	Select Counties in Ohio		2	12	2			2						www.optumrx.com	www.uhccommunityplan.com	www.uhccommunityplan.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)-																
H2533	1	0	1	48	5	H2533_001_0	4	1			05/31/2019	2020.01	05/31/2019 07:58:02 AM Pacific Daylight Time					05/31/2019 04:34:16 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)	5	48		1			H2533	1	0	2020	South Carolina		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)735-5831		(855)735-5831		(855)701-4887		(855)701-4887		(855)735-5831		(855)735-5831		(855)701-4887		(855)701-4887		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H2537	1	0	1	20	8	H2537_001_0	1	1			05/21/2019	2020.01	05/21/2019 08:12:19 AM Eastern Daylight Time		05/20/2019 09:41:03 AM Eastern Daylight Time			05/21/2019 08:14:30 AM Eastern Daylight Time	SPIRITRUST LUTHERAN LIFE	SpiriTrust Lutheran LIFE	www.spiritrustlutheranlife.org	SpiriTrust Lutheran LIFE - Dual (PACE)	8	20		1			H2537	1	0	2020	"Franklin, Cumberland, Perry Counties"		2		2			2						www.norlandavenuepharmacy.com	www.lifelutheranservices.org										(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	2	0	1	20	8	H2537_002_0	1	1			05/21/2019	2020.01	05/21/2019 08:13:00 AM Eastern Daylight Time		05/20/2019 09:40:34 AM Eastern Daylight Time			05/21/2019 08:14:30 AM Eastern Daylight Time	SPIRITRUST LUTHERAN LIFE	SpiriTrust Lutheran LIFE	www.spiritrustlutheranlife.org	SpiriTrust Lutheran LIFE  - Medicare Only (PACE)	8	20		1			H2537	2	0	2020	"Franklin, Cumberland, Perry Counties"		2		2			2						www.norlandavenuepharmacy.com	www.lifelutheranservices.org										(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	3	0	1	1	1	H2563_003_0	11	1			08/05/2019	2020.01	08/05/2019 11:59:52 AM Eastern Daylight Time	08/05/2019 03:41:18 PM Eastern Daylight Time	08/05/2019 01:35:48 PM Eastern Daylight Time			08/06/2019 11:20:02 AM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	1	1		1			H2563	3	0	2020	"Greater Hampton Roads, Virginia"		2	42854	2			2						www.optimahealth.com	www.optimahealth.com/medicare	HTTP://optimahealth.prismisp.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)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	4	0	1	1	1	H2563_004_0	9	1	2	1	07/02/2019	2020.01	07/02/2019 02:09:07 PM Eastern Daylight Time	08/05/2019 03:42:42 PM Eastern Daylight Time	08/05/2019 01:35:14 PM Eastern Daylight Time			08/06/2019 11:20:02 AM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Community Complete (HMO D-SNP)	1	1		1			H2563	4	0	2020	Virginia		2	24750	2			1	3		1		2	www.optimahealth.com	www.optimahealth.com/medicare	HTTP://optimahealth.prismisp.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)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	5	1	1	1	1	H2563_005_1	11	1			08/05/2019	2020.01	08/05/2019 12:00:04 PM Eastern Daylight Time	08/05/2019 03:47:39 PM Eastern Daylight Time	08/05/2019 01:34:37 PM Eastern Daylight Time			08/06/2019 11:20:02 AM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Prime (HMO)	1	1		1			H2563	5	1	2020	"Greater Hampton Roads, Virginia"	"Greater Hampton Roads, VA - Southside"	2	16383	2			2						www.optimahealth.com	www.optimahealth.com/medicare	http://optimahealth.prismisp.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)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	5	2	1	1	1	H2563_005_2	11	1			08/05/2019	2020.01	08/05/2019 12:00:18 PM Eastern Daylight Time	08/05/2019 03:50:36 PM Eastern Daylight Time	08/05/2019 01:33:58 PM Eastern Daylight Time			08/06/2019 11:20:02 AM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Prime (HMO)	1	1		1			H2563	5	2	2020	"Greater Hampton Roads, Virginia"	"Greater Hampton Roads, VA - Greater Peninsula"	2	5685	2			2						www.optimahealth.com	www.optimahealth.com/medicare	http://optimahealth.prismisp.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)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	8	0	1	1	1	H2563_008_0	9	1			08/05/2019	2020.01	08/05/2019 12:00:31 PM Eastern Daylight Time	08/05/2019 03:43:29 PM Eastern Daylight Time	08/05/2019 01:33:06 PM Eastern Daylight Time			08/06/2019 11:20:02 AM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	1	1		1			H2563	8	0	2020	Select Counties in Central and Northern VA		2	24855	2			2						www.optimahealth.com	www.optimahealth.com/medicare	http://optimahealth.prismisp.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)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	9	0	1	1	1	H2563_009_0	9	1			08/05/2019	2020.01	08/05/2019 12:00:44 PM Eastern Daylight Time	08/05/2019 03:44:17 PM Eastern Daylight Time	08/05/2019 01:32:26 PM Eastern Daylight Time			08/06/2019 11:20:02 AM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value (HMO)	1	1		1			H2563	9	0	2020	Halifax County and Surrounding Areas		2	9320	2			2						www.optimahealth.com	www.optimahealth.com/medicare	http://optimahealth.prismisp.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)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	12	0	1	1	1	H2563_012_0	8	1			08/05/2019	2020.01	08/05/2019 12:00:58 PM Eastern Daylight Time	08/05/2019 03:45:11 PM Eastern Daylight Time	08/05/2019 01:31:48 PM Eastern Daylight Time			08/06/2019 11:20:02 AM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Prime (HMO)	1	1		1			H2563	12	0	2020	Select Counties in Central and Northern VA		2	9270	2			2						www.optimahealth.com	www.optimahealth.com/medicare	http://optimahealth.prismisp.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)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	13	0	1	1	1	H2563_013_0	8	1			08/05/2019	2020.01	08/05/2019 12:01:10 PM Eastern Daylight Time	08/05/2019 03:45:58 PM Eastern Daylight Time	08/05/2019 01:31:07 PM Eastern Daylight Time			08/06/2019 11:20:02 AM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Prime (HMO)	1	1		1			H2563	13	0	2020	Halifax County and Surrounding Areas		2	3267	2			2						www.optimahealth.com	www.optimahealth.com/medicare	http://optimahealth.prismisp.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)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		(800)828-1140		(711)-		2					2					2	2			
H2563	14	0	1	1	1	H2563_014_0	8	1			07/02/2019	2020.01	07/02/2019 02:10:58 PM Eastern Daylight Time	06/02/2019 02:29:40 PM Eastern Daylight Time				07/02/2019 05:10:12 PM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Medicare	www.optimahealth.com/medicare	Optima Medicare Value - Medical only (HMO)	1	1		1			H2563	14	0	2020	"Greater Hampton Roads, Virginia"		2	1409	2			2						www.optimahealth.com	www.optimahealth.com/medicare	http://optimahealth.prismisp.com/	(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160										(800)828-1140		(711)-		(800)828-1140		(711)-										2					2					2	2			
H2577	1	1	1	4	1	H2577_001_1	3	1			08/05/2019	2020.01	08/05/2019 10:55:11 AM Central Daylight Time	08/02/2019 10:12:35 AM Central Daylight Time	07/30/2019 07:50:06 PM Central Daylight Time			08/06/2019 08:37:16 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 1 (PPO)	1	4		1			H2577	1	1	2020	Select counties in Colorado	Larimer and Weld counties	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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			
H2577	1	2	1	4	1	H2577_001_2	3	1			08/05/2019	2020.01	08/05/2019 10:57:13 AM Central Daylight Time	08/02/2019 10:14:57 AM Central Daylight Time	07/30/2019 07:50:36 PM Central Daylight Time			08/06/2019 08:37:16 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 1 (PPO)	1	4		1			H2577	1	2	2020	Select counties in Colorado	"El Paso, Fremont, Pueblo, and Teller counties"	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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			
H2577	2	0	1	4	1	H2577_002_0	3	1			08/05/2019	2020.01	08/05/2019 10:59:39 AM Central Daylight Time	08/02/2019 10:17:22 AM Central Daylight Time	07/30/2019 07:51:10 PM Central Daylight Time			08/06/2019 08:37:16 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H2577	2	0	2020	Select counties in Denver		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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			
H2577	3	1	1	4	1	H2577_003_1	3	1			08/05/2019	2020.01	08/05/2019 11:01:31 AM Central Daylight Time	08/02/2019 10:19:42 AM Central Daylight Time	07/30/2019 07:51:42 PM Central Daylight Time			08/06/2019 08:37:16 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 2 (PPO)	1	4		1			H2577	3	1	2020	Select counties in Colorado	Larimer and Weld counties	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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			
H2577	3	2	1	4	1	H2577_003_2	3	1			08/05/2019	2020.01	08/05/2019 11:01:54 AM Central Daylight Time	08/02/2019 10:22:03 AM Central Daylight Time	07/30/2019 07:52:16 PM Central Daylight Time			08/06/2019 08:37:16 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens Plan 2 (PPO)	1	4		1			H2577	3	2	2020	Select counties in Colorado	"El Paso, Fremont, Pueblo, and Teller counties"	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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			
H2577	4	0	1	4	1	H2577_004_0	3	1			07/11/2019	2020.01	07/11/2019 04:39:15 PM Central Daylight Time	08/02/2019 10:24:21 AM Central Daylight Time	07/30/2019 07:52:50 PM Central Daylight Time			08/05/2019 05:22:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2577	4	0	2020	Select Counties in North Carolina		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2577	5	0	1	4	1	H2577_005_0	3	1			07/11/2019	2020.01	07/11/2019 04:39:31 PM Central Daylight Time	08/02/2019 10:26:50 AM Central Daylight Time	07/30/2019 07:53:24 PM Central Daylight Time			08/05/2019 05:22:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H2577	5	0	2020	Select Counties in South Carolina		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2577	6	0	1	4	1	H2577_006_0	3	1			07/11/2019	2020.01	07/11/2019 04:39:44 PM Central Daylight Time	08/02/2019 10:29:17 AM Central Daylight Time	07/30/2019 07:54:00 PM Central Daylight Time			08/05/2019 05:22:41 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H2577	6	0	2020	Select Counties in South Carolina		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2577	7	0	1	4	1	H2577_007_0	3	1			08/02/2019	2020.01	08/02/2019 11:39:10 AM Central Daylight Time	08/02/2019 10:31:43 AM Central Daylight Time	07/30/2019 07:54:33 PM Central Daylight Time			08/05/2019 06:10:28 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H2577	7	0	2020	Nashville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2577	8	0	1	4	1	H2577_008_0	5	1			08/02/2019	2020.01	08/02/2019 11:37:02 AM Central Daylight Time	08/02/2019 10:34:06 AM Central Daylight Time	07/30/2019 07:55:07 PM Central Daylight Time			08/05/2019 06:10:28 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H2577	8	0	2020	Memphis Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2577	9	0	1	4	1	H2577_009_0	2	1			08/02/2019	2020.01	08/02/2019 09:41:58 AM Central Daylight Time	08/02/2019 10:36:31 AM Central Daylight Time	07/30/2019 07:55:40 PM Central Daylight Time			08/06/2019 12:49:57 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H2577	9	0	2020	Northern VA and Washington DC Area		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2582	2	0	1	1	1	H2582_002_0	4	1	2	1	08/06/2019	2020.01	08/06/2019 09:05:21 AM Central Daylight Time	08/02/2019 11:51:46 AM Central Daylight Time	07/30/2019 07:56:14 PM Central Daylight Time			08/06/2019 09:21:24 AM Central Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	UnitedHealthcare	www.UHCCommunityPlan.com	Rocky Mountain Health Plans DualCare Plus (HMO D-SNP)	1	1		1			H2582	2	0	2020	Mesa County		2		2			1	3		2		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.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	2			
H2591	801	0	1	4	1	H2591_801_0	2	1			05/22/2019	2020.01	05/22/2019 03:58:13 PM Central Daylight Time					05/31/2019 03:22:23 PM Central Daylight Time	"HEALTH ALLIANCE - MIDWEST, INC."	Health Alliance Medicare	healthalliancemedicare.org	Medicare Employer PPO (PPO)	1	4		1			H2591	801	0	2020	Health Alliance Medicare		1	120	1	1		2						healthalliancemedicare.org	healthalliancemedicare.org	healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2591	802	0	1	4	1	H2591_802_0	2	1			05/22/2019	2020.01	05/22/2019 03:58:07 PM Central Daylight Time					05/31/2019 03:22:23 PM Central Daylight Time	"HEALTH ALLIANCE - MIDWEST, INC."	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare (PPO)	1	4		1			H2591	802	0	2020	Health Alliance Medicare		1	3648	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2591	803	0	1	4	1	H2591_803_0	2	1			05/22/2019	2020.01	05/22/2019 03:58:20 PM Central Daylight Time					05/31/2019 03:22:23 PM Central Daylight Time	"HEALTH ALLIANCE - MIDWEST, INC."	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare (non calendar) (PPO)	1	4		1			H2591	803	0	2020	Health Alliance Medicare  (non calendar)		1	0	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2593	1	0	1	1	1	H2593_001_0	10	1			08/04/2019	2020.01	08/04/2019 08:16:11 PM Pacific Daylight Time	08/05/2019 06:57:03 AM Pacific Daylight Time	07/30/2019 04:33:39 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	//shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	1	1		1			H2593	1	0	2020	Pima County		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(866)772-1142		(866)772-1142		(888)816-2790		(888)816-2790		(866)772-1144		(866)772-1144		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	3	0	1	1	1	H2593_003_0	9	1		1	08/04/2019	2020.01	08/04/2019 08:16:17 PM Pacific Daylight Time	08/05/2019 06:57:03 AM Pacific Daylight Time	07/30/2019 04:34:16 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	//shop.amerigroup.com/medicare	Amerivantage CareMore Care To You (HMO I-SNP)	1	1		1			H2593	3	0	2020	Pima County		2		2			1	1	3				www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(866)772-1142		(866)772-1142		(888)816-2790		(888)816-2790		(866)772-1144		(866)772-1144		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	5	0	1	1	1	H2593_005_0	9	1		1	08/04/2019	2020.01	08/04/2019 08:16:23 PM Pacific Daylight Time	08/05/2019 06:57:03 AM Pacific Daylight Time	07/30/2019 04:34:53 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	//shop.amerigroup.com/medicare	Amerivantage COPD (HMO C-SNP)	1	1		1			H2593	5	0	2020	Pima County		2		2			1	4			100000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(866)772-1142		(866)772-1142		(888)816-2790		(888)816-2790		(866)772-1144		(866)772-1144		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	6	0	1	1	1	H2593_006_0	9	1		1	08/04/2019	2020.01	08/04/2019 08:18:45 PM Pacific Daylight Time	08/05/2019 06:57:04 AM Pacific Daylight Time	07/30/2019 04:35:30 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	//shop.amerigroup.com/medicare	Amerivantage Diabetes (HMO C-SNP)	1	1		1			H2593	6	0	2020	Pima County		2		2			1	4			1E+13		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(866)772-1142		(866)772-1142		(888)816-2790		(888)816-2790		(866)772-1144		(866)772-1144		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	13	0	1	1	1	H2593_013_0	9	1		1	08/04/2019	2020.01	08/04/2019 08:18:51 PM Pacific Daylight Time	08/05/2019 06:57:04 AM Pacific Daylight Time	07/30/2019 04:36:06 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	//shop.amerigroup.com/medicare	Amerivantage Heart Care (HMO C-SNP)	1	1		1			H2593	13	0	2020	Pima County		2		2			1	4			10000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(866)772-1142		(866)772-1142		(888)816-2790		(888)816-2790		(866)772-1144		(866)772-1144		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	18	0	1	1	1	H2593_018_0	9	1			07/29/2019	2020.01	07/29/2019 09:56:01 PM Pacific Daylight Time	08/05/2019 06:57:04 AM Pacific Daylight Time	07/30/2019 04:36:44 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	//shop.amerigroup.com/medicare	Amerivantage Smart Value (HMO)	1	1		1			H2593	18	0	2020	Pima County		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(866)772-1142		(866)772-1142		(888)816-2790		(888)816-2790		(866)772-1144		(866)772-1144		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	19	0	1	1	1	H2593_019_0	9	1		1	08/01/2019	2020.01	08/01/2019 03:34:54 PM Pacific Daylight Time	08/05/2019 06:57:05 AM Pacific Daylight Time	07/30/2019 04:37:20 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	//shop.amerigroup.com/medicare	Amerivantage CareMore Care To You (HMO I-SNP)	1	1		1			H2593	19	0	2020	Maricopa County		2		2			1	1	3				www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(866)772-1142		(866)772-1142		(888)816-2790		(888)816-2790		(866)772-1144		(866)772-1144		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	20	0	1	1	1	H2593_020_0	11	1			07/30/2019	2020.01	07/30/2019 05:14:25 PM Pacific Daylight Time	08/05/2019 06:57:05 AM Pacific Daylight Time	07/30/2019 04:37:57 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	//shop.amerigroup.com/medicare	Amerivantage Care Access (HMO)	1	1		1			H2593	20	0	2020	Pima County		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(866)772-1142		(866)772-1142		(888)816-2790		(888)816-2790		(866)772-1144		(866)772-1144		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	21	0	1	1	1	H2593_021_0	8	1	2	1	07/22/2019	2020.01	07/22/2019 03:04:11 PM Eastern Daylight Time	08/05/2019 09:57:05 AM Eastern Daylight Time	07/30/2019 07:38:34 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination (HMO D-SNP)	1	1		1			H2593	21	0	2020	Select Counties in Tennessee		2		2			1	3		1		1	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(877)411-0929		(877)411-0929		(800)797-5957		(800)797-5957		(877)411-0929		(877)411-0929		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	22	0	1	1	1	H2593_022_0	7	1			07/31/2019	2020.01	07/31/2019 09:49:39 PM Eastern Daylight Time	08/05/2019 09:57:06 AM Eastern Daylight Time	07/30/2019 07:39:11 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	1	1		1			H2593	22	0	2020	Select Counties in Tennessee		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(800)797-5957		(800)797-5957		(866)805-4589		(866)805-4589		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	23	0	1	1	1	H2593_023_0	6	1			07/31/2019	2020.01	07/31/2019 09:50:50 PM Eastern Daylight Time	08/05/2019 09:57:06 AM Eastern Daylight Time	07/30/2019 07:39:48 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	1	1		1			H2593	23	0	2020	Select Counties in Tennessee		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(800)797-5957		(800)797-5957		(866)805-4589		(866)805-4589		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	24	0	1	1	1	H2593_024_0	10	1			08/01/2019	2020.01	08/01/2019 05:10:00 PM Eastern Daylight Time	08/05/2019 09:57:06 AM Eastern Daylight Time	07/30/2019 07:40:26 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Plus (HMO)	1	1		1			H2593	24	0	2020	Select Counties in Tennessee		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(800)797-5957		(800)797-5957		(866)805-4589		(866)805-4589		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7d;7e1;7e2;7f;7h1;7h2;	
H2593	25	0	1	1	1	H2593_025_0	7	1			07/22/2019	2020.01	07/22/2019 03:29:19 PM Eastern Daylight Time	08/05/2019 09:57:07 AM Eastern Daylight Time	07/30/2019 07:41:04 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Balance (HMO)	1	1		1			H2593	25	0	2020	Select Counties in Tennessee		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(800)797-5957		(800)797-5957		(866)805-4589		(866)805-4589		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	26	0	1	1	1	H2593_026_0	12	1			07/31/2019	2020.01	07/31/2019 02:20:26 PM Pacific Daylight Time	08/05/2019 06:57:07 AM Pacific Daylight Time	07/30/2019 04:41:40 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Select (HMO)	1	1		1			H2593	26	0	2020	San Antonio Area		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	27	0	1	1	1	H2593_027_0	12	1			07/31/2019	2020.01	07/31/2019 02:22:41 PM Pacific Daylight Time	08/05/2019 06:57:07 AM Pacific Daylight Time	07/30/2019 04:42:17 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Select (HMO)	1	1		1			H2593	27	0	2020	El Paso County		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	28	1	1	1	1	H2593_028_1	14	1			07/31/2019	2020.01	07/31/2019 03:34:47 PM Pacific Daylight Time	08/05/2019 06:57:08 AM Pacific Daylight Time	07/30/2019 04:42:54 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	1	1		1			H2593	28	1	2020	Select TX  counties	Houston Area and Surrounding Counties	2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	28	2	1	1	1	H2593_028_2	14	1			07/31/2019	2020.01	07/31/2019 02:29:25 PM Pacific Daylight Time	08/05/2019 06:57:08 AM Pacific Daylight Time	07/30/2019 04:43:31 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	1	1		1			H2593	28	2	2020	Select TX  counties	Dallas-Fort Worth Area and Surrounding Counties	2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	28	3	1	1	1	H2593_028_3	13	1			07/31/2019	2020.01	07/31/2019 10:35:56 PM Pacific Daylight Time	08/05/2019 06:57:08 AM Pacific Daylight Time	07/30/2019 04:44:08 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	1	1		1			H2593	28	3	2020	Select TX  counties	San Antonio Area Area and Surrounding Counties	2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	28	4	1	1	1	H2593_028_4	13	1			07/31/2019	2020.01	07/31/2019 10:46:08 PM Pacific Daylight Time	08/05/2019 06:57:09 AM Pacific Daylight Time	07/30/2019 04:44:45 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	1	1		1			H2593	28	4	2020	Select TX  counties	El Paso and Hudspeth Counties	2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	28	5	1	1	1	H2593_028_5	13	1			07/31/2019	2020.01	07/31/2019 03:25:54 PM Pacific Daylight Time	08/05/2019 06:57:09 AM Pacific Daylight Time	07/30/2019 04:45:22 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	1	1		1			H2593	28	5	2020	Select TX  counties	Lubbuck Area and Surrounding Counties	2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	28	6	1	1	1	H2593_028_6	14	1			07/31/2019	2020.01	07/31/2019 03:42:16 PM Pacific Daylight Time	08/05/2019 06:57:09 AM Pacific Daylight Time	07/30/2019 04:45:58 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Classic (HMO)	1	1		1			H2593	28	6	2020	Select TX  counties	Austin Area and Surrounding Counties	2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	29	0	1	1	1	H2593_029_0	12	1			08/01/2019	2020.01	08/01/2019 01:55:48 PM Pacific Daylight Time	08/05/2019 06:57:10 AM Pacific Daylight Time	07/30/2019 04:46:35 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Select (HMO)	1	1		1			H2593	29	0	2020	Houston Metro		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	30	1	1	1	1	H2593_030_1	13	1	2	1	06/25/2019	2020.01	06/25/2019 04:08:21 PM Pacific Daylight Time	08/05/2019 06:57:10 AM Pacific Daylight Time	07/30/2019 04:47:13 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination (HMO D-SNP)	1	1		1			H2593	30	1	2020	Select Counties in Texas	Houston Area and Surrounding Counties	2		2			1	3		2		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)765-5165		(844)765-5165		(844)326-8142		(844)326-8142		(844)765-5165		(844)765-5165		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	30	2	1	1	1	H2593_030_2	13	1	2	1	07/29/2019	2020.01	07/29/2019 12:26:05 PM Pacific Daylight Time	08/05/2019 06:57:11 AM Pacific Daylight Time	07/30/2019 04:47:49 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination (HMO D-SNP)	1	1		1			H2593	30	2	2020	Select Counties in Texas	Dallas-Fort Worth Area and Surrounding Counties	2		2			1	3		2		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)765-5165		(844)765-5165		(844)326-8142		(844)326-8142		(844)765-5165		(844)765-5165		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	30	3	1	1	1	H2593_030_3	13	1	2	1	07/22/2019	2020.01	07/22/2019 11:10:14 PM Pacific Daylight Time	08/05/2019 06:56:59 AM Pacific Daylight Time	07/30/2019 04:48:27 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination (HMO D-SNP)	1	1		1			H2593	30	3	2020	Select Counties in Texas	San Antonio Area and Surrounding Counties	2		2			1	3		2		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)765-5165		(844)765-5165		(844)326-8142		(844)326-8142		(844)765-5165		(844)765-5165		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	30	4	1	1	1	H2593_030_4	13	1	2	1	08/05/2019	2020.01	08/05/2019 09:38:44 AM Pacific Daylight Time	08/05/2019 06:57:00 AM Pacific Daylight Time	07/30/2019 04:49:05 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination (HMO D-SNP)	1	1		1			H2593	30	4	2020	Select Counties in Texas	El Paso and Hudspeth Counties	2		2			1	3		2		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)765-5165		(844)765-5165		(844)326-8142		(844)326-8142		(844)765-5165		(844)765-5165		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	30	5	1	1	1	H2593_030_5	13	1	2	1	06/25/2019	2020.01	06/25/2019 04:11:11 PM Pacific Daylight Time	08/05/2019 06:57:00 AM Pacific Daylight Time	07/30/2019 04:49:41 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination (HMO D-SNP)	1	1		1			H2593	30	5	2020	Select Counties in Texas	Lubbuck Area and Surrounding Counties	2		2			1	3		2		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)765-5165		(844)765-5165		(844)326-8142		(844)326-8142		(844)765-5165		(844)765-5165		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	30	6	1	1	1	H2593_030_6	13	1	2	1	06/25/2019	2020.01	06/25/2019 04:12:01 PM Pacific Daylight Time	08/05/2019 06:57:01 AM Pacific Daylight Time	07/30/2019 04:50:19 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Coordination (HMO D-SNP)	1	1		1			H2593	30	6	2020	Select Counties in Texas	Austin Area and Surrounding Counties	2		2			1	3		2		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)765-5165		(844)765-5165		(844)326-8142		(844)326-8142		(844)765-5165		(844)765-5165		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	31	0	1	2	1	H2593_031_0	15	1		1	07/17/2019	2020.01	07/17/2019 12:01:35 PM Pacific Daylight Time		07/30/2019 04:50:56 PM Pacific Daylight Time		08/05/2019 06:59:28 AM Pacific Daylight Time	08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage ESRD (HMO-POS C-SNP)	1	2		1			H2593	31	0	2020	Select Counties in Texas		2		2			1	4			1E+11		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(877)269-5660		(877)269-5660		(844)326-8142		(844)326-8142		(877)269-5660		(877)269-5660		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	32	0	1	1	1	H2593_032_0	12	1	2	1	07/31/2019	2020.01	07/31/2019 03:52:10 PM Pacific Daylight Time	08/05/2019 06:59:28 AM Pacific Daylight Time	07/30/2019 04:51:35 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Premier (HMO D-SNP)	1	1		1			H2593	32	0	2020	Houston Area and Surrounding Counties		2		2			1	3		2		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)765-5165		(844)765-5165		(844)326-8142		(844)326-8142		(844)765-5165		(844)765-5165		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	33	0	1	1	1	H2593_033_0	10	1	2	1	07/17/2019	2020.01	07/17/2019 01:06:53 AM Pacific Daylight Time	08/05/2019 06:59:28 AM Pacific Daylight Time	07/30/2019 04:52:12 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Secure (HMO D-SNP)	1	1		1			H2593	33	0	2020	Dallas-Fort Worth Area and Surrounding Counties		2		2			1	3		1		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)469-6822		(844)469-6822		(844)326-8142		(844)326-8142		(844)469-6822		(844)469-6822		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	34	0	1	1	1	H2593_034_0	11	1	2	1	07/29/2019	2020.01	07/29/2019 12:24:45 PM Pacific Daylight Time	08/05/2019 06:59:29 AM Pacific Daylight Time	07/30/2019 04:52:50 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Secure (HMO D-SNP)	1	1		1			H2593	34	0	2020	San Antonio Area and Surrounding Counties		2		2			1	3		2		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)469-6822		(844)469-6822		(844)326-8142		(844)326-8142		(844)469-6822		(844)469-6822		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	35	0	1	1	1	H2593_035_0	11	1	2	1	07/29/2019	2020.01	07/29/2019 12:25:13 PM Pacific Daylight Time	08/05/2019 06:59:29 AM Pacific Daylight Time	07/30/2019 04:53:27 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Secure (HMO D-SNP)	1	1		1			H2593	35	0	2020	"El Paso, Hudspeth"		2		2			1	3		2		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)469-6822		(844)469-6822		(844)326-8142		(844)326-8142		(844)469-6822		(844)469-6822		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	36	0	1	1	1	H2593_036_0	11	1	2	1	06/25/2019	2020.01	06/25/2019 04:21:41 PM Pacific Daylight Time	08/05/2019 06:59:29 AM Pacific Daylight Time	07/30/2019 04:54:05 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Dual Secure (HMO D-SNP)	1	1		1			H2593	36	0	2020	Austin Area and Surrounding Counties		2		2			1	3		2		2	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)469-6822		(844)469-6822		(844)326-8142		(844)326-8142		(844)469-6822		(844)469-6822		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	37	0	1	1	1	H2593_037_0	14	1		1	07/31/2019	2020.01	07/31/2019 03:57:08 PM Pacific Daylight Time	08/05/2019 06:59:30 AM Pacific Daylight Time	07/30/2019 04:54:42 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Diabetes (HMO C-SNP)	1	1		1			H2593	37	0	2020	Harris County		2		2			1	4			1E+13		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)469-6823		(844)469-6823		(844)326-8142		(844)326-8142		(844)469-6823		(844)469-6823		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	38	0	1	1	1	H2593_038_0	14	1		1	07/31/2019	2020.01	07/31/2019 04:00:37 PM Pacific Daylight Time	08/05/2019 06:59:30 AM Pacific Daylight Time	07/30/2019 04:55:20 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Heart (HMO C-SNP)	1	1		1			H2593	38	0	2020	Harris County		2		2			1	4			10000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)469-6823		(844)469-6823		(844)326-8142		(844)326-8142		(844)469-6823		(844)469-6823		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	39	0	1	1	1	H2593_039_0	14	1		1	07/31/2019	2020.01	07/31/2019 04:03:58 PM Pacific Daylight Time	08/05/2019 06:59:30 AM Pacific Daylight Time	07/30/2019 04:55:58 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage COPD (HMO C-SNP)	1	1		1			H2593	39	0	2020	Harris County		2		2			1	4			100000000		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(844)469-6823		(844)469-6823		(844)326-8142		(844)326-8142		(844)469-6823		(844)469-6823		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	40	0	1	1	1	H2593_040_0	12	1		1	08/04/2019	2020.01	08/04/2019 08:18:59 PM Pacific Daylight Time		07/30/2019 04:56:35 PM Pacific Daylight Time		08/05/2019 06:59:31 AM Pacific Daylight Time	08/05/2019 02:59:26 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	//shop.amerigroup.com/medicare	Amerivantage CareMore ESRD (HMO C-SNP)	1	1		1			H2593	40	0	2020	Pima County		2		2			1	4			1E+11		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(866)772-1142		(866)772-1142		(888)816-2790		(888)816-2790		(866)772-1144		(866)772-1144		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	41	0	1	1	1	H2593_041_0	9	1		1	07/31/2019	2020.01	07/31/2019 11:36:52 PM Pacific Daylight Time	08/05/2019 06:59:31 AM Pacific Daylight Time	07/30/2019 04:57:13 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Diabetes (HMO C-SNP)	1	1		1			H2593	41	0	2020	Tarrant County		2		2			1	4			1E+13		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	42	0	1	1	1	H2593_042_0	12	1		1	08/02/2019	2020.01	08/02/2019 06:22:02 PM Pacific Daylight Time	08/05/2019 06:59:31 AM Pacific Daylight Time	07/30/2019 04:57:51 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	https://shop.amerigroup.com/medicare	Amerivantage Care To You (HMO I-SNP)	1	1		1			H2593	42	0	2020	Harris and Tarrant Counties		2		2			1	1	3				www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(866)805-4589		(866)805-4589		(844)326-8142		(844)326-8142		(866)805-4589		(866)805-4589		(844)326-8215		(844)326-8215		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2593	802	0	1	1	1	H2593_802_0	1	1			05/29/2019	2020.01	05/29/2019 08:07:46 PM Pacific Daylight Time					05/29/2019 08:53:45 PM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup	caremore.com	Amerivantage EGWP MAPD (HMO)	1	1		1			H2593	802	0	2020	Arizona		1	125	2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare	(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(888)816-2790		(888)816-2790		(877)211-6614		(877)211-6614		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;	1					1				
H2610	5	0	1	1	1	H2610_005_0	5	1			08/02/2019	2020.01	08/02/2019 09:57:43 AM Central Daylight Time	08/01/2019 03:40:27 PM Central Daylight Time	08/01/2019 03:42:13 PM Central Daylight Time			08/02/2019 03:11:58 PM Central Daylight Time	"ESSENCE HEALTHCARE, INC."	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	1	1		1			H2610	5	0	2020	St. Louis Metropolitan Area		2		2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5398		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	6	0	1	1	1	H2610_006_0	5	1			08/02/2019	2020.01	08/02/2019 10:19:49 AM Central Daylight Time	08/01/2019 03:33:45 PM Central Daylight Time	08/01/2019 03:36:10 PM Central Daylight Time			08/02/2019 03:11:58 PM Central Daylight Time	"ESSENCE HEALTHCARE, INC."	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Plus (HMO)	1	1		1			H2610	6	0	2020	St. Louis Metropolitan Area		2		2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5398		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	11	0	1	1	1	H2610_011_0	4	1			08/02/2019	2020.01	08/02/2019 10:30:01 AM Central Daylight Time	08/01/2019 03:28:03 PM Central Daylight Time	08/01/2019 03:30:38 PM Central Daylight Time			08/02/2019 03:11:58 PM Central Daylight Time	"ESSENCE HEALTHCARE, INC."	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	1	1		1			H2610	11	0	2020	Columbia Metropolitan Area		2		2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5398		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	15	0	1	1	1	H2610_015_0	4	1			08/02/2019	2020.01	08/02/2019 10:37:01 AM Central Daylight Time	08/01/2019 03:22:18 PM Central Daylight Time	08/01/2019 03:25:04 PM Central Daylight Time			08/02/2019 03:11:58 PM Central Daylight Time	"ESSENCE HEALTHCARE, INC."	Essence Healthcare	www.essencehealthcare.com	CoxHealth MedicarePlus (HMO)	1	1		1			H2610	15	0	2020	Southwest Missouri		2		2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5398		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	16	0	1	1	1	H2610_016_0	3	1			08/02/2019	2020.01	08/02/2019 10:42:36 AM Central Daylight Time	08/01/2019 03:14:15 PM Central Daylight Time	08/01/2019 03:17:43 PM Central Daylight Time			08/02/2019 03:11:58 PM Central Daylight Time	"ESSENCE HEALTHCARE, INC."	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Select (HMO)	1	1		1			H2610	16	0	2020	St. Louis Metropolitan area		2		2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5398		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2610	803	0	1	1	1	H2610_803_0	2	1			05/21/2019	2020.01	05/21/2019 08:29:43 PM Central Daylight Time					05/30/2019 02:18:09 PM Central Daylight Time	"ESSENCE HEALTHCARE, INC."	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD calendar (HMO)	1	1		1			H2610	803	0	2020	MO and IL Service Area		1	600	2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;17a;18a;	1					1				
H2610	804	0	1	1	1	H2610_804_0	2	1			05/21/2019	2020.01	05/21/2019 08:35:14 PM Central Daylight Time					05/30/2019 02:18:09 PM Central Daylight Time	"ESSENCE HEALTHCARE, INC."	Essence Healthcare	www.essencehealthcare.com	Essence Advantage EGWP MAPD non-calendar (HMO)	1	1		1			H2610	804	0	2020	MO and IL Service Area		1	600	2			2						https://www.everythingessence.com/public/find-a-pharmacy.aspx	https://www.everythingessence.com/public/drug-formulary.aspx	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5398		(314)209-3930		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;17a;18a;	1					1				
H2624	1	0	1	1	1	H2624_001_0	7	1		1	07/10/2019	2020.01	07/10/2019 01:02:03 PM Eastern Daylight Time	07/31/2019 02:23:33 PM Eastern Daylight Time	07/31/2019 04:26:48 PM Eastern Daylight Time			08/05/2019 02:42:41 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.healthteamadvantage.com	HealthTeam Advantage HMO I (HMO SNP)	1	1		1			H2624	1	0	2020	Guilford		2	2100	2			1	4			100		www.healthteamadvantage.com	www.healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	2	0	1	1	1	H2663_002_0	3	1			07/03/2019	2020.01	07/03/2019 05:41:20 PM Central Daylight Time	08/02/2019 07:24:19 AM Central Daylight Time	07/30/2019 08:57:17 PM Central Daylight Time			08/02/2019 03:11:01 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra 2 (HMO)	1	1		1			H2663	2	0	2020	St. Louis MO Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	5	0	1	1	1	H2663_005_0	3	1			08/01/2019	2020.01	08/01/2019 10:24:31 AM Central Daylight Time	08/02/2019 07:25:56 AM Central Daylight Time	07/30/2019 08:58:28 PM Central Daylight Time			08/02/2019 03:11:01 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Gold Advantage Prime (HMO)	1	1		1			H2663	5	0	2020	St. Louis MO Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	6	0	1	2	1	H2663_006_0	3	1			07/03/2019	2020.01	07/03/2019 05:41:49 PM Central Daylight Time	08/02/2019 07:27:13 AM Central Daylight Time	07/30/2019 08:59:38 PM Central Daylight Time			08/02/2019 03:11:01 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra 1 (HMO-POS)	1	2		1			H2663	6	0	2020	St. Louis MO Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	15	0	1	2	1	H2663_015_0	3	1			07/31/2019	2020.01	07/31/2019 10:30:24 AM Central Daylight Time	08/02/2019 07:28:20 AM Central Daylight Time	07/30/2019 09:00:49 PM Central Daylight Time			08/02/2019 03:11:01 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (HMO-POS)	1	2		1			H2663	15	0	2020	St. Louis MO Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	17	0	1	1	1	H2663_017_0	3	1			07/31/2019	2020.01	07/31/2019 10:30:43 AM Central Daylight Time	08/02/2019 07:32:50 AM Central Daylight Time	07/30/2019 09:02:00 PM Central Daylight Time			08/02/2019 03:11:01 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare UnityPoint Health Prime (HMO)	1	1		1			H2663	17	0	2020	"Peoria, Tazewell Illinois"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	21	0	1	1	1	H2663_021_0	3	1			07/31/2019	2020.01	07/31/2019 12:31:15 PM Central Daylight Time	08/02/2019 12:47:48 PM Central Daylight Time	07/30/2019 09:03:10 PM Central Daylight Time			08/02/2019 03:11:01 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	1	1		1			H2663	21	0	2020	Southwest Missouri		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	22	0	1	1	1	H2663_022_0	3	1			07/03/2019	2020.01	07/03/2019 05:42:29 PM Central Daylight Time	05/30/2019 08:57:27 AM Central Daylight Time				07/03/2019 06:15:25 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Core Value (HMO)	1	1		1			H2663	22	0	2020	Southwest Missouri		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2663	23	0	1	2	1	H2663_023_0	3	1			08/01/2019	2020.01	08/01/2019 11:57:07 AM Central Daylight Time	08/02/2019 12:23:49 PM Central Daylight Time	07/30/2019 09:04:21 PM Central Daylight Time			08/02/2019 03:11:01 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (HMO-POS)	1	2		1			H2663	23	0	2020	Southwest Missouri		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	25	0	1	1	1	H2663_025_0	2	1			07/03/2019	2020.01	07/03/2019 05:42:48 PM Central Daylight Time	05/30/2019 08:58:51 AM Central Daylight Time				07/03/2019 06:15:25 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Core Value (HMO)	1	1		1			H2663	25	0	2020	Limited counties Missouri and Kansas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2663	26	0	1	1	1	H2663_026_0	4	1			08/01/2019	2020.01	08/01/2019 11:53:51 AM Central Daylight Time	08/02/2019 12:24:26 PM Central Daylight Time	07/30/2019 09:05:33 PM Central Daylight Time			08/02/2019 03:11:01 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	1	1		1			H2663	26	0	2020	Kansas City Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	28	0	1	1	1	H2663_028_0	3	1			07/31/2019	2020.01	07/31/2019 12:34:28 PM Central Daylight Time	08/02/2019 12:25:03 PM Central Daylight Time	07/30/2019 09:06:44 PM Central Daylight Time			08/02/2019 03:11:01 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	1	1		1			H2663	28	0	2020	Wichita Kansas Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	29	0	1	1	1	H2663_029_0	3	1			08/01/2019	2020.01	08/01/2019 11:54:13 AM Central Daylight Time	08/02/2019 12:25:39 PM Central Daylight Time	07/30/2019 09:07:56 PM Central Daylight Time			08/02/2019 03:11:01 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	1	1		1			H2663	29	0	2020	NW Arkansas		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	32	0	1	1	1	H2663_032_0	3	1			07/31/2019	2020.01	07/31/2019 10:31:10 AM Central Daylight Time	08/02/2019 07:35:14 AM Central Daylight Time	07/30/2019 09:09:07 PM Central Daylight Time			08/02/2019 03:11:01 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Gold Advantage Value Prime (HMO)	1	1		1			H2663	32	0	2020	St. Louis and surrounding counties IL-MO		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	34	0	1	1	1	H2663_034_0	3	1			07/31/2019	2020.01	07/31/2019 11:56:54 AM Eastern Daylight Time	08/01/2019 12:08:58 PM Pacific Daylight Time	07/30/2019 07:10:17 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	1	1		1			H2663	34	0	2020	Oklahoma City and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	35	0	1	1	1	H2663_035_0	3	1			07/31/2019	2020.01	07/31/2019 12:35:48 PM Central Daylight Time	08/02/2019 12:26:15 PM Central Daylight Time	07/30/2019 09:11:28 PM Central Daylight Time			08/02/2019 03:11:01 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Preferred (HMO)	1	1		1			H2663	35	0	2020	Kansas City Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	36	0	1	1	1	H2663_036_0	3	1			07/31/2019	2020.01	07/31/2019 12:36:02 PM Central Daylight Time	08/02/2019 12:26:53 PM Central Daylight Time	07/30/2019 09:12:38 PM Central Daylight Time			08/02/2019 03:11:01 PM Central Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Preferred (HMO)	1	1		1			H2663	36	0	2020	Southwest Missouri		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2663	805	0	1	1	1	H2663_805_0	1	1			05/24/2019	2020.01	05/24/2019 09:37:54 AM Eastern Daylight Time					05/30/2019 07:33:47 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H2663	805	0	2020	Missouri and Illinois		1	5130	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H2663	810	0	1	1	1	H2663_810_0	1	1			05/24/2019	2020.01	05/24/2019 09:38:05 AM Eastern Daylight Time					05/30/2019 07:33:47 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H2663	810	0	2020	"Kansas, Missouri, Illinois"		1	126460	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H2663	814	0	1	1	1	H2663_814_0	1	1			05/30/2019	2020.01	05/30/2019 07:32:46 PM Eastern Daylight Time					05/30/2019 07:33:47 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF MISSOURI, INC"	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H2663	814	0	2020	Missouri and Illinois		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H2678	1	0	1	1	1	H2678_001_0	9	1			08/01/2019	2020.01	08/01/2019 05:11:16 PM Central Daylight Time	08/01/2019 09:58:57 AM Central Daylight Time	07/30/2019 03:44:35 PM Central Daylight Time			08/05/2019 04:03:53 PM Central Daylight Time	"MA DELIVERY INNOVATIONS, INC."	MoreCare	https://mymorecare.com/	MoreCare For You (HMO)	1	1		1			H2678	1	0	2020	"Chicago, IL"		2		2			2						www.mymorecare.com	www.mymorecare.com		(312)274-0126		(312)274-0126		(877)770-2636		(877)770-2636		(888)495-3166		(888)495-3166		(877)770-2636		(877)770-2636		(771)-		(771)-		(771)-		(312)274-0126		(771)-		(771)-		(771)-		(312)274-0126		2					2					2	2			
H2678	2	0	1	1	1	H2678_002_0	8	1		1	08/01/2019	2020.01	08/01/2019 05:11:36 PM Central Daylight Time	08/01/2019 10:01:52 AM Central Daylight Time	07/30/2019 03:45:41 PM Central Daylight Time			08/05/2019 04:03:53 PM Central Daylight Time	"MA DELIVERY INNOVATIONS, INC."	MoreCare	https://mymorecare.com/	MoreCare + (HMO C-SNP)	1	1		1			H2678	2	0	2020	"Chicago, IL"		2		2			1	4			1000000000		www.mymorecare.com	www.mymorecare.com		(312)274-0126		(312)274-0126		(877)770-2636		(877)770-2636		(888)495-3166		(888)495-3166		(877)770-2636		(877)770-2636		(771)-		(771)-		(771)-		(312)274-0126		(771)-		(771)-		(771)-		(312)274-0126		2					2					2	2			
H2678	3	0	1	1	1	H2678_003_0	8	1		1	08/01/2019	2020.01	08/01/2019 05:11:51 PM Central Daylight Time	08/01/2019 04:01:00 PM Central Daylight Time	07/30/2019 03:46:30 PM Central Daylight Time			08/05/2019 04:03:53 PM Central Daylight Time	"MA DELIVERY INNOVATIONS, INC."	MoreCare	https://mymorecare.com/	MoreCare Home (HMO I-SNP)	1	1		1			H2678	3	0	2020	"Chicago, IL"		2		2			1	1	3				www.mymorecare.com	www.mymorecare.com		(312)274-0126		(312)274-0126		(877)770-2636		(877)770-2636		(888)495-3166		(888)495-3166		(877)770-2636		(877)770-2636		(771)-		(771)-		(771)-		(312)274-0126		(771)-		(771)-		(771)-		(312)274-0126		2					2					2	2			
H2678	4	0	1	1	1	H2678_004_0	8	1		1	08/01/2019	2020.01	08/01/2019 05:12:08 PM Central Daylight Time	08/01/2019 10:03:20 AM Central Daylight Time	07/30/2019 03:48:06 PM Central Daylight Time			08/05/2019 04:03:53 PM Central Daylight Time	"MA DELIVERY INNOVATIONS, INC."	MoreCare	https://mymorecare.com/	MoreCare At Home (HMO I-SNP)	1	1		1			H2678	4	0	2020	"Chicago, IL"		2		2			1	1	3				www.mymorecare.com	www.mymorecare.com		(312)274-0126		(312)274-0126		(877)770-2636		(877)770-2636		(888)495-3166		(888)495-3166		(877)770-2636		(877)770-2636		(771)-		(771)-		(771)-		(312)274-0126		(771)-		(771)-		(771)-		(312)274-0126		2					2					2	2			
H2722	1	0	1	2	1	H2722_001_0	11	1			08/02/2019	2020.01	08/02/2019 10:24:44 AM Central Daylight Time	08/02/2019 10:07:20 AM Central Daylight Time	08/02/2019 10:02:56 AM Central Daylight Time			08/05/2019 08:48:05 AM Central Daylight Time	"VANTAGE HEALTH PLAN OF ARKANSAS, INC."	"Vantage Health Plan of Arkansas, Inc."	www.VantageMedicare.com	Vantage TRADITIONAL PLUS (HMO-POS)	1	2		1			H2722	1	0	2020	South Arkansas		2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	2			
H2722	2	0	1	2	1	H2722_002_0	12	1			08/02/2019	2020.01	08/02/2019 10:25:00 AM Central Daylight Time	08/02/2019 10:08:36 AM Central Daylight Time	08/02/2019 10:03:34 AM Central Daylight Time			08/05/2019 08:48:05 AM Central Daylight Time	"VANTAGE HEALTH PLAN OF ARKANSAS, INC."	"Vantage Health Plan of Arkansas, Inc."	www.VantageMedicare.com	Vantage BASIC (HMO-POS)	1	2		1			H2722	2	0	2020	South Arkansas		2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	2			
H2722	801	0	1	2	1	H2722_801_0	8	1			06/27/2019	2020.01	06/27/2019 02:36:00 PM Central Daylight Time					06/27/2019 03:17:06 PM Central Daylight Time	"VANTAGE HEALTH PLAN OF ARKANSAS, INC."	"Vantage Health Plan of Arkansas, Inc."	www.VantageMedicare.com	Vantage - MAPD EGWP CY (HMO-POS)	1	2		1			H2722	801	0	2020	Arkansas		1	0	2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	2			
H2773	3	0	1	1	1	H2773_003_0	5	1		1	07/17/2019	2020.01	07/17/2019 07:54:57 PM Eastern Daylight Time	08/06/2019 03:48:14 PM Eastern Daylight Time	08/06/2019 03:48:38 PM Eastern Daylight Time			08/06/2019 03:54:14 PM Eastern Daylight Time	"QUALITY HEALTH PLANS OF NEW YORK, INC."	QUALITY HEALTH PLANS	www.qhpny.com	Advantage Health LI - SNP (HMO C-SNP)	1	1		1			H2773	3	0	2020	"Nassau, and Suffolk Counties"		2	18754	2			1	4			10		www.qhpny.com	www.qhpny.com	www.qhpny.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	2			
H2773	17	0	1	1	1	H2773_017_0	8	1		1	07/17/2019	2020.01	07/17/2019 07:50:55 PM Eastern Daylight Time	08/06/2019 03:48:14 PM Eastern Daylight Time	08/06/2019 03:48:38 PM Eastern Daylight Time			08/06/2019 03:59:27 PM Eastern Daylight Time	"QUALITY HEALTH PLANS OF NEW YORK, INC."	QUALITY HEALTH PLANS	www.qhpny.com	Advantage Health NYC - SNP (HMO C-SNP)	1	1		1			H2773	17	0	2020	Queens County and Staten Island		2	2226	2			1	4			10		www.qhpny.com	www.qhpny.com	www.qhpny.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	2			
H2773	18	0	1	1	1	H2773_018_0	5	1	2	1	07/17/2019	2020.01	07/17/2019 08:18:21 PM Eastern Daylight Time	08/06/2019 03:48:15 PM Eastern Daylight Time	08/06/2019 03:48:38 PM Eastern Daylight Time			08/06/2019 04:01:43 PM Eastern Daylight Time	"QUALITY HEALTH PLANS OF NEW YORK, INC."	QUALITY HEALTH PLANS	www.qhpny.com	Advantage Value One NY - Dual (HMO D-SNP)	1	1		1			H2773	18	0	2020	"Nassau, Queens, Staten Island and Suffolk Counties"		2	755	2			1	3		2		2	www.qhpny.com	www.qhpny.com	www.qhpny.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	2			
H2773	19	0	1	1	1	H2773_019_0	5	1			07/17/2019	2020.01	07/17/2019 07:52:34 PM Eastern Daylight Time	08/06/2019 03:48:13 PM Eastern Daylight Time	08/06/2019 03:48:37 PM Eastern Daylight Time			08/06/2019 04:03:31 PM Eastern Daylight Time	"QUALITY HEALTH PLANS OF NEW YORK, INC."	QUALITY HEALTH PLANS	www.qhpny.com	Advantage Silver - NY (HMO)	1	1		1			H2773	19	0	2020	Nassau and Suffolk Counties		2	51336	2			2						www.qhpny.com	www.qhpny.com	www.qhpny.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	2			
H2773	20	0	1	1	1	H2773_020_0	5	1			07/18/2019	2020.01	07/18/2019 05:37:17 PM Eastern Daylight Time	08/06/2019 03:48:13 PM Eastern Daylight Time	08/06/2019 03:48:37 PM Eastern Daylight Time			08/06/2019 04:05:21 PM Eastern Daylight Time	"QUALITY HEALTH PLANS OF NEW YORK, INC."	QUALITY HEALTH PLANS	www.qhpny.com	Advantage Silver - NY City (HMO)	1	1		1			H2773	20	0	2020	Queens and Staten Island		2	7713	2			2						www.qhpny.com	www.qhpny.com	www.qhpny.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	2			
H2773	23	0	1	1	1	H2773_023_0	6	1			07/17/2019	2020.01	07/17/2019 07:53:51 PM Eastern Daylight Time	08/06/2019 03:48:14 PM Eastern Daylight Time	08/06/2019 03:48:37 PM Eastern Daylight Time			08/06/2019 04:07:09 PM Eastern Daylight Time	"QUALITY HEALTH PLANS OF NEW YORK, INC."	QUALITY HEALTH PLANS	www.qhpny.com	Advantage Premium NY (HMO)	1	1		1			H2773	23	0	2020	"Nassau, Suffolk, Richmond Counties"		2	417	2			2						www.qhpny.com	www.qhpny.com	www.qhpny.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	2			
H2775	100	0	1	4	1	H2775_100_0	7	1			07/12/2019	2020.01	07/12/2019 11:25:38 AM Eastern Daylight Time	08/02/2019 06:11:45 AM Eastern Daylight Time	07/30/2019 10:25:00 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 750B (PPO)	1	4		1			H2775	100	0	2020	Select counties in NY		2	23515	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	105	0	1	4	1	H2775_105_0	8	1			07/16/2019	2020.01	07/16/2019 01:40:30 PM Eastern Daylight Time	08/02/2019 06:13:36 AM Eastern Daylight Time	07/30/2019 10:25:36 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 150A (PPO)	1	4		1			H2775	105	0	2020	Select counties in NY		2	77195	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	106	0	1	4	1	H2775_106_0	9	1			07/12/2019	2020.01	07/12/2019 11:27:40 AM Eastern Daylight Time	08/02/2019 06:15:26 AM Eastern Daylight Time	07/30/2019 10:26:12 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 550B (PPO)	1	4		1			H2775	106	0	2020	Select counties in NY		2	365489	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	107	0	1	4	1	H2775_107_0	8	1			07/12/2019	2020.01	07/12/2019 11:29:10 AM Eastern Daylight Time	08/02/2019 06:17:02 AM Eastern Daylight Time	07/30/2019 10:26:48 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 550B (PPO)	1	4		1			H2775	107	0	2020	Select counties in NY		2	40591	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	108	0	1	4	1	H2775_108_0	6	1			07/12/2019	2020.01	07/12/2019 11:29:57 AM Eastern Daylight Time	06/02/2019 03:21:41 PM Eastern Daylight Time				07/12/2019 07:31:53 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	WellCare Today's Options Advantage 300 (PPO)	1	4		1			H2775	108	0	2020	Select counties in NY		2	16108	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2						2			
H2775	109	0	1	4	1	H2775_109_0	8	1			07/12/2019	2020.01	07/12/2019 11:31:15 AM Eastern Daylight Time	08/02/2019 06:20:23 AM Eastern Daylight Time	07/30/2019 10:27:24 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	WellCare Today's Options Advantage Plus 550B (PPO)	1	4		1			H2775	109	0	2020	Select counties in ME		2	102688	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H2775	801	0	1	4	1	H2775_801_0	3	1			05/26/2019	2020.01	05/26/2019 05:28:52 PM Eastern Daylight Time					05/31/2019 09:08:01 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	Today's Options PPO - MA Group Plan (PPO)	1	4		1			H2775	801	0	2020	National		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2775	802	0	1	4	1	H2775_802_0	3	1			05/26/2019	2020.01	05/26/2019 05:30:01 PM Eastern Daylight Time					05/31/2019 09:08:01 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	Today's Options PPO - MAPD Group Plan (PPO)	1	4		1			H2775	802	0	2020	National		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2775	803	0	1	4	1	H2775_803_0	3	1			05/26/2019	2020.01	05/26/2019 05:31:51 PM Eastern Daylight Time					05/31/2019 09:08:01 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	Today's Options PPO - MAPD Group Plan - NCY (PPO)	1	4		1			H2775	803	0	2020	National		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(866)422-5009		(866)422-5009		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H2793	3	0	1	1	1	H2793_003_0	4	1			05/31/2019	2020.01	05/31/2019 09:15:13 PM Eastern Daylight Time	08/02/2019 02:39:48 PM Eastern Daylight Time	08/02/2019 02:06:39 PM Eastern Daylight Time			08/04/2019 04:30:34 PM Eastern Daylight Time	"IMPERIAL INSURANCE COMPANY OF TEXAS, INC."	"Imperial Insurance Company of Texas, Inc"	www.IICTX.com	Imperial Health Insurance Traditional (HMO)	1	1		1			H2793	3	0	2020	Metro Texas and Arizona		2	36000	2			2						www.IICTX.com	www.IICTX.com	www.IICTX.com	(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2793	4	0	1	1	1	H2793_004_0	4	1	2	1	08/02/2019	2020.01	08/02/2019 04:39:09 PM Eastern Daylight Time	08/02/2019 02:43:01 PM Eastern Daylight Time	08/02/2019 02:07:51 PM Eastern Daylight Time			08/04/2019 04:30:34 PM Eastern Daylight Time	"IMPERIAL INSURANCE COMPANY OF TEXAS, INC."	"Imperial Insurance Company of Texas, Inc"	www.IICTX.com	Imperial Health Insurance Dual (HMO D-SNP)	1	1		1			H2793	4	0	2020	Metro Texas and Arizona		2	18000	2			1	3		2		2	www.IICTX.com	www.IICTX.com	www.IICTX.com	(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2793	5	0	1	1	1	H2793_005_0	4	1		1	08/02/2019	2020.01	08/02/2019 04:18:56 PM Eastern Daylight Time	08/02/2019 02:47:07 PM Eastern Daylight Time	08/02/2019 02:10:35 PM Eastern Daylight Time			08/04/2019 04:30:34 PM Eastern Daylight Time	"IMPERIAL INSURANCE COMPANY OF TEXAS, INC."	"Imperial Insurance Company of Texas, Inc"	www.IICTX.com	Imperial Health Insurance Value  (HMO C-SNP)	1	1		1			H2793	5	0	2020	Metro Texas and Arizona		2	18000	2			1	4			10		www.IICTX.com	www.IICTX.com	www.IICTX.com	(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(800)883-1533		(214)856-8454		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	1	0	1	2	1	H2802_001_0	3	1			08/02/2019	2020.01	08/02/2019 10:51:03 AM Central Daylight Time	08/02/2019 11:55:28 AM Central Daylight Time	07/30/2019 07:56:47 PM Central Daylight Time			08/06/2019 10:33:33 AM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H2802	1	0	2020	Omaha Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	7	0	1	2	1	H2802_007_0	3	1			08/02/2019	2020.01	08/02/2019 10:01:12 AM Central Daylight Time	08/02/2019 12:59:41 PM Central Daylight Time	07/30/2019 07:57:22 PM Central Daylight Time			08/05/2019 05:48:51 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Profile (HMO-POS)	1	2		1			H2802	7	0	2020	Fort Wayne area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	8	0	1	2	1	H2802_008_0	3	1			08/02/2019	2020.01	08/02/2019 10:01:29 AM Central Daylight Time	08/02/2019 11:57:55 AM Central Daylight Time	07/30/2019 07:57:56 PM Central Daylight Time			08/05/2019 05:48:51 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H2802	8	0	2020	South Bend area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	10	0	1	2	1	H2802_010_0	3	1			08/02/2019	2020.01	08/02/2019 10:01:48 AM Central Daylight Time	08/02/2019 12:00:28 PM Central Daylight Time	07/30/2019 07:58:30 PM Central Daylight Time			08/05/2019 05:48:51 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H2802	10	0	2020	Indianapolis and Central Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	12	0	1	2	1	H2802_012_0	3	1			08/02/2019	2020.01	08/02/2019 10:02:05 AM Central Daylight Time	08/02/2019 12:03:08 PM Central Daylight Time	07/30/2019 07:59:03 PM Central Daylight Time			08/05/2019 05:48:51 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H2802	12	0	2020	Evansville area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	15	0	1	2	1	H2802_015_0	3	1			08/02/2019	2020.01	08/02/2019 01:28:18 PM Central Daylight Time	08/02/2019 12:05:25 PM Central Daylight Time	07/30/2019 07:59:38 PM Central Daylight Time			08/05/2019 05:48:51 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	1	2		1			H2802	15	0	2020	Northeast Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	16	0	1	2	1	H2802_016_0	3	1			08/02/2019	2020.01	08/02/2019 10:02:40 AM Central Daylight Time	08/02/2019 12:07:43 PM Central Daylight Time	07/30/2019 08:00:10 PM Central Daylight Time			08/05/2019 05:48:51 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H2802	16	0	2020	Southeast Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	18	0	1	2	1	H2802_018_0	3	1			08/02/2019	2020.01	08/02/2019 10:02:58 AM Central Daylight Time	08/02/2019 12:10:10 PM Central Daylight Time	07/30/2019 08:00:45 PM Central Daylight Time			08/05/2019 05:48:51 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H2802	18	0	2020	Northwest Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	20	0	1	2	1	H2802_020_0	3	1			08/02/2019	2020.01	08/02/2019 01:33:58 PM Central Daylight Time	08/02/2019 12:12:19 PM Central Daylight Time	07/30/2019 08:01:17 PM Central Daylight Time			08/05/2019 05:48:51 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H2802	20	0	2020	West Indiana		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	24	0	1	1	1	H2802_024_0	3	1			08/02/2019	2020.01	08/02/2019 12:06:05 PM Central Daylight Time	08/02/2019 12:14:25 PM Central Daylight Time	07/30/2019 08:01:51 PM Central Daylight Time			08/05/2019 04:51:27 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Access (HMO)	1	1		1			H2802	24	0	2020	Chicago Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	25	0	1	1	1	H2802_025_0	4	1			08/02/2019	2020.01	08/02/2019 12:06:35 PM Central Daylight Time	08/02/2019 12:16:50 PM Central Daylight Time	07/30/2019 08:02:23 PM Central Daylight Time			08/05/2019 04:51:27 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H2802	25	0	2020	Chicago Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	26	0	1	1	1	H2802_026_0	3	1			08/02/2019	2020.01	08/02/2019 12:07:57 PM Central Daylight Time	08/02/2019 12:19:04 PM Central Daylight Time	07/30/2019 08:02:58 PM Central Daylight Time			08/05/2019 04:51:27 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H2802	26	0	2020	Chicago Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	27	0	1	2	1	H2802_027_0	2	1		1	08/02/2019	2020.01	08/02/2019 12:24:19 PM Central Daylight Time	08/02/2019 12:21:13 PM Central Daylight Time	07/30/2019 08:03:33 PM Central Daylight Time			08/05/2019 05:22:41 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (HMO-POS I-SNP)	1	2		1			H2802	27	0	2020	Chicago Metro area		2		2			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	2			
H2802	28	0	1	2	1	H2802_028_0	3	1			08/02/2019	2020.01	08/02/2019 12:09:12 PM Central Daylight Time	08/02/2019 12:23:30 PM Central Daylight Time	07/30/2019 08:04:08 PM Central Daylight Time			08/05/2019 04:51:27 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H2802	28	0	2020	St. Louis Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	29	0	1	2	1	H2802_029_0	3	1			08/02/2019	2020.01	08/02/2019 12:09:37 PM Central Daylight Time	08/02/2019 12:25:45 PM Central Daylight Time	07/30/2019 08:04:41 PM Central Daylight Time			08/05/2019 04:51:27 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H2802	29	0	2020	Jefferson City and Columbia Metro Areas		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	30	0	1	2	1	H2802_030_0	2	1			08/02/2019	2020.01	08/02/2019 12:13:13 PM Central Daylight Time	08/02/2019 12:29:27 PM Central Daylight Time	07/30/2019 08:05:14 PM Central Daylight Time			08/05/2019 04:51:27 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	1	2		1			H2802	30	0	2020	Springfield Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	31	0	1	2	1	H2802_031_0	3	1			08/02/2019	2020.01	08/02/2019 12:13:32 PM Central Daylight Time	08/02/2019 12:31:47 PM Central Daylight Time	07/30/2019 08:05:49 PM Central Daylight Time			08/05/2019 04:51:27 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H2802	31	0	2020	Springfield Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	32	0	1	2	1	H2802_032_0	3	1			08/02/2019	2020.01	08/02/2019 12:13:52 PM Central Daylight Time	08/02/2019 12:34:10 PM Central Daylight Time	07/30/2019 08:06:21 PM Central Daylight Time			08/05/2019 04:51:27 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	1	2		1			H2802	32	0	2020	Kansas City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	33	0	1	2	1	H2802_033_0	3	1			08/02/2019	2020.01	08/02/2019 12:14:12 PM Central Daylight Time	08/02/2019 12:37:07 PM Central Daylight Time	07/30/2019 08:06:55 PM Central Daylight Time			08/05/2019 04:51:27 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H2802	33	0	2020	Kansas City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	34	0	1	2	1	H2802_034_0	2	1			08/02/2019	2020.01	08/02/2019 12:14:46 PM Central Daylight Time	08/02/2019 12:39:42 PM Central Daylight Time	07/30/2019 08:07:29 PM Central Daylight Time			08/05/2019 04:51:27 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H2802	34	0	2020	"Butler, Harvey, and Sedgwick Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	35	0	1	2	1	H2802_035_0	2	1			08/02/2019	2020.01	08/02/2019 12:15:10 PM Central Daylight Time	08/02/2019 12:42:00 PM Central Daylight Time	07/30/2019 08:08:03 PM Central Daylight Time			08/05/2019 04:51:27 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	1	2		1			H2802	35	0	2020	"Butler, Harvey, and Sedgwick Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	41	0	1	1	1	H2802_041_0	5	1			08/06/2019	2020.01	08/06/2019 10:08:07 AM Central Daylight Time	08/02/2019 12:44:26 PM Central Daylight Time	07/30/2019 08:08:43 PM Central Daylight Time			08/06/2019 10:16:24 AM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	1	1		1			H2802	41	0	2020	Select Counties in Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	42	0	1	1	1	H2802_042_0	4	1			08/02/2019	2020.01	08/02/2019 11:40:28 AM Central Daylight Time	08/02/2019 12:46:45 PM Central Daylight Time	07/30/2019 08:09:17 PM Central Daylight Time			08/05/2019 06:10:28 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 4 (HMO)	1	1		1			H2802	42	0	2020	Select Counties in Alabama		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	44	0	1	1	1	H2802_044_0	4	1	2	1	08/06/2019	2020.01	08/06/2019 10:09:07 AM Central Daylight Time	08/02/2019 12:49:07 PM Central Daylight Time	07/30/2019 08:09:53 PM Central Daylight Time			08/06/2019 10:16:24 AM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Plan 2 (HMO D-SNP)	1	1		1			H2802	44	0	2020	Select Counties in Alabama		2		2			1	3		2		2	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	48	0	1	1	1	H2802_048_0	3	1			08/02/2019	2020.01	08/02/2019 12:15:30 PM Central Daylight Time	08/02/2019 12:51:26 PM Central Daylight Time	07/30/2019 08:10:27 PM Central Daylight Time			08/05/2019 04:51:27 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H2802	48	0	2020	Columbia Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	49	0	1	2	1	H2802_049_0	3	1			08/02/2019	2020.01	08/02/2019 12:15:51 PM Central Daylight Time	08/02/2019 12:53:30 PM Central Daylight Time	07/30/2019 08:11:04 PM Central Daylight Time			08/05/2019 04:51:27 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H2802	49	0	2020	"Bollinger, Scott and Stoddard Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2802	801	0	1	1	1	H2802_801_0	1	1			05/13/2019	2020.01	05/13/2019 07:24:35 PM Central Daylight Time					06/02/2019 03:31:56 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H2802	801	0	2020	Select Counties in Alabama		1	192	2			2						www.UHCRetiree.com	www.UHCRetiree.com	www.UHCRetiree.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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H2802	802	0	1	1	1	H2802_802_0	1	1			05/13/2019	2020.01	05/13/2019 07:29:00 PM Central Daylight Time					06/02/2019 03:31:56 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H2802	802	0	2020	Select Counties in Alabama		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H2802	803	0	1	1	1	H2802_803_0	1	1			05/13/2019	2020.01	05/13/2019 07:30:36 PM Central Daylight Time					06/02/2019 03:31:56 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H2802	803	0	2020	Select Counties in Alabama		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H2802	804	0	1	1	1	H2802_804_0	1	1			05/13/2019	2020.01	05/13/2019 07:32:48 PM Central Daylight Time					06/02/2019 03:31:56 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H2802	804	0	2020	St Louis Area		1	34656	2			2						www.UHCRetiree.com	www.UHCRetiree.com	www.UHCRetiree.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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H2802	805	0	1	1	1	H2802_805_0	1	1			05/13/2019	2020.01	05/13/2019 07:34:11 PM Central Daylight Time					06/02/2019 03:31:56 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H2802	805	0	2020	St Louis Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H2802	806	0	1	1	1	H2802_806_0	1	1			05/13/2019	2020.01	05/13/2019 07:35:55 PM Central Daylight Time					06/02/2019 03:31:56 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H2802	806	0	2020	St Louis Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H2802	807	0	1	1	1	H2802_807_0	1	1			05/13/2019	2020.01	05/13/2019 07:37:26 PM Central Daylight Time					06/02/2019 03:31:56 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H2802	807	0	2020	Springfield Area		1	156	2			2						www.UHCRetiree.com	www.UHCRetiree.com	www.UHCRetiree.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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H2802	808	0	1	1	1	H2802_808_0	1	1			05/13/2019	2020.01	05/13/2019 07:40:32 PM Central Daylight Time					06/02/2019 03:31:56 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H2802	808	0	2020	Springfield Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H2802	809	0	1	1	1	H2802_809_0	1	1			05/13/2019	2020.01	05/13/2019 07:42:29 PM Central Daylight Time					06/02/2019 03:31:56 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MIDLANDS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H2802	809	0	2020	Springfield Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H2815	1	0	1	20	8	H2815_001_0	1	1			05/20/2019	2020.01	05/20/2019 08:45:52 AM Mountain Daylight Time		05/20/2019 10:00:54 AM Mountain Daylight Time			05/20/2019 10:41:45 AM Mountain Daylight Time	"VOANS SENIOR COMMUNITY CARE OF COLORADO, INC"	Senior CommUnity Care of Colorado	www.seniorcommunitycare.org	Senior CommUnity Care of Colorado (PACE)	8	20		1			H2815	1	0	2020	Senior CommUnity Care of Colorado		2		2			2						www.voa.org	www.voa.org										(866)961-1451		(970)835-2900		(866)961-1451		(970)835-2900												(970)252-0522				(970)252-0522																
H2815	2	0	1	20	8	H2815_002_0	1	1			05/20/2019	2020.01	05/20/2019 08:46:54 AM Mountain Daylight Time		05/20/2019 10:00:30 AM Mountain Daylight Time			05/20/2019 10:41:45 AM Mountain Daylight Time	"VOANS SENIOR COMMUNITY CARE OF COLORADO, INC"	Senior CommUnity Care of Colorado	www.seniorcommunitycare.org	Senior CommUnity Care of Colorado (PACE)	8	20		1			H2815	2	0	2020	Senior CommUnity Care of Colorado		2		2			2						www.voa.org	www.voa.org										(866)961-1451		(970)252-0522		(866)961-1451		(970)252-0522												(970)252-0522				(970)252-0522																
H2816	13	0	1	9	4	H2816_013_0	8	1			07/16/2019	2020.01	07/16/2019 01:44:08 PM Eastern Daylight Time	08/02/2019 06:22:06 AM Eastern Daylight Time	07/30/2019 10:28:00 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	WellCare Today's Options Premier Plus 250A (PFFS)	4	9	1	1			H2816	13	0	2020	Select counties in NY		2	7887	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2816	19	0	1	9	4	H2816_019_0	8	1			07/11/2019	2020.01	07/11/2019 02:15:08 PM Eastern Daylight Time	08/02/2019 06:23:50 AM Eastern Daylight Time	07/30/2019 10:28:36 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	WellCare Today's Options Premier Plus 650B (PFFS)	4	9	1	1			H2816	19	0	2020	Select counties in NY		2	12572	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2816	37	0	1	9	4	H2816_037_0	7	1			07/11/2019	2020.01	07/11/2019 02:15:53 PM Eastern Daylight Time	07/05/2019 02:12:32 AM Eastern Daylight Time				07/12/2019 07:31:53 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	WellCare Today's Options Premier 200 (PFFS)	4	9	1	1			H2816	37	0	2020	Select counties in NY		2	14283	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	38	0	1	9	4	H2816_038_0	6	1			07/11/2019	2020.01	07/11/2019 02:16:33 PM Eastern Daylight Time	06/02/2019 02:09:35 PM Eastern Daylight Time				07/12/2019 07:31:53 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	WellCare Today's Options Premier 300 (PFFS)	4	9	1	1			H2816	38	0	2020	Select counties in NY		2	73138	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	39	0	1	9	4	H2816_039_0	6	1			07/11/2019	2020.01	07/11/2019 02:17:25 PM Eastern Daylight Time	06/02/2019 07:04:34 AM Eastern Daylight Time				07/12/2019 07:31:53 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	WellCare Today's Options Premier 200 (PFFS)	4	9	1	1			H2816	39	0	2020	Select counties in ME		2	9196	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	40	0	1	9	4	H2816_040_0	6	1			07/11/2019	2020.01	07/11/2019 02:18:24 PM Eastern Daylight Time	06/02/2019 07:05:26 AM Eastern Daylight Time				07/12/2019 07:31:53 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	WellCare Today's Options Premier 300 (PFFS)	4	9	1	1			H2816	40	0	2020	Select counties in ME		2	14984	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2816	801	0	1	9	4	H2816_801_0	3	1			05/24/2019	2020.01	05/24/2019 10:48:41 AM Eastern Daylight Time					05/31/2019 09:08:01 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	Today's Options PFFS - MA Group Plan (PFFS)	4	9	1	1			H2816	801	0	2020	National		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										1					1					1				
H2816	802	0	1	9	4	H2816_802_0	3	1			05/24/2019	2020.01	05/24/2019 10:55:54 AM Eastern Daylight Time					05/31/2019 09:08:01 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	Today's Options PFFS - MAPD Group Plan (PFFS)	4	9	1	1			H2816	802	0	2020	National		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056		(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1					1					1				
H2816	803	0	1	9	4	H2816_803_0	3	1			05/24/2019	2020.01	05/24/2019 10:57:09 AM Eastern Daylight Time					05/31/2019 09:08:01 PM Eastern Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	WellCare	www.wellcare.com/medicare	Today's Options PFFS - MAPD Group Plan - NCY (PFFS)	4	9	1	1			H2816	803	0	2020	National		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056		(866)568-8921		(866)568-8921		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1					1					1				
H2825	1	0	1	1	1	H2825_001_0	4	1			08/02/2019	2020.01	08/02/2019 08:14:30 AM Central Daylight Time	08/01/2019 03:52:09 PM Central Daylight Time	08/01/2019 03:57:23 PM Central Daylight Time			08/02/2019 10:21:06 PM Central Daylight Time	MARY WASHINGTON HEALTH PLAN	Mary Washington Medicare Advantage	www.marywashingtonhealthcare.com	Mary Washington Medicare Advantage Complete (HMO)	1	1		1			H2825	1	0	2020	Greater Fredericksburg Region		2		2			2						www.marywashingtonhealthcare.com	www.marywashingtonhealthcare.com	www.marywashingtonhealthcare.com	(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2825	2	0	1	1	1	H2825_002_0	4	1			08/02/2019	2020.01	08/02/2019 08:18:31 AM Central Daylight Time	08/01/2019 04:01:36 PM Central Daylight Time	08/01/2019 04:03:58 PM Central Daylight Time			08/02/2019 10:21:06 PM Central Daylight Time	MARY WASHINGTON HEALTH PLAN	Mary Washington Medicare Advantage	www.marywashingtonhealthcare.com	Mary Washington Medicare Advantage Rewards (HMO)	1	1		1			H2825	2	0	2020	Greater Fredericksburg Region		2		2			2						www.marywashingtonhealthcare.com	www.marywashingtonhealthcare.com	www.marywashingtonhealthcare.com	(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2825	801	0	1	1	1	H2825_801_0	3	1			05/20/2019	2020.01	05/20/2019 04:20:31 PM Central Daylight Time					05/30/2019 03:42:09 PM Central Daylight Time	MARY WASHINGTON HEALTH PLAN	Mary Washington Medicare Advantage	www.marywashingtonhealthcare.com	EGWP MAPD Calendar year (HMO)	1	1		1			H2825	801	0	2020	Greater Fredericksburg Region		1	300	2			2						www.marywashingtonhealthcare.com	www.marywashingtonhealthcare.com	www.marywashingtonhealthcare.com	(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;17a;18a;	1					1				
H2825	802	0	1	1	1	H2825_802_0	3	1			05/21/2019	2020.01	05/21/2019 11:54:04 AM Central Daylight Time					05/30/2019 03:42:09 PM Central Daylight Time	MARY WASHINGTON HEALTH PLAN	Mary Washington Medicare Advantage	www.marywashingtonhealthcare.com	EGWP MAPD Non-Calendar year (HMO)	1	1		1			H2825	802	0	2020	Greater Fredericksburg Region		1	300	2			2						www.marywashingtonhealthcare.com	www.marywashingtonhealthcare.com	www.marywashingtonhealthcare.com	(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(844)529-3760		(844)529-3760		(844)529-3827		(844)529-3827		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;17a;18a;	1					1				
H2829	1	0	1	1	1	H2829_001_0	5	1			08/01/2019	2020.01	08/01/2019 01:30:14 PM Eastern Daylight Time	08/02/2019 09:53:27 AM Eastern Daylight Time	07/30/2019 10:13:49 PM Eastern Daylight Time			08/02/2019 03:09:47 PM Eastern Daylight Time	"INNOVATION HEALTH PLAN, INC."	Innovation Health Medicare	www.innovationhealthmedicare.com	Innovation Health-Aetna Medicare Connect (HMO)	1	1		1			H2829	1	0	2020	Fairfax County and Surrounding Area		2		2			2						www.innovationhealthmedicare.com/findpharmacy	www.innovationhealthmedicare.com/formulary	www.innovationhealthmedicare.com/findprovider	(855)249-1282		(855)249-1282		(844)656-8722		(844)656-8722		(855)249-1282		(855)249-1282		(844)656-8722		(844)656-8722		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	4b;7a;7d;7g;	
H2835	1	0	1	20	8	H2835_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:07:14 PM Eastern Daylight Time		05/22/2019 01:01:11 PM Eastern Daylight Time			05/22/2019 01:12:00 PM Eastern Daylight Time	"THE CASCADE PACE, INC."	Thome PACE	www.thomepace.org	Thome PACE (PACE)	8	20		1			H2835	1	0	2020	"Jackson, Lenawee, and Hillsdale Counties"		2		2			2						www.hometownpharmacy.com	www.thomepace.org	www.thomepace.org									(844)855-7223		(517)768-9791		(844)855-7223		(517)768-9791										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777																
H2835	2	0	1	20	8	H2835_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:08:11 PM Eastern Daylight Time		05/22/2019 01:00:39 PM Eastern Daylight Time			05/22/2019 01:12:00 PM Eastern Daylight Time	"THE CASCADE PACE, INC."	Thome PACE	www.thomepace.org	Thome PACE Medicare Only (PACE)	8	20		1			H2835	2	0	2020	"Jackson, Lenawee, and Hillsdale County"		2		2			2						www.hometownpharmacy.com	www.thomepace.org	www.thomepace.org									(844)855-7223		(517)768-9791		(844)855-7223		(517)768-9791										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777																
H2836	801	0	1	4	1	H2836_801_0	2	1			05/30/2019	2020.01	05/30/2019 04:18:13 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Preferred (PPO)	1	4		1			H2836	801	0	2020	Connecticut		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H2879	1	0	1	1	1	H2879_001_0	9	1	2	1	07/19/2019	2020.01	07/19/2019 11:40:31 AM Pacific Daylight Time	08/05/2019 09:38:30 AM Pacific Daylight Time	07/31/2019 11:10:44 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF WISCONSIN, INC."	Molina Healthcare of Wisconsin	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	1	1		1			H2879	1	0	2020	Select Counties in Wisconsin		2		2			1	3		2		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	2			
H2882	3	0	1	20	8	H2882_003_0	2	1			06/03/2019	2020.01	06/03/2019 01:05:21 PM Eastern Daylight Time		06/03/2019 12:48:17 PM Eastern Daylight Time			06/03/2019 01:11:10 PM Eastern Daylight Time	"PACE CENTRAL MICHIGAN, INC."	PACE Central Michigan	www.pacecmi.org	PACE Central Michigan (PACE)	8	20		1			H2882	3	0	2020	Central Michigan		2		2			2						https://hometownpharmacy.com/	N/A												(989)953-5800				(989)953-5800												(771)-				(771)-																
H2882	4	0	1	20	8	H2882_004_0	2	1			06/03/2019	2020.01	06/03/2019 01:09:07 PM Eastern Daylight Time		06/03/2019 12:47:57 PM Eastern Daylight Time			06/03/2019 01:11:10 PM Eastern Daylight Time	"PACE CENTRAL MICHIGAN, INC."	PACE Central Michigan	www.pacecmi.org	PACE Central Michigan (PACE)	8	20		1			H2882	4	0	2020	Central Michigan		2		2			2						https://hometownpharmacy.com/	N/A												(989)953-5800				(989)953-5800												(771)-				(771)-																
H2915	1	0	1	1	1	H2915_001_0	3	1	2	1	07/08/2019	2020.01	07/08/2019 02:11:36 PM Eastern Daylight Time	07/15/2019 10:46:37 AM Pacific Daylight Time	07/15/2019 10:12:05 AM Pacific Daylight Time			07/15/2019 04:03:56 PM Pacific Daylight Time	"PENNSYLVANIA HEALTH & WELLNESS, INC."	Allwell	allwell.pahealthwellness.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H2915	1	0	2020	Western PA Counties		2		2			1	3		1		1	allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	2	0	1	1	1	H2915_002_0	3	1	2	1	07/08/2019	2020.01	07/08/2019 02:12:18 PM Eastern Daylight Time	07/15/2019 10:46:44 AM Pacific Daylight Time	07/15/2019 10:11:57 AM Pacific Daylight Time			07/15/2019 04:03:56 PM Pacific Daylight Time	"PENNSYLVANIA HEALTH & WELLNESS, INC."	Allwell	allwell.pahealthwellness.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H2915	2	0	2020	Southeastern PA Counties		2		2			1	3		1		1	allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	3	0	1	1	1	H2915_003_0	5	1			08/01/2019	2020.01	08/01/2019 01:14:07 PM Eastern Daylight Time	08/05/2019 04:16:41 PM Central Daylight Time	08/05/2019 03:12:28 PM Central Daylight Time			08/06/2019 12:18:26 PM Central Daylight Time	"PENNSYLVANIA HEALTH & WELLNESS, INC."	Allwell	allwell.pahealthwellness.com	Allwell Medicare (HMO)	1	1		1			H2915	3	0	2020	Western PA Counties		2		2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	6	0	1	1	1	H2915_006_0	3	1			08/01/2019	2020.01	08/01/2019 01:14:44 PM Eastern Daylight Time	08/05/2019 04:16:38 PM Central Daylight Time	08/05/2019 03:12:25 PM Central Daylight Time			08/06/2019 12:18:26 PM Central Daylight Time	"PENNSYLVANIA HEALTH & WELLNESS, INC."	Allwell	allwell.pahealthwellness.com	Allwell Medicare (HMO)	1	1		1			H2915	6	0	2020	Eastern PA Counties		2		2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	7	0	1	1	1	H2915_007_0	2	1	2	1	07/08/2019	2020.01	07/08/2019 02:12:58 PM Eastern Daylight Time	07/15/2019 10:46:31 AM Pacific Daylight Time	07/15/2019 10:11:59 AM Pacific Daylight Time			07/15/2019 04:03:56 PM Pacific Daylight Time	"PENNSYLVANIA HEALTH & WELLNESS, INC."	Allwell	allwell.pahealthwellness.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H2915	7	0	2020	Central PA Counties		2		2			1	3		1		1	allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(866)330-9368		(866)330-9368		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2915	801	0	1	1	1	H2915_801_0	2	1			05/03/2019	2020.01	05/03/2019 12:58:29 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"PENNSYLVANIA HEALTH & WELLNESS, INC."	Allwell	allwell.pahealthwellness.com	Allwell Group (HMO)	1	1		1			H2915	801	0	2020	Pennsylvania		1	100	2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2915	802	0	1	1	1	H2915_802_0	2	1			05/03/2019	2020.01	05/03/2019 12:58:41 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"PENNSYLVANIA HEALTH & WELLNESS, INC."	Allwell	allwell.pahealthwellness.com	Allwell Group (HMO)	1	1		1			H2915	802	0	2020	Pennsylvania		1	100	2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2915	803	0	1	1	1	H2915_803_0	2	1			05/03/2019	2020.01	05/03/2019 12:58:53 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"PENNSYLVANIA HEALTH & WELLNESS, INC."	Allwell	allwell.pahealthwellness.com	Allwell Group (HMO)	1	1		1			H2915	803	0	2020	Pennsylvania		1	100	2			2						allwell.pahealthwellness.com/findadoctor	allwell.pahealthwellness.com/formulary	allwell.pahealthwellness.com/findadoctor	(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(855)766-1456		(855)766-1456		(877)891-6103		(877)891-6103		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H2926	1	0	1	1	1	H2926_001_0	3	1	2	1	07/25/2019	2020.01	07/25/2019 09:06:23 AM Central Daylight Time	07/31/2019 09:33:15 AM Central Daylight Time	07/31/2019 09:35:56 AM Central Daylight Time			07/31/2019 09:51:32 AM Central Daylight Time	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	PrimeWest Health	www.primewest.org/phc	Prime Health Complete (HMO D-SNP)	1	1		1			H2926	1	0	2020	"Northern, west central, and southwestern Minnesota"		2	2088	2			1	3		1		1	https://primewest.org/drug-search	https://primewest.org/pharmacy-search	https://www.primewest.org/find-a-health-care-provider	(877)600-4913		(320)335-5243		(877)600-4913		(320)335-5243		(877)600-4913		(320)335-5243		(877)600-4913		(320)335-5243		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H2936	1	0	1	20	8	H2936_001_0	1	1			05/15/2019	2020.01	05/15/2019 08:36:53 AM Eastern Daylight Time		05/15/2019 08:33:03 AM Eastern Daylight Time			05/15/2019 08:38:15 AM Eastern Daylight Time	LIFECIRCLES	LIFECIRCLES	http:www.lifecircles-pace.org	LifeCircles (PACE)	8	20		1			H2936	1	0	2020	"Muskegon, Ottawa, Allegan"		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	2	0	1	20	8	H2936_002_0	1	1			05/15/2019	2020.01	05/15/2019 08:37:08 AM Eastern Daylight Time		05/15/2019 08:33:13 AM Eastern Daylight Time			05/15/2019 08:38:15 AM Eastern Daylight Time	LIFECIRCLES	LIFECIRCLES	http:www.lifecircles-pace.org	002 - Medicare Only (PACE)	8	20		1			H2936	2	0	2020	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	1	0	1	20	8	H2937_001_0	1	1			05/20/2019	2020.01	05/20/2019 02:11:54 PM Eastern Daylight Time		05/20/2019 01:05:05 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"SENIOR LIFE GREENSBURG, INC."	"Senior LIFE Greensburg, Inc."	www.seniorlifepa.com	Senior LIFE Greensburg Dual Eligible (PACE)	8	20		1			H2937	1	0	2020	Westmoreland County		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2937	2	0	1	20	8	H2937_002_0	1	1			05/20/2019	2020.01	05/20/2019 02:12:05 PM Eastern Daylight Time		05/20/2019 01:04:59 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"SENIOR LIFE GREENSBURG, INC."	"Senior LIFE Greensburg, Inc."	www.Seniorlifegreensburg.com	Senior LIFE Greensburg Medicare Only (PACE)	8	20		1			H2937	2	0	2020	Westmoreland County		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2941	1	0	1	20	8	H2941_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:09:03 PM Eastern Daylight Time		05/22/2019 12:52:01 PM Eastern Daylight Time			05/22/2019 01:13:58 PM Eastern Daylight Time	"SENTARA LIFE CARE CORPORATION, INC"	Sentara PACE	www.sentara.com/pace	Sentara Senior Community Care Dual (PACE)	8	20		1			H2941	1	0	2020	South Hampton Roads Area		2		2			2						www.sentara.com	www.sentara.com										(800)736-8272		(757)892-5400		(800)736-8272		(757)892-5400										(844)359-0862		(757)390-4049		(844)359-0862		(757)390-4049																
H2941	2	0	1	20	8	H2941_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:09:26 PM Eastern Daylight Time		05/22/2019 12:52:26 PM Eastern Daylight Time			05/22/2019 01:13:58 PM Eastern Daylight Time	"SENTARA LIFE CARE CORPORATION, INC"	Sentara PACE	www.sentara.com/pace	Sentara Senior Community Care Private (PACE)	8	20		1			H2941	2	0	2020	South Hampton Roads area		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	13	0	1	9	4	H2944_013_0	5	1			07/15/2019	2020.01	07/15/2019 10:58:53 AM Eastern Daylight Time	08/02/2019 09:33:30 AM Eastern Daylight Time	08/02/2019 01:18:12 PM Eastern Daylight Time			08/05/2019 10:50:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H2944-013 (PFFS)	4	9	3	1			H2944	13	0	2020	"Select Counties in KS, MO and OK"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2944	114	0	1	9	4	H2944_114_0	4	1			07/15/2019	2020.01	07/15/2019 11:01:05 AM Eastern Daylight Time	08/04/2019 11:34:07 AM Eastern Daylight Time	08/02/2019 01:18:12 PM Eastern Daylight Time			08/05/2019 10:50:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H2944-114 (PFFS)	4	9	3	1			H2944	114	0	2020	Select Counties in Georgia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2944	127	0	1	9	4	H2944_127_0	3	1			07/15/2019	2020.01	07/15/2019 01:29:52 PM Eastern Daylight Time	08/04/2019 06:24:58 PM Eastern Daylight Time	08/02/2019 01:18:12 PM Eastern Daylight Time			08/05/2019 10:54:35 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H2944-127 (PFFS)	4	9	3	1			H2944	127	0	2020	Select Counties in Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2944	197	0	1	9	4	H2944_197_0	4	1			07/15/2019	2020.01	07/15/2019 10:59:42 AM Eastern Daylight Time	05/31/2019 02:39:38 PM Eastern Daylight Time				07/16/2019 05:28:45 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H2944-197 (PFFS)	4	9	3	1			H2944	197	0	2020	"Select Counties in KS, MO and OK"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H2960	4	0	1	1	1	H2960_004_0	4	1			08/02/2019	2020.01	08/02/2019 02:59:31 PM Pacific Daylight Time	08/02/2019 02:47:23 PM Pacific Daylight Time	08/02/2019 02:46:28 PM Pacific Daylight Time			08/02/2019 03:00:20 PM Pacific Daylight Time	"HOMETOWN HEALTH PLAN, INC."	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Enhanced Plan (HMO)	1	1		1			H2960	4	0	2020	"Washoe, Carson City Counties, NV"		2	72816	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	4b;9a1;9a2;9b;	
H2960	9	0	1	1	1	H2960_009_0	3	1			07/09/2019	2020.01	07/09/2019 02:23:25 PM Pacific Daylight Time	06/03/2019 09:20:10 AM Pacific Daylight Time				07/10/2019 11:11:22 AM Pacific Daylight Time	"HOMETOWN HEALTH PLAN, INC."	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Basic Plan (HMO)	1	1		1			H2960	9	0	2020	"Washoe, Carson City Counties, NV"		2	6348	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112										(711)-		(711)-		(711)-		(711)-										2					2					2	1	1	4b;9a1;9a2;9b;	
H2960	12	0	1	1	1	H2960_012_0	5	1			08/02/2019	2020.01	08/02/2019 02:59:42 PM Pacific Daylight Time	08/02/2019 02:47:23 PM Pacific Daylight Time	08/02/2019 02:46:28 PM Pacific Daylight Time			08/02/2019 03:02:09 PM Pacific Daylight Time	"HOMETOWN HEALTH PLAN, INC."	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Plan (HMO)	1	1		1			H2960	12	0	2020	"Washoe, Carson City Counties, NV"		2	120552	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	4b;9a1;9a2;9b;	
H2960	18	0	1	1	1	H2960_018_0	4	1			08/02/2019	2020.01	08/02/2019 02:59:50 PM Pacific Daylight Time	08/02/2019 02:47:23 PM Pacific Daylight Time	08/02/2019 02:46:28 PM Pacific Daylight Time			08/02/2019 03:03:30 PM Pacific Daylight Time	"HOMETOWN HEALTH PLAN, INC."	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Select (HMO)	1	1		1			H2960	18	0	2020	"Washoe, Carson City Counties, NV"		2	11652	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	4b;9a1;9a2;9b;	
H2960	19	0	1	1	1	H2960_019_0	4	1			08/02/2019	2020.01	08/02/2019 02:59:58 PM Pacific Daylight Time	08/02/2019 02:47:23 PM Pacific Daylight Time	08/02/2019 02:46:28 PM Pacific Daylight Time			08/02/2019 03:04:51 PM Pacific Daylight Time	"HOMETOWN HEALTH PLAN, INC."	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Complete (HMO)	1	1		1			H2960	19	0	2020	Clark and Nye Counties		2	15648	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(702)914-0863		(888)775-7003		(702)914-0863		(800)681-9585		(800)681-9585		(888)775-7003		(702)914-0863		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	4b;	
H2960	803	0	1	1	1	H2960_803_0	2	1			07/09/2019	2020.01	07/09/2019 02:11:50 PM Pacific Daylight Time					07/10/2019 11:18:46 AM Pacific Daylight Time	"HOMETOWN HEALTH PLAN, INC."	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Group Plan (HMO)	1	1		1			H2960	803	0	2020	State of Nevada		1	3336	2			2						www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3112		(800)681-9585		(800)681-9585		(888)775-7003		(775)982-3112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	1	0	1	1	1	H2962_001_0	12	1			07/19/2019	2020.01	07/19/2019 02:17:51 PM Eastern Daylight Time	08/02/2019 04:47:30 PM Eastern Daylight Time	08/01/2019 04:25:10 PM Eastern Daylight Time			08/04/2019 02:21:34 PM Eastern Daylight Time	"ULTIMATE HEALTH PLANS, INC."	Ultimate Health Plans	www.chooseultimate.com	Premier by Ultimate (HMO)	1	1		1			H2962	1	0	2020	Hernando County		2	43074	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	11	0	1	1	1	H2962_011_0	11	1			07/19/2019	2020.01	07/19/2019 02:18:00 PM Eastern Daylight Time	08/02/2019 04:48:28 PM Eastern Daylight Time	08/01/2019 04:26:32 PM Eastern Daylight Time			08/04/2019 02:21:34 PM Eastern Daylight Time	"ULTIMATE HEALTH PLANS, INC."	Ultimate Health Plans	www.chooseultimate.com	Acclaim by Ultimate (HMO)	1	1		1			H2962	11	0	2020	"Pinellas County, Florida"		2	5217	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	12	0	1	1	1	H2962_012_0	11	1			07/19/2019	2020.01	07/19/2019 02:20:57 PM Eastern Daylight Time	08/02/2019 04:49:22 PM Eastern Daylight Time	08/01/2019 04:27:27 PM Eastern Daylight Time			08/04/2019 02:21:34 PM Eastern Daylight Time	"ULTIMATE HEALTH PLANS, INC."	Ultimate Health Plans	www.chooseultimate.com	Acclaim Plus by Ultimate (HMO)	1	1		1			H2962	12	0	2020	"Pinellas County, Florida"		2	3470	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	13	3	1	1	1	H2962_013_3	11	1			07/19/2019	2020.01	07/19/2019 02:21:10 PM Eastern Daylight Time	08/02/2019 04:53:37 PM Eastern Daylight Time	08/01/2019 05:30:08 PM Eastern Daylight Time			08/04/2019 02:21:34 PM Eastern Daylight Time	"ULTIMATE HEALTH PLANS, INC."	Ultimate Health Plans	www.chooseultimate.com	Elite by Ultimate (HMO)	1	1		1			H2962	13	3	2020	"Citrus and Pasco Counties, FL"	Pasco County	2	17349	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	13	4	1	1	1	H2962_013_4	11	1			07/19/2019	2020.01	07/19/2019 02:21:20 PM Eastern Daylight Time	08/02/2019 04:54:36 PM Eastern Daylight Time	08/01/2019 05:30:51 PM Eastern Daylight Time			08/04/2019 02:21:34 PM Eastern Daylight Time	"ULTIMATE HEALTH PLANS, INC."	Ultimate Health Plans	www.chooseultimate.com	Elite by Ultimate (HMO)	1	1		1			H2962	13	4	2020	"Citrus and Pasco Counties, FL"	Citrus County	2	14358	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	14	1	1	1	1	H2962_014_1	11	1			07/19/2019	2020.01	07/19/2019 02:21:28 PM Eastern Daylight Time	08/02/2019 04:55:24 PM Eastern Daylight Time	08/01/2019 05:31:33 PM Eastern Daylight Time			08/04/2019 02:21:34 PM Eastern Daylight Time	"ULTIMATE HEALTH PLANS, INC."	Ultimate Health Plans	www.chooseultimate.com	Premier Plus by Ultimate (HMO)	1	1		1			H2962	14	1	2020	"Citrus, Hernando and Pasco Counties, FL"	Hernando and Pasco Counties	2	8232	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	14	2	1	1	1	H2962_014_2	11	1			07/19/2019	2020.01	07/19/2019 02:21:39 PM Eastern Daylight Time	08/02/2019 04:56:15 PM Eastern Daylight Time	08/01/2019 05:32:12 PM Eastern Daylight Time			08/04/2019 02:21:34 PM Eastern Daylight Time	"ULTIMATE HEALTH PLANS, INC."	Ultimate Health Plans	www.chooseultimate.com	Premier Plus by Ultimate (HMO)	1	1		1			H2962	14	2	2020	"Citrus, Hernando and Pasco Counties, FL"	Citrus County	2	646	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	16	0	1	1	1	H2962_016_0	12	1			07/19/2019	2020.01	07/19/2019 02:21:48 PM Eastern Daylight Time	08/05/2019 09:01:01 AM Eastern Daylight Time	08/05/2019 09:05:07 AM Eastern Daylight Time			08/05/2019 09:08:01 AM Eastern Daylight Time	"ULTIMATE HEALTH PLANS, INC."	Ultimate Health Plans	www.chooseultimate.com	Ascend Plus by Ultimate (HMO)	1	1		1			H2962	16	0	2020	"Marion County, FL"		2	3721	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	18	0	1	1	1	H2962_018_0	13	1			07/19/2019	2020.01	07/19/2019 02:21:57 PM Eastern Daylight Time	08/05/2019 09:03:15 AM Eastern Daylight Time	08/05/2019 09:06:46 AM Eastern Daylight Time			08/05/2019 09:08:01 AM Eastern Daylight Time	"ULTIMATE HEALTH PLANS, INC."	Ultimate Health Plans	www.chooseultimate.com	Ascend Plus by Ultimate (HMO)	1	1		1			H2962	18	0	2020	"Sumter County, FL"		2	3721	2			2						www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	19	1	1	1	1	H2962_019_1	12	1		1	07/19/2019	2020.01	07/19/2019 02:22:30 PM Eastern Daylight Time	08/02/2019 04:57:12 PM Eastern Daylight Time	08/01/2019 05:32:54 PM Eastern Daylight Time			08/04/2019 02:21:34 PM Eastern Daylight Time	"ULTIMATE HEALTH PLANS, INC."	Ultimate Health Plans	www.chooseultimate.com	Advantage Care by Ultimate (HMO C-SNP)	1	1		1			H2962	19	1	2020	Hernando and Pasco Counties in Florida	"Hernando County, FL"	2	16703	2			1	4			1000		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	19	2	1	1	1	H2962_019_2	12	1		1	07/19/2019	2020.01	07/19/2019 02:22:38 PM Eastern Daylight Time	08/02/2019 04:58:02 PM Eastern Daylight Time	08/01/2019 05:33:29 PM Eastern Daylight Time			08/04/2019 02:21:34 PM Eastern Daylight Time	"ULTIMATE HEALTH PLANS, INC."	Ultimate Health Plans	www.chooseultimate.com	Advantage Care by Ultimate (HMO C-SNP)	1	1		1			H2962	19	2	2020	Hernando and Pasco Counties in Florida	"Pasco County, FL"	2	3960	2			1	4			1000		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2962	21	0	1	1	1	H2962_021_0	11	1		1	07/19/2019	2020.01	07/19/2019 02:22:50 PM Eastern Daylight Time	08/02/2019 04:52:39 PM Eastern Daylight Time	08/01/2019 04:35:22 PM Eastern Daylight Time			08/04/2019 02:21:34 PM Eastern Daylight Time	"ULTIMATE HEALTH PLANS, INC."	Ultimate Health Plans	www.chooseultimate.com	Advantage Care by Ultimate (HMO C-SNP)	1	1		1			H2962	21	0	2020	"Citrus County, FL"		2	3984	2			1	4			1000		www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)277-5370		(800)311-7517		(402)965-8418		(855)858-7526		(352)277-5370		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	1	0	1	1	1	H2986_001_0	17	1			07/16/2019	2020.01	07/16/2019 12:47:28 PM Pacific Daylight Time	08/05/2019 11:06:08 AM Pacific Daylight Time	08/05/2019 11:06:12 AM Pacific Daylight Time			08/05/2019 11:12:24 AM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Platinum (HMO)	1	1		1			H2986	1	0	2020	Santa Clara County		2	26380	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)878-2636		(844)878-2636		(800)243-2051		(800)243-2051		(844)878-2636		(844)878-2636		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	2	0	1	1	1	H2986_002_0	17	1			07/16/2019	2020.01	07/16/2019 12:58:42 PM Pacific Daylight Time	08/05/2019 11:06:16 AM Pacific Daylight Time	08/05/2019 11:06:18 AM Pacific Daylight Time			08/05/2019 11:12:24 AM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Gold (HMO)	1	1		1			H2986	2	0	2020	Santa Clara County		2	4314	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)878-2636		(844)878-2636		(800)243-2051		(800)243-2051		(844)878-2636		(844)878-2636		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	4	0	1	1	1	H2986_004_0	16	1			07/16/2019	2020.01	07/16/2019 12:58:08 PM Pacific Daylight Time	08/05/2019 11:06:21 AM Pacific Daylight Time	08/05/2019 11:06:24 AM Pacific Daylight Time			08/05/2019 11:12:24 AM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Platinum (HMO)	1	1		1			H2986	4	0	2020	Alameda County		2	26380	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)878-2636		(844)878-2636		(800)243-2051		(800)243-2051		(844)878-2636		(844)878-2636		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	5	0	1	1	1	H2986_005_0	17	1			07/16/2019	2020.01	07/16/2019 01:00:15 PM Pacific Daylight Time	08/05/2019 11:06:27 AM Pacific Daylight Time	08/05/2019 11:06:30 AM Pacific Daylight Time			08/05/2019 11:12:24 AM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Gold (HMO)	1	1		1			H2986	5	0	2020	Alameda County		2	4314	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)878-2636		(844)878-2636		(800)243-2051		(800)243-2051		(844)878-2636		(844)878-2636		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	6	0	1	1	1	H2986_006_0	17	1			07/16/2019	2020.01	07/16/2019 01:02:04 PM Pacific Daylight Time	08/05/2019 11:06:33 AM Pacific Daylight Time	08/05/2019 11:06:36 AM Pacific Daylight Time			08/05/2019 11:12:24 AM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Platinum (HMO)	1	1		1			H2986	6	0	2020	San Mateo County		2	26380	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)878-2636		(844)878-2636		(800)243-2051		(800)243-2051		(844)878-2636		(844)878-2636		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	7	0	1	1	1	H2986_007_0	17	1			07/16/2019	2020.01	07/16/2019 01:03:49 PM Pacific Daylight Time	08/05/2019 11:06:39 AM Pacific Daylight Time	08/05/2019 11:06:42 AM Pacific Daylight Time			08/05/2019 11:12:24 AM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage - Gold (HMO)	1	1		1			H2986	7	0	2020	San Mateo County		2	4314	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)878-2636		(844)878-2636		(800)243-2051		(800)243-2051		(844)878-2636		(844)878-2636		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H2986	801	0	1	1	1	H2986_801_0	12	1			06/02/2019	2020.01	06/02/2019 11:20:37 AM Pacific Daylight Time					06/03/2019 06:38:42 PM Pacific Daylight Time	STANFORD HEALTHCARE ADVANTAGE	Stanford Health Care Advantage	www.StanfordHealthCareAdvantage.org	Stanford Health Care Advantage (HMO)	1	1		1			H2986	801	0	2020	"Alameda, Santa Clara, San Mateo counties"		1	300	2			2						www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	www.StanfordHealthCareAdvantage.org	(855)996-8422		(855)996-8422		(844)878-2636		(844)878-2636		(800)243-2051		(800)243-2051		(844)878-2636		(844)878-2636		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H2992	1	0	1	20	8	H2992_001_0	1	1			05/20/2019	2020.01	05/20/2019 02:12:23 PM Eastern Daylight Time		05/20/2019 01:04:49 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"SENIORLIFE WASHINGTON, INC."	Senior LIFE Washington / Uniontown / Greene	www.seniorlifepa.com	Senior LIFE Washington Dual Eligible (PACE)	8	20		1			H2992	1	0	2020	Washington and Greene Counties		2		2			2						http://granerx.com/	None										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2992	2	0	1	20	8	H2992_002_0	1	1			05/20/2019	2020.01	05/20/2019 02:12:34 PM Eastern Daylight Time		05/20/2019 01:04:43 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"SENIORLIFE WASHINGTON, INC."	Senior LIFE Washington / Uniontown / Greene	www.seniorlifewashington.com	Senior LIFE Washington Medicare Only (PACE)	8	20		1			H2992	2	0	2020	Washington and Greene Counties		2		2			2						http://granerx.com/	None										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2992	3	0	1	20	8	H2992_003_0	1	1			05/20/2019	2020.01	05/20/2019 02:12:47 PM Eastern Daylight Time		05/20/2019 01:04:42 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"SENIORLIFE WASHINGTON, INC."	Senior LIFE Washington / Uniontown / Greene	www.seniorlifeuniontown.com	Senior LIFE Uniontown Dual Eligible (PACE)	8	20		1			H2992	3	0	2020	Fayette County		2		2			2						http://granerx.com/	None										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H2992	4	0	1	20	8	H2992_004_0	1	1			05/20/2019	2020.01	05/20/2019 02:12:57 PM Eastern Daylight Time		05/20/2019 01:04:41 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"SENIORLIFE WASHINGTON, INC."	Senior LIFE Washington / Uniontown / Greene	www.seniorlifeuniontown.com	Senior LIFE Uniontown Medicare Only (PACE)	8	20		1			H2992	4	0	2020	Fayette County		2		2			2						http://granerx.com/	None										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H3060	1	0	1	20	8	H3060_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:22:07 PM Eastern Daylight Time		05/22/2019 11:29:13 AM Eastern Daylight Time			05/22/2019 01:27:47 PM Eastern Daylight Time	"VIECARE BUTLER, LLC"	LIFE Butler County	www.lutheranseniorlife.org	"VieCare Butler, LLC dba LIFE Butler County (PACE)"	8	20		1			H3060	1	0	2020	Butler County		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)287-5433				(724)287-5433												(711)-				(711)-																
H3060	2	0	1	20	8	H3060_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:22:29 PM Eastern Daylight Time		05/22/2019 11:30:09 AM Eastern Daylight Time			05/22/2019 01:27:47 PM Eastern Daylight Time	"VIECARE BUTLER, LLC"	LIFE Butler County	www.lutheranseniorlife.org	"VieCare Butler, LLC dba LIFE Butler County (PACE)"	8	20		1			H3060	2	0	2020	Butler County		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)287-5433				(724)287-5433												(711)-				(711)-																
H3071	2	0	1	1	1	H3071_002_0	4	1			06/01/2019	2020.01	06/01/2019 10:17:01 AM Central Daylight Time	08/06/2019 09:42:23 AM Central Daylight Time	08/06/2019 09:43:10 AM Central Daylight Time			08/06/2019 11:22:10 AM Central Daylight Time	"COMMUNITY CARE ALLIANCE OF ILLINOIS, NFP"	Community Care Alliance of Illinois	www.ccaillinois.com/medicare	Community Advantage (HMO)	1	1		1			H3071	2	0	2020	"Rockford Area, Chicago Area"		2	41274	2			2						www.ccaillinois.com/medicare	www.ccaillinois.com/medicare	www.ccaillinois.com/medicare	(855)275-2781		(855)275-2781		(855)275-2781		(855)275-2781		(888)232-8479		(888)232-8479		(855)275-2781		(855)275-2781		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3071	3	0	1	2	1	H3071_003_0	4	1			08/05/2019	2020.01	08/05/2019 11:32:59 AM Central Daylight Time	08/06/2019 09:43:51 AM Central Daylight Time	08/06/2019 09:44:25 AM Central Daylight Time			08/06/2019 11:22:10 AM Central Daylight Time	"COMMUNITY CARE ALLIANCE OF ILLINOIS, NFP"	Community Care Alliance of Illinois	www.ccaillinois.com/medicare	Community Flex-Plan (HMO-POS)	1	2		1			H3071	3	0	2020	"Rockford Area, Chicago Area"		2	32548	2			2						www.ccaillinois.com/medicare	www.ccaillinois.com/medicare	www.ccaillinois.com/medicare	(855)275-2781		(855)275-2781		(855)275-2781		(855)275-2781		(888)232-8479		(888)232-8479		(855)275-2781		(855)275-2781		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3084	1	0	1	20	8	H3084_001_0	2	1			05/22/2019	2020.01	05/22/2019 10:22:54 AM Pacific Daylight Time		05/31/2019 11:46:44 AM Pacific Daylight Time			05/31/2019 11:48:49 AM Pacific Daylight Time	INTERNATIONAL COMMUNITY HEALTH SERVICES(ICHS)	International Community Health Services	www.ichs.com	ICHS PACE - Dual Eligible (PACE)	8	20		1			H3084	1	0	2020	Parts of King County		2		2			2						"www.ichs,com"	NA												(206)462-7189				(206)462-7189												(206)788-3774				(206)788-3774																
H3084	2	0	1	20	8	H3084_002_0	2	1			05/22/2019	2020.01	05/22/2019 10:23:41 AM Pacific Daylight Time		05/31/2019 11:42:52 AM Pacific Daylight Time			05/31/2019 11:48:49 AM Pacific Daylight Time	INTERNATIONAL COMMUNITY HEALTH SERVICES(ICHS)	International Community Health Services	www.ichs.com	ICHS PACE - Medicare Only (PACE)	8	20		1			H3084	2	0	2020	Parts of King County		2		2			2						"www.ichs,com"	NA												(206)462-7189				(206)462-7189												(206)788-3774				(206)788-3774																
H3113	1	0	1	1	1	H3113_001_0	2	1		1	05/15/2019	2020.01	05/15/2019 02:13:43 PM Central Daylight Time	08/02/2019 01:02:59 PM Central Daylight Time	07/30/2019 08:11:41 PM Central Daylight Time			08/05/2019 05:22:41 PM Central Daylight Time	"OXFORD HEALTH PLANS (NJ), INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO I-SNP)	1	1		1			H3113	1	0	2020	Northern and Central New Jersey		2		2			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	2			
H3113	5	0	1	1	1	H3113_005_0	3	1	2	1	07/11/2019	2020.01	07/11/2019 09:51:26 AM Central Daylight Time	08/02/2019 01:03:33 PM Central Daylight Time	07/30/2019 08:12:18 PM Central Daylight Time			08/06/2019 12:14:20 PM Central Daylight Time	"OXFORD HEALTH PLANS (NJ), INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO D-SNP)	1	1		1			H3113	5	0	2020	Select counties in New Jersey		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)514-4911		(800)514-4911		(888)834-3721		(888)834-3721		(800)514-4911		(800)514-4911		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3113	8	0	1	1	1	H3113_008_0	3	1		1	07/17/2019	2020.01	07/17/2019 10:08:19 AM Central Daylight Time	08/02/2019 01:04:13 PM Central Daylight Time	07/30/2019 08:12:53 PM Central Daylight Time			08/05/2019 05:22:41 PM Central Daylight Time	"OXFORD HEALTH PLANS (NJ), INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO I-SNP)	1	1		1			H3113	8	0	2020	Lane County		2		2			1	1	2				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	2			
H3113	9	0	1	1	1	H3113_009_0	2	1	2	1	08/05/2019	2020.01	08/05/2019 11:37:53 AM Central Daylight Time	08/02/2019 01:04:51 PM Central Daylight Time	07/30/2019 08:13:30 PM Central Daylight Time			08/06/2019 12:14:20 PM Central Daylight Time	"OXFORD HEALTH PLANS (NJ), INC."	UnitedHealthcare	www.UHC.com/PADual	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H3113	9	0	2020	Select counties in Pennsylvania		2		2			1	3		1		1	www.UHC.com/PADual	www.UHC.com/PADual	www.UHC.com/PADual	(800)290-4009		(800)290-4009		(888)834-3721		(888)834-3721		(800)290-4009		(800)290-4009		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3113	10	0	1	1	1	H3113_010_0	3	1	2	1	07/11/2019	2020.01	07/11/2019 05:31:21 PM Central Daylight Time	08/02/2019 01:05:24 PM Central Daylight Time	07/30/2019 08:14:10 PM Central Daylight Time			08/06/2019 12:14:20 PM Central Daylight Time	"OXFORD HEALTH PLANS (NJ), INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H3113	10	0	2020	State of Rhode Island		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3113	11	0	1	1	1	H3113_011_0	2	1	2	1	08/02/2019	2020.01	08/02/2019 09:06:44 AM Central Daylight Time	08/02/2019 01:05:58 PM Central Daylight Time	07/30/2019 08:14:43 PM Central Daylight Time			08/06/2019 12:14:20 PM Central Daylight Time	"OXFORD HEALTH PLANS (NJ), INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H3113	11	0	2020	"Kent, New Castle, and Sussex Counties"		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)262-9919		(866)262-9919		(888)834-3721		(888)834-3721		(866)262-9919		(866)262-9919		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3132	1	0	1	1	1	H3132_001_0	5	1		1	07/02/2019	2020.01	07/02/2019 10:41:05 AM Pacific Daylight Time	08/02/2019 03:07:48 PM Pacific Daylight Time	08/02/2019 03:07:47 PM Pacific Daylight Time			08/02/2019 03:09:46 PM Pacific Daylight Time	"AHF MCO OF FLORIDA, INC."	AHF	www.php-fl.org	PHP (HMO C-SNP)	1	1		1			H3132	1	0	2020	"Broward, Miami-Dade and Duval Counties, Florida"		2		2			1	4			1000000000		www.php-fl.org/provider-find	www.php-fl.org/for-members/drug-benefit/formulary	www.php-fl.org/provider-find	(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	2			
H3146	1	0	1	1	1	H3146_001_0	3	1			08/01/2019	2020.01	08/01/2019 10:16:59 AM Eastern Daylight Time	08/01/2019 05:22:31 PM Eastern Daylight Time	07/30/2019 10:14:59 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3146	1	0	2020	Charlotte NC and Surrounding Area		2	31500	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	2	0	1	1	1	H3146_002_0	3	1	2	1	07/03/2019	2020.01	07/03/2019 01:05:58 PM Eastern Daylight Time	08/01/2019 05:23:34 PM Eastern Daylight Time	07/30/2019 10:16:10 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plan (HMO D-SNP)	1	1		1			H3146	2	0	2020	Triangle NC Area		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	3	0	1	1	1	H3146_003_0	3	1	2	1	07/03/2019	2020.01	07/03/2019 01:07:31 PM Eastern Daylight Time	08/01/2019 05:24:29 PM Eastern Daylight Time	07/30/2019 10:17:20 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Plan (HMO D-SNP)	1	1		1			H3146	3	0	2020	Triad NC Area		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3146	801	0	1	1	1	H3146_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:40:22 AM Eastern Daylight Time					05/30/2019 06:10:42 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H3146	801	0	2020	North Carolina		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3146	802	0	1	1	1	H3146_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:40:32 AM Eastern Daylight Time					05/30/2019 06:10:42 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H3146	802	0	2020	North Carolina		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3146	803	0	1	1	1	H3146_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:40:43 AM Eastern Daylight Time					05/30/2019 06:10:42 PM Eastern Daylight Time	AETNA BETTER HEALTH INC. (GA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H3146	803	0	2020	North Carolina		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3152	22	0	1	1	1	H3152_022_0	4	1			07/03/2019	2020.01	07/03/2019 07:47:19 PM Eastern Daylight Time	08/01/2019 05:40:07 PM Eastern Daylight Time	07/30/2019 10:18:32 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier (HMO)	1	1		1			H3152	22	0	2020	"Counties: ATL, BUR, CAM, CPM, CUM, GLO, SLM"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	45	0	1	1	1	H3152_045_0	2	1			07/03/2019	2020.01	07/03/2019 07:47:26 PM Eastern Daylight Time	05/30/2019 09:37:18 AM Eastern Daylight Time				07/03/2019 08:46:21 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Core Value (HMO)	1	1		1			H3152	45	0	2020	New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3152	48	0	1	1	1	H3152_048_0	3	1			07/03/2019	2020.01	07/03/2019 07:47:33 PM Eastern Daylight Time	08/01/2019 05:42:17 PM Eastern Daylight Time	07/30/2019 10:19:43 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier Plus (HMO)	1	1		1			H3152	48	0	2020	Northern New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	80	0	1	1	1	H3152_080_0	3	1			08/01/2019	2020.01	08/01/2019 03:07:50 PM Eastern Daylight Time	08/01/2019 05:49:14 PM Eastern Daylight Time	07/30/2019 10:20:57 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Value (HMO)	1	1		1			H3152	80	0	2020	"Counties: HUN, MRS, PAS, SOM, SSX, UNN, WRN"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	82	0	1	1	1	H3152_082_0	3	1			07/31/2019	2020.01	07/31/2019 05:44:01 PM Eastern Daylight Time	08/01/2019 05:51:11 PM Eastern Daylight Time	07/30/2019 10:22:09 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Value (HMO)	1	1		1			H3152	82	0	2020	"Middlesex, Monmouth and Ocean counties"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	84	0	1	1	1	H3152_084_0	3	1			07/31/2019	2020.01	07/31/2019 05:44:48 PM Eastern Daylight Time	08/01/2019 05:53:32 PM Eastern Daylight Time	07/30/2019 10:23:22 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Elite (HMO)	1	1		1			H3152	84	0	2020	"Northern New Jersey, Southern New Jersey"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	88	0	1	1	1	H3152_088_0	3	1			07/31/2019	2020.01	07/31/2019 05:45:41 PM Eastern Daylight Time	08/01/2019 05:58:07 PM Eastern Daylight Time	07/30/2019 10:24:33 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Credit Value (HMO)	1	1		1			H3152	88	0	2020	New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	89	0	1	1	1	H3152_089_0	3	1			07/03/2019	2020.01	07/03/2019 07:47:42 PM Eastern Daylight Time	08/01/2019 06:03:53 PM Eastern Daylight Time	07/30/2019 10:25:45 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Premier (HMO)	1	1		1			H3152	89	0	2020	New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3152	801	0	1	1	1	H3152_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:40:57 AM Eastern Daylight Time					05/30/2019 06:22:32 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H3152	801	0	2020	New Jersey		1	179840	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3152	804	0	1	1	1	H3152_804_0	1	1			05/24/2019	2020.01	05/24/2019 09:41:09 AM Eastern Daylight Time					05/30/2019 06:22:32 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H3152	804	0	2020	New Jersey		1	11280	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3152	806	0	1	1	1	H3152_806_0	1	1			05/24/2019	2020.01	05/24/2019 09:41:21 AM Eastern Daylight Time					05/30/2019 06:22:32 PM Eastern Daylight Time	AETNA HEALTH INC. (NJ)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H3152	806	0	2020	New Jersey		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3154	4	0	1	1	1	H3154_004_0	9	1			07/17/2019	2020.01	07/17/2019 09:02:08 AM Eastern Daylight Time	08/05/2019 02:30:34 PM Eastern Daylight Time	08/05/2019 02:24:58 PM Eastern Daylight Time			08/05/2019 02:39:04 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Value w/Rx (HMO)	1	1		1			H3154	4	0	2020	"Cape May, Hudson, Salem, Union, Warren"		2	33583	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	13	0	1	1	1	H3154_013_0	6	1			07/17/2019	2020.01	07/17/2019 09:01:18 AM Eastern Daylight Time	07/25/2019 07:40:56 AM Eastern Daylight Time				07/25/2019 07:54:10 AM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Value (HMO)	1	1		1			H3154	13	0	2020	"Cape May, Hudson, Salem, Union, Warren"		2	2211	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3154	22	0	1	1	1	H3154_022_0	8	1			07/17/2019	2020.01	07/17/2019 09:01:32 AM Eastern Daylight Time	08/05/2019 02:31:21 PM Eastern Daylight Time	08/05/2019 02:25:26 PM Eastern Daylight Time			08/05/2019 02:39:04 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Choice w/Rx (HMO)	1	1		1			H3154	22	0	2020	11 Counties Throughout New Jersey		2	50420	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	29	0	1	1	1	H3154_029_0	8	1			08/01/2019	2020.01	08/01/2019 11:43:20 AM Eastern Daylight Time	08/05/2019 02:32:37 PM Eastern Daylight Time	08/05/2019 02:25:59 PM Eastern Daylight Time			08/05/2019 02:47:53 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Advantage (HMO)	1	1		1			H3154	29	0	2020	Ocean and Monmouth		2	56810	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	30	0	1	1	1	H3154_030_0	9	1			08/01/2019	2020.01	08/01/2019 11:44:11 AM Eastern Daylight Time	08/05/2019 02:33:49 PM Eastern Daylight Time	08/05/2019 02:26:42 PM Eastern Daylight Time			08/05/2019 02:39:04 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Advantage (HMO)	1	1		1			H3154	30	0	2020	Bergen Essex Hudson Mercer Middlesex Passaic Union		2	64391	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	31	0	1	1	1	H3154_031_0	8	1			08/01/2019	2020.01	08/01/2019 11:44:44 AM Eastern Daylight Time	08/05/2019 02:34:21 PM Eastern Daylight Time	08/05/2019 02:27:15 PM Eastern Daylight Time			08/05/2019 02:39:04 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Advantage (HMO)	1	1		1			H3154	31	0	2020	"Hunterdon, Somerset, Sussex, Warren"		2	23261	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	32	0	1	1	1	H3154_032_0	7	1			08/01/2019	2020.01	08/01/2019 11:45:11 AM Eastern Daylight Time	08/05/2019 02:35:52 PM Eastern Daylight Time	08/05/2019 02:28:01 PM Eastern Daylight Time			08/05/2019 02:39:04 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Advantage (HMO)	1	1		1			H3154	32	0	2020	"Atlantic, Cumberland, Morris"		2	14861	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	33	0	1	2	1	H3154_033_0	5	1			08/01/2019	2020.01	08/01/2019 11:45:39 AM Eastern Daylight Time	08/05/2019 02:36:35 PM Eastern Daylight Time	08/05/2019 02:28:33 PM Eastern Daylight Time			08/05/2019 02:39:04 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue Select (HMO-POS)	1	2		1			H3154	33	0	2020	Union County		2	1300	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3154	801	0	1	2	1	H3154_801_0	1	1			05/22/2019	2020.01	05/22/2019 12:42:07 PM Eastern Daylight Time					05/22/2019 02:25:06 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Access Group (HMO-POS)	1	2		1			H3154	801	0	2020	New Jersey		1	21993	2			2						https://medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1				
H3154	802	0	1	2	1	H3154_802_0	2	1			05/22/2019	2020.01	05/22/2019 12:42:14 PM Eastern Daylight Time					05/22/2019 02:25:06 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Access Group w/Rx (HMO-POS)	1	2		1			H3154	802	0	2020	New Jersey		1	6243	2			2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJHMOG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJHMOG/en/find-medicine.html	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1				
H3154	811	0	1	1	1	H3154_811_0	1	1			05/22/2019	2020.01	05/22/2019 12:42:21 PM Eastern Daylight Time					05/22/2019 02:25:06 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Advantage HMO10 (HMO)	1	1		1			H3154	811	0	2020	New Jersey		1	120	2			2						https://medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1					1				
H3154	812	0	1	2	1	H3154_812_0	1	1			05/22/2019	2020.01	05/22/2019 12:42:27 PM Eastern Daylight Time					05/22/2019 02:25:06 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Access Group w/Rx Value (HMO-POS)	1	2		1			H3154	812	0	2020	New Jersey		1	120	2			2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJHMOG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJHMOG/en/find-medicine.html	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1				
H3170	1	0	1	1	1	H3170_001_0	5	1			08/02/2019	2020.01	08/02/2019 12:44:50 PM Eastern Daylight Time	08/05/2019 03:23:54 PM Eastern Daylight Time	08/05/2019 03:23:55 PM Eastern Daylight Time			08/05/2019 03:49:29 PM Eastern Daylight Time	"SAPPHIRE EDGE, INC."	Blue Cross and Blue Shield of Nebraska	http://medicare.nebraskablue.com	Blue Cross Blue Shield Nebraska MA Core (HMO)	1	1		1			H3170	1	0	2020	Omaha/Lincoln Metro Area and Central Nebraska		2	13473	2			2						https://www.myprime.com/en/find-pharmacy.html	https://medicare.nebraskablue.com/MedicareAdvantage/RXCost	https://medicare.nebraskablue.com/MedicareAdvantage/FindADoc	(888)488-9850		(888)488-9850		(844)899-6060		(844)899-6060		(855)457-1349		(855)457-1349		(844)899-6060		(844)899-6060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-	1	2					2					2	2			
H3170	2	0	1	2	1	H3170_002_0	5	1			08/02/2019	2020.01	08/02/2019 12:48:07 PM Eastern Daylight Time	08/05/2019 03:23:54 PM Eastern Daylight Time	08/05/2019 03:23:55 PM Eastern Daylight Time			08/05/2019 03:49:29 PM Eastern Daylight Time	"SAPPHIRE EDGE, INC."	Blue Cross and Blue Shield of Nebraska	http://medicare.nebraskablue.com	Blue Cross Blue Shield Nebraska MA Choice (HMO-POS)	1	2		1			H3170	2	0	2020	Omaha/Lincoln Metro Area and Central Nebraska		2	7255	2			2						https://www.myprime.com/en/find-pharmacy.html	https://medicare.nebraskablue.com/MedicareAdvantage/RXCost	https://medicare.nebraskablue.com/MedicareAdvantage/FindADoc	(888)488-9850		(888)488-9850		(844)899-6060		(844)899-6060		(855)457-1349		(855)457-1349		(844)899-6060		(844)899-6060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3192	1	0	1	1	1	H3192_001_0	4	1			08/01/2019	2020.01	08/01/2019 09:41:50 AM Eastern Daylight Time	08/02/2019 11:20:31 AM Eastern Daylight Time	07/30/2019 10:26:57 PM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (HMO)	1	1		1			H3192	1	0	2020	Chicagoland		2	17448	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3192	2	0	1	1	1	H3192_002_0	4	1			07/31/2019	2020.01	07/31/2019 02:26:36 PM Eastern Daylight Time	08/02/2019 11:21:09 AM Eastern Daylight Time	07/30/2019 10:28:09 PM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	1	1		1			H3192	2	0	2020	Midland County		2	17448	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3192	3	0	1	1	1	H3192_003_0	4	1			07/31/2019	2020.01	07/31/2019 02:27:49 PM Eastern Daylight Time	08/02/2019 11:21:47 AM Eastern Daylight Time	07/30/2019 10:29:21 PM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	1	1		1			H3192	3	0	2020	Southeast Michigan		2	17448	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3192	801	0	1	1	1	H3192_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:41:34 AM Eastern Daylight Time					05/30/2019 06:25:57 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H3192	801	0	2020	Illinois and Michigan		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3192	802	0	1	1	1	H3192_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:41:44 AM Eastern Daylight Time					05/30/2019 06:25:57 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H3192	802	0	2020	Illinois and Michigan		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3192	803	0	1	1	1	H3192_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:41:55 AM Eastern Daylight Time					05/30/2019 06:25:57 PM Eastern Daylight Time	AETNA HEALTH OF MICHIGAN INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H3192	803	0	2020	Illinois and Michigan		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3204	1	0	1	1	1	H3204_001_0	8	1			07/18/2019	2020.01	07/18/2019 05:29:12 PM Mountain Daylight Time	08/01/2019 01:51:52 PM Mountain Daylight Time	07/30/2019 01:56:14 PM Mountain Daylight Time			08/05/2019 03:18:02 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Senior Care Plan 2 with Rx (HMO)	1	1		1			H3204	1	0	2020	"Greater Albuquerque Area, Rio Arriba and Santa Fe"		2	271469	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		2					2					2	2			
H3204	7	0	1	1	1	H3204_007_0	7	1			07/01/2019	2020.01	07/01/2019 02:06:07 PM Mountain Daylight Time	08/01/2019 03:48:58 PM Mountain Daylight Time	07/30/2019 01:56:42 PM Mountain Daylight Time			08/05/2019 03:18:02 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Senior Care Plan 3 with Rx (HMO)	1	1		1			H3204	7	0	2020	"Greater Albuquerque Area, Rio Arriba and Santa Fe"		2	46402	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		2					2					2	2			
H3204	8	0	1	1	1	H3204_008_0	5	1			07/01/2019	2020.01	07/01/2019 02:15:40 PM Mountain Daylight Time	07/18/2019 07:41:54 AM Mountain Daylight Time				07/18/2019 09:08:31 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Senior Care Plan 1 (HMO)	1	1		1			H3204	8	0	2020	"Greater Albuquerque Area, Rio Arriba and Santa Fe"		2	26511	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(800)659-8331		(711)-		(800)659-8331		(711)-										2					2					2	2			
H3204	12	0	1	1	1	H3204_012_0	8	1	2	1	08/05/2019	2020.01	08/05/2019 10:05:43 AM Mountain Daylight Time	08/01/2019 01:55:50 PM Mountain Daylight Time	07/30/2019 01:57:12 PM Mountain Daylight Time			08/05/2019 03:18:02 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Dual Plus (HMO D-SNP)	1	1		1			H3204	12	0	2020	"Bernalilo, Sandoval, Torrance, Valencia"		2	42104	2			1	3		2		2	www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		2					2					2	2			
H3204	801	0	1	1	1	H3204_801_0	1	1			06/03/2019	2020.01	06/03/2019 12:04:48 PM Mountain Daylight Time					06/03/2019 12:29:16 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Pres Senior Care Emp Group Plan 2 with Rx (HMO)	1	1		1			H3204	801	0	2020	"Greater Albuquerque Area, Rio Arriba and Santa Fe"		1	2100	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		1	1	1a;1b;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1					1				
H3204	802	0	1	1	1	H3204_802_0	1	1			06/03/2019	2020.01	06/03/2019 12:05:28 PM Mountain Daylight Time					06/03/2019 12:29:16 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Pres Senior Care Emp Group Plan 1 (HMO)	1	1		1			H3204	802	0	2020	"Greater Albuquerque Area, Rio Arriba and Santa Fe"		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(800)659-8331		(711)-		(800)659-8331		(711)-										1	1	1a;1b;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1					1				
H3204	803	0	1	1	1	H3204_803_0	1	1			06/03/2019	2020.01	06/03/2019 12:06:11 PM Mountain Daylight Time					06/03/2019 12:29:16 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Pres Senior Care Emp Group Plan 2 w/ Rx NC (HMO)	1	1		1			H3204	803	0	2020	"Greater Albuquerque Area, Rio Arriba and Santa Fe"		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		1	1	1a;1b;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1					1				
H3204	808	0	1	2	1	H3204_808_0	1	1			06/03/2019	2020.01	06/03/2019 12:06:39 PM Mountain Daylight Time					06/03/2019 12:29:16 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 5 (HMO-POS)	1	2		1			H3204	808	0	2020	State of New Mexico		1	111300	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		1	1	1a;1b;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1	2		2		1				
H3204	809	0	1	2	1	H3204_809_0	1	1			06/03/2019	2020.01	06/03/2019 12:07:51 PM Mountain Daylight Time					06/03/2019 12:29:16 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 6 (HMO-POS)	1	2		1			H3204	809	0	2020	State of New Mexico		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(800)659-8331		(711)-		(800)659-8331		(711)-										1	1	1a;1b;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1	2		2		2				
H3204	810	0	1	2	1	H3204_810_0	1	1			06/03/2019	2020.01	06/03/2019 12:10:13 PM Mountain Daylight Time					06/03/2019 12:29:16 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Health Plan	http://www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 5 NC (HMO-POS)	1	2		1			H3204	810	0	2020	State of New Mexico		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		1	1	1a;1b;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1	2		2		2				
H3206	1	0	1	4	1	H3206_001_0	8	1			07/09/2019	2020.01	07/09/2019 07:58:46 PM Mountain Daylight Time	08/01/2019 01:57:06 PM Mountain Daylight Time	07/30/2019 01:57:42 PM Mountain Daylight Time			08/05/2019 03:18:02 PM Mountain Daylight Time	"PRESBYTERIAN INSURANCE COMPANY, INC."	"Presbyterian Insurance Company, Inc."	http://www.phs.org/Medicare	Presbyterian MediCare PPO Plan 2 with Rx (PPO)	1	4		1			H3206	1	0	2020	State of New Mexico		2	27309	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		2					2						2			
H3206	3	0	1	4	1	H3206_003_0	5	1			07/02/2019	2020.01	07/02/2019 02:39:19 PM Mountain Daylight Time	07/18/2019 07:41:56 AM Mountain Daylight Time				07/18/2019 09:08:31 AM Mountain Daylight Time	"PRESBYTERIAN INSURANCE COMPANY, INC."	"Presbyterian Insurance Company, Inc."	http://www.phs.org/Medicare	Presbyterian MediCare PPO Plan 1 (PPO)	1	4		1			H3206	3	0	2020	State of New Mexico		2	2030	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(800)659-8331		(711)-		(800)659-8331		(711)-										2					2						2			
H3206	801	0	1	4	1	H3206_801_0	1	1			06/03/2019	2020.01	06/03/2019 12:00:00 PM Mountain Daylight Time					06/03/2019 12:29:16 PM Mountain Daylight Time	"PRESBYTERIAN INSURANCE COMPANY, INC."	"Presbyterian Insurance Company, Inc."	http://www.phs.org/Medicare	Pres MediCare PPO Emp Group Plan 2 with Rx (PPO)	1	4		1			H3206	801	0	2020	State of New Mexico		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		1	1	1a;1b;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1									
H3206	802	0	1	4	1	H3206_802_0	1	1			06/03/2019	2020.01	06/03/2019 12:02:31 PM Mountain Daylight Time					06/03/2019 12:29:16 PM Mountain Daylight Time	"PRESBYTERIAN INSURANCE COMPANY, INC."	"Presbyterian Insurance Company, Inc."	http://www.phs.org/Medicare	Pres Medicare PPO Employer Group Plan 1 (PPO)	1	4		1			H3206	802	0	2020	State of New Mexico		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(800)659-8331		(711)-		(800)659-8331		(711)-										1	1	1a;1b;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1									
H3206	803	0	1	4	1	H3206_803_0	1	1			06/03/2019	2020.01	06/03/2019 12:04:14 PM Mountain Daylight Time					06/03/2019 12:29:16 PM Mountain Daylight Time	"PRESBYTERIAN INSURANCE COMPANY, INC."	"Presbyterian Insurance Company, Inc."	http://www.phs.org/Medicare	Pres MediCare PPO Empl Group Plan 2 +Rx NC (PPO)	1	4		1			H3206	803	0	2020	State of New Mexico		1	12	2			2						www.phs.org/Medicare	http://www.phs.org/Medicare	https://www.phs.org/doctors-services/Pages/find-a-doctor.aspx	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		(800)659-8331		(711)-		1	1	1a;1b;5;6;8b1;8b2;9a1;9a2;9b;11a;11b;	2		1									
H3219	1	0	1	4	1	H3219_001_0	6	1			07/31/2019	2020.01	07/31/2019 11:13:09 AM Eastern Daylight Time	08/05/2019 04:04:29 PM Eastern Daylight Time	07/30/2019 10:30:32 PM Eastern Daylight Time			08/05/2019 04:58:21 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health Aetna Medicare Discover Plus (PPO)	1	4		1			H3219	1	0	2020	MN		2		2			2						www.AllinaHealthAetnaMedicare.com/findpharmacy	www.AllinaHealthAetnaMedicare.com/formulary	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(855)327-7541		(855)327-7541		(833)570-6671		(833)570-6671		(855)327-7541		(855)327-7541		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3219	2	0	1	4	1	H3219_002_0	6	1			07/03/2019	2020.01	07/03/2019 05:34:07 PM Eastern Daylight Time	08/05/2019 04:05:24 PM Eastern Daylight Time	07/30/2019 10:31:44 PM Eastern Daylight Time			08/05/2019 04:58:21 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health Aetna Medicare Discover Premier (PPO)	1	4		1			H3219	2	0	2020	MN		2		2			2						www.AllinaHealthAetnaMedicare.com/findpharmacy	www.AllinaHealthAetnaMedicare.com/formulary	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(855)327-7541		(855)327-7541		(833)570-6671		(833)570-6671		(855)327-7541		(855)327-7541		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3219	3	0	1	4	1	H3219_003_0	6	1			07/03/2019	2020.01	07/03/2019 05:34:24 PM Eastern Daylight Time	08/05/2019 04:06:41 PM Eastern Daylight Time	07/30/2019 10:32:55 PM Eastern Daylight Time			08/05/2019 04:58:21 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health Aetna Medicare Discover Grand (PPO)	1	4		1			H3219	3	0	2020	MN		2		2			2						www.AllinaHealthAetnaMedicare.com/findpharmacy	www.AllinaHealthAetnaMedicare.com/formulary	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(855)327-7541		(855)327-7541		(833)570-6671		(833)570-6671		(855)327-7541		(855)327-7541		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3219	4	0	1	4	1	H3219_004_0	6	1			07/03/2019	2020.01	07/03/2019 05:34:39 PM Eastern Daylight Time	08/05/2019 04:07:44 PM Eastern Daylight Time	07/30/2019 10:34:07 PM Eastern Daylight Time			08/05/2019 04:58:21 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health Aetna Medicare Discover Elite (PPO)	1	4		1			H3219	4	0	2020	MN		2		2			2						www.AllinaHealthAetnaMedicare.com/findpharmacy	www.AllinaHealthAetnaMedicare.com/formulary	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(855)327-7541		(855)327-7541		(833)570-6671		(833)570-6671		(855)327-7541		(855)327-7541		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3219	5	0	1	4	1	H3219_005_0	3	1			07/03/2019	2020.01	07/03/2019 05:35:10 PM Eastern Daylight Time	05/28/2019 06:24:06 PM Eastern Daylight Time				07/03/2019 05:40:11 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.AllinaHealthAetnaMedicare.com	Allina Health Aetna Medicare Discover Value (PPO)	1	4		1			H3219	5	0	2020	MN		2		2			2						www.AllinaHealthAetnaMedicare.com	www.AllinaHealthAetnaMedicare.com	www.AllinaHealthAetnaMedicare.com/findprovider	(833)570-6671		(833)570-6671		(855)327-7541		(855)327-7541										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3219	801	0	1	4	1	H3219_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:42:09 AM Eastern Daylight Time					05/30/2019 06:28:23 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.aetnamedicare.com	Allina Health Aetna Medicare Plan (PPO)	1	4		1			H3219	801	0	2020	Minnesota		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	https://www.allinahealthaetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3219	802	0	1	4	1	H3219_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:42:20 AM Eastern Daylight Time					05/30/2019 06:28:23 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	www.aetnamedicare.com	Allina Health Aetna Medicare w/Rx Plan (PPO)	1	4		1			H3219	802	0	2020	Minnesota		1	120	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	https://www.allinahealthaetnamedicare.com/findprovider	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3219	803	0	1	4	1	H3219_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:42:30 AM Eastern Daylight Time					05/30/2019 06:28:23 PM Eastern Daylight Time	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Allina Health Aetna Medicare	https://www.aetnamedicare.com	Allina Health Aetna Medicare Plan w/Rx SH (PPO)	1	4		1			H3219	803	0	2020	Minnesota		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3227	1	0	1	1	1	H3227_001_0	6	1	2	1	08/12/2019	2020.01	08/12/2019 12:46:42 PM Eastern Daylight Time	08/02/2019 02:25:58 PM Eastern Daylight Time	08/02/2019 02:28:24 PM Eastern Daylight Time			08/12/2019 02:51:30 PM Eastern Daylight Time	"KALOS HEALTH, INC."	Kalos Health Plan	Kaloshealth.org	Kalos Health Gold Plus (HMO D-SNP)	1	1		1			H3227	1	0	2020	Western New York		2	6150	2			1	3		1		1	Kaloshealth.org	Kaloshealth.org	Kaloshealth.org	(800)399-1954		(716)304-1213		(800)399-1954		(716)304-1213		(800)399-1954		(716)304-1213		(800)399-1954		(716)304-1213		(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					1	2			
H3237	1	0	1	48	5	H3237_001_0	4	1			08/21/2019	2020.01	08/21/2019 01:38:32 PM Central Daylight Time					08/21/2019 02:51:09 PM Pacific Daylight Time	"HEALTH NET COMMUNITY SOLUTIONS, INC."	Health Net Cal MediConnect Medicare Medicaid Plan	www.healthnet.com/calmediconnect	Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)	5	48		1			H3237	1	0	2020	Los Angeles County		2	113000	2			2						mmp.healthnetcalifornia.com/mmp/find-a-doctor.html	mmp.healthnetcalifornia.com/mmp/prescription-drug-part-d/formulary.html	mmp.healthnetcalifornia.com/mmp/find-a-doctor.html	(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)-																
H3237	2	0	1	48	5	H3237_002_0	4	1			08/21/2019	2020.01	08/21/2019 01:39:39 PM Central Daylight Time					08/21/2019 02:51:09 PM Pacific Daylight Time	"HEALTH NET COMMUNITY SOLUTIONS, INC."	Health Net Cal MediConnect Medicare Medicaid Plan	www.healthnet.com/calmediconnect	Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)	5	48		1			H3237	2	0	2020	San Diego County		2	18000	2			2						mmp.healthnetcalifornia.com/mmp/find-a-doctor.html	mmp.healthnetcalifornia.com/mmp/prescription-drug-part-d/formulary.html	mmp.healthnetcalifornia.com/mmp/find-a-doctor.html	(855)464-3572		(855)464-3572		(888)788-5805		(888)788-5805		(855)464-3572		(855)464-3572		(888)788-5805		(888)788-5805		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H3239	1	0	1	1	1	H3239_001_0	5	1	2	1	07/10/2019	2020.01	07/10/2019 04:31:34 PM Eastern Daylight Time	08/01/2019 05:53:32 PM Eastern Daylight Time	07/30/2019 10:35:19 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	"AETNA BETTER HEALTH, INC. (LA)"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	1	1		1			H3239	1	0	2020	New Orleans and Surrounding Parishes		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3239	2	0	1	1	1	H3239_002_0	4	1	2	1	07/10/2019	2020.01	07/10/2019 04:32:04 PM Eastern Daylight Time	08/01/2019 05:54:06 PM Eastern Daylight Time	07/30/2019 10:36:32 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	"AETNA BETTER HEALTH, INC. (LA)"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	1	1		1			H3239	2	0	2020	Select Birmingham and Northern AL counties		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3239	3	0	1	1	1	H3239_003_0	4	1	2	1	07/10/2019	2020.01	07/10/2019 04:33:25 PM Eastern Daylight Time	08/01/2019 05:54:40 PM Eastern Daylight Time	07/30/2019 10:37:45 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	"AETNA BETTER HEALTH, INC. (LA)"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	1	1		1			H3239	3	0	2020	"Mobile County, AL"		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	13	0	1	1	1	H3240_013_0	10	1	2	1	08/01/2019	2020.01	08/01/2019 12:05:39 PM Eastern Daylight Time	08/05/2019 09:59:32 AM Eastern Daylight Time	07/30/2019 07:58:28 PM Eastern Daylight Time			08/05/2019 03:43:59 PM Eastern Daylight Time	"AMERIGROUP NEW JERSEY, INC."	Amerigroup Community Care	https://shop.amerigroup.com/medicare/	Amerivantage Dual Coordination (HMO D-SNP)	1	1		1			H3240	13	0	2020	Eastern and Central New Jersey		2		2			1	3		1		1	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(844)765-5160		(844)765-5160		(844)316-0355		(844)316-0355		(844)765-5160		(844)765-5160		(844)288-7623		(844)288-7623		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	16	0	1	1	1	H3240_016_0	8	1	2	1	08/01/2019	2020.01	08/01/2019 12:06:53 PM Eastern Daylight Time	08/05/2019 09:59:32 AM Eastern Daylight Time	07/30/2019 07:59:05 PM Eastern Daylight Time			08/05/2019 03:43:59 PM Eastern Daylight Time	"AMERIGROUP NEW JERSEY, INC."	Amerigroup Community Care	https://shop.amerigroup.com/medicare/	Amerivantage Dual Coordination (HMO D-SNP)	1	1		1			H3240	16	0	2020	Select Counties in New Jersey		2		2			1	3		1		1	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(844)765-5160		(844)765-5160		(844)316-0355		(844)316-0355		(844)765-5160		(844)765-5160		(844)288-7623		(844)288-7623		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	17	0	1	2	1	H3240_017_0	11	1		1	07/16/2019	2020.01	07/16/2019 06:58:11 PM Eastern Daylight Time		07/30/2019 07:59:44 PM Eastern Daylight Time		08/05/2019 09:59:32 AM Eastern Daylight Time	08/05/2019 03:43:59 PM Eastern Daylight Time	"AMERIGROUP NEW JERSEY, INC."	Amerigroup Community Care	https://shop.amerigroup.com/medicare/	Amerivantage ESRD (HMO-POS C-SNP)	1	2		1			H3240	17	0	2020	Select Counties in New Jersey		2		2			1	4			1E+11		www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(844)887-6350		(844)887-6350		(844)316-0355		(844)316-0355		(844)887-6350		(844)887-6350		(844)288-7623		(844)288-7623		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	21	0	1	1	1	H3240_021_0	8	1			07/16/2019	2020.01	07/16/2019 07:05:58 PM Eastern Daylight Time	08/05/2019 09:59:33 AM Eastern Daylight Time	07/30/2019 08:00:21 PM Eastern Daylight Time			08/05/2019 03:43:59 PM Eastern Daylight Time	"AMERIGROUP NEW JERSEY, INC."	Amerigroup Community Care	https://shop.amerigroup.com/medicare/	Amerivantage Balance (HMO)	1	1		1			H3240	21	0	2020	Select Counties in New Jersey		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)288-7623		(844)288-7623		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	22	0	1	1	1	H3240_022_0	6	1			08/01/2019	2020.01	08/01/2019 12:20:35 PM Eastern Daylight Time	08/05/2019 09:59:33 AM Eastern Daylight Time	07/30/2019 08:00:57 PM Eastern Daylight Time			08/05/2019 03:43:59 PM Eastern Daylight Time	"AMERIGROUP NEW JERSEY, INC."	Amerigroup Community Care	https://shop.amerigroup.com/medicare/	Amerivantage Classic (HMO)	1	1		1			H3240	22	0	2020	Select Counties in New Jersey		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(866)805-4589		(866)805-4589		(844)316-0355		(844)316-0355		(866)805-4589		(866)805-4589		(844)288-7623		(844)288-7623		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3240	24	0	1	2	1	H3240_024_0	8	1	2	1	08/01/2019	2020.01	08/01/2019 12:07:42 PM Eastern Daylight Time	08/05/2019 09:59:33 AM Eastern Daylight Time	07/30/2019 08:01:34 PM Eastern Daylight Time			08/05/2019 03:43:59 PM Eastern Daylight Time	"AMERIGROUP NEW JERSEY, INC."	Amerigroup Community Care	https://shop.amerigroup.com/medicare/	Amerivantage Dual Secure (HMO-POS D-SNP)	1	2		1			H3240	24	0	2020	Select Counties in New Jersey		2		2			1	3		1		1	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(844)765-5160		(844)765-5160		(844)316-0355		(844)316-0355		(844)765-5160		(844)765-5160		(844)288-7623		(844)288-7623		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3251	2	0	1	1	1	H3251_002_0	4	1			06/19/2019	2020.01	06/19/2019 11:09:54 AM Mountain Daylight Time	08/06/2019 01:24:28 PM Mountain Daylight Time	08/06/2019 01:24:32 PM Mountain Daylight Time			08/06/2019 02:45:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of New Mexico	www.getbluenm.com/mapd	Blue Cross Medicare Advantage Select (HMO)	1	1		1			H3251	2	0	2020	Greater New Mexico Area		2	109493	2			2						www.getbluenm.com/mapd/pharmacies	www.getbluenm.com/mapd/druglist	www.getbluenm.com/mapd/providers	(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	2			
H3251	29	0	1	1	1	H3251_029_0	4	1	2	1	08/06/2019	2020.01	08/06/2019 02:19:11 PM Mountain Daylight Time	08/06/2019 01:24:28 PM Mountain Daylight Time	08/06/2019 01:24:32 PM Mountain Daylight Time			08/06/2019 02:45:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of New Mexico	www.getbluenm.com/dsnp	Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)	1	1		1			H3251	29	0	2020	"Bern,Torrance,Valencia,Sandoval,Santa Fe, Dona Ana"		2	3576	2			1	3		2		2	www.getbluenm.com/dsnp/pharmacies	www.getbluenm.com/dsnp/druglist	www.getbluenm.com/dsnp/providers	(877)688-1813		(877)688-1813		(877)583-8129		(877)583-8129		(877)688-1813		(877)688-1813		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3251	804	0	1	1	1	H3251_804_0	2	1			05/29/2019	2020.01	05/29/2019 04:18:57 PM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of New Mexico	www.getbluenm.com/mapd	Blue Cross Medicare Advantage (HMO)	1	1		1			H3251	804	0	2020	New Mexico Statewide		1	10411	2			2						www.myprime.com	www.myprime.com	www.getbluenm.com/mapd/providers	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H3259	1	0	1	1	1	H3259_001_0	4	1	2	1	08/02/2019	2020.01	08/02/2019 09:04:40 AM Eastern Daylight Time	08/05/2019 03:18:47 PM Eastern Daylight Time	08/05/2019 03:19:22 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	VOLUNTEER STATE HEALTH PLAN	BlueCare Plus Tennessee	bluecareplus.bcbst.com	BlueCare Plus (HMO D-SNP)	1	1		1			H3259	1	0	2020	Tennessee		2		2			1	3		1		1	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	2			
H3259	2	0	1	1	1	H3259_002_0	4	1	2	1	08/02/2019	2020.01	08/02/2019 09:05:01 AM Eastern Daylight Time	08/05/2019 03:18:48 PM Eastern Daylight Time	08/05/2019 03:19:23 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	VOLUNTEER STATE HEALTH PLAN	BlueCare Plus Tennessee	bluecareplus.bcbst.com	BlueCare Plus Choice (HMO D-SNP)	1	1		1			H3259	2	0	2020	Tennessee		2		2			1	3		1		1	bluecareplus.bcbst.com	bluecareplus.bcbst.com	bluecareplus.bcbst.com	(855)339-6071		(855)339-6071		(888)413-9637		(888)413-9637		(855)339-6071		(855)339-6071		(888)413-9637		(888)413-9637		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3276	1	0	1	1	1	H3276_001_0	9	1	2	1	08/09/2019	2020.01	08/09/2019 10:22:38 AM Eastern Daylight Time	08/09/2019 10:46:01 AM Eastern Daylight Time	07/31/2019 09:09:46 AM Eastern Daylight Time			08/09/2019 10:51:38 AM Eastern Daylight Time	"CONNECTICARE INSURANCE COMPANY, INC."	ConnectiCare	175 Scott Swamp Road	ConnectiCare Choice Dual (HMO D-SNP)	1	1		1			H3276	1	0	2020	State of Connecticut		2	22500	2			1	3		1		1	www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(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	2			
H3281	1	0	1	4	1	H3281_001_0	6	1			07/25/2019	2020.01	07/25/2019 05:05:27 PM Central Daylight Time	08/02/2019 04:22:55 PM Central Daylight Time	08/02/2019 04:52:49 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex (PPO)	1	4		1			H3281	1	0	2020	Volusia County		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-7736		(844)221-7736		(833)412-6729		(833)412-6729		(844)221-7736		(844)221-7736		(833)412-6729		(833)412-6729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3281	3	0	1	4	1	H3281_003_0	6	1			07/25/2019	2020.01	07/25/2019 05:05:42 PM Central Daylight Time	08/02/2019 04:22:52 PM Central Daylight Time	08/02/2019 04:52:47 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex (PPO)	1	4		1			H3281	3	0	2020	"Orange, Osceola, Pasco, and Seminole Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-7642		(844)221-7642		(833)412-6731		(833)412-6731		(844)221-7642		(844)221-7642		(833)412-6731		(833)412-6731		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3281	5	0	1	4	1	H3281_005_0	6	1			07/16/2019	2020.01	07/16/2019 12:24:58 PM Central Daylight Time	08/02/2019 04:22:47 PM Central Daylight Time	08/02/2019 04:52:05 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex (PPO)	1	4		1			H3281	5	0	2020	Palm Beach County		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-7734		(844)221-7734		(833)412-6733		(833)412-6733		(844)221-7734		(844)221-7734		(833)412-6733		(833)412-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	1	0	1	4	1	H3288_001_0	3	1			07/31/2019	2020.01	07/31/2019 11:27:13 AM Eastern Daylight Time	08/01/2019 12:09:36 PM Pacific Daylight Time	07/30/2019 07:39:00 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H3288	1	0	2020	Bexar and Comal counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	2	0	1	4	1	H3288_002_0	3	1			07/31/2019	2020.01	07/31/2019 11:31:12 AM Eastern Daylight Time	08/01/2019 12:10:12 PM Pacific Daylight Time	07/30/2019 07:40:11 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice II Plan (PPO)	1	4		1			H3288	2	0	2020	Dallas and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	3	0	1	4	1	H3288_003_0	3	1			07/31/2019	2020.01	07/31/2019 11:32:53 AM Eastern Daylight Time	08/01/2019 12:10:48 PM Pacific Daylight Time	07/30/2019 07:41:23 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H3288	3	0	2020	Harris County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	4	0	1	4	1	H3288_004_0	3	1			07/31/2019	2020.01	07/31/2019 11:34:59 AM Eastern Daylight Time	08/01/2019 12:11:26 PM Pacific Daylight Time	07/30/2019 07:42:35 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H3288	4	0	2020	Travis and Williamson Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	5	0	1	4	1	H3288_005_0	3	1			07/31/2019	2020.01	07/31/2019 11:35:33 AM Eastern Daylight Time	08/01/2019 12:12:04 PM Pacific Daylight Time	07/30/2019 07:43:46 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H3288	5	0	2020	South Texas Non Metro counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	6	0	1	4	1	H3288_006_0	3	1			07/31/2019	2020.01	07/31/2019 11:36:11 AM Eastern Daylight Time	08/01/2019 12:12:42 PM Pacific Daylight Time	07/30/2019 07:44:56 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H3288	6	0	2020	Southeast Non Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	7	0	1	4	1	H3288_007_0	3	1			07/31/2019	2020.01	07/31/2019 11:36:38 AM Eastern Daylight Time	08/01/2019 12:13:20 PM Pacific Daylight Time	07/30/2019 07:46:23 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H3288	7	0	2020	El Paso County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	8	0	1	4	1	H3288_008_0	3	1			07/31/2019	2020.01	07/31/2019 11:37:09 AM Eastern Daylight Time	08/01/2019 12:14:00 PM Pacific Daylight Time	07/30/2019 07:48:06 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H3288	8	0	2020	North Texas Non Metro counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	9	0	1	4	1	H3288_009_0	3	1			07/31/2019	2020.01	07/31/2019 11:37:39 AM Eastern Daylight Time	08/01/2019 12:14:40 PM Pacific Daylight Time	07/30/2019 07:49:20 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H3288	9	0	2020	Rio Grande Valley and Corpus Christi		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	10	0	1	4	1	H3288_010_0	3	1			07/31/2019	2020.01	07/31/2019 11:38:54 AM Eastern Daylight Time	08/01/2019 12:15:17 PM Pacific Daylight Time	07/30/2019 07:50:33 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	1	4		1			H3288	10	0	2020	El Paso County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	11	0	1	4	1	H3288_011_0	3	1			07/31/2019	2020.01	07/31/2019 11:39:41 AM Eastern Daylight Time	08/01/2019 12:15:56 PM Pacific Daylight Time	07/30/2019 07:51:45 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H3288	11	0	2020	Panhandle Region		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	12	0	1	4	1	H3288_012_0	3	1			07/31/2019	2020.01	07/31/2019 11:40:15 AM Eastern Daylight Time	08/01/2019 12:16:36 PM Pacific Daylight Time	07/30/2019 07:52:56 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	1	4		1			H3288	12	0	2020	Rio Grande Valley and Corpus Christi		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	13	0	1	4	1	H3288_013_0	3	1			07/31/2019	2020.01	07/31/2019 11:40:50 AM Eastern Daylight Time	08/01/2019 12:17:15 PM Pacific Daylight Time	07/30/2019 07:54:08 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	1	4		1			H3288	13	0	2020	Bexar County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	14	0	1	4	1	H3288_014_0	3	1			07/31/2019	2020.01	07/31/2019 11:41:20 AM Eastern Daylight Time	08/01/2019 12:17:51 PM Pacific Daylight Time	07/30/2019 07:55:19 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	1	4		1			H3288	14	0	2020	Harris County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	15	0	1	4	1	H3288_015_0	3	1			07/31/2019	2020.01	07/31/2019 11:41:46 AM Eastern Daylight Time	08/01/2019 12:18:28 PM Pacific Daylight Time	07/30/2019 07:56:30 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	1	4		1			H3288	15	0	2020	Dallas County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	16	0	1	4	1	H3288_016_0	3	1			07/31/2019	2020.01	07/31/2019 11:42:19 AM Eastern Daylight Time	08/01/2019 12:19:06 PM Pacific Daylight Time	07/30/2019 07:57:40 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H3288	16	0	2020	Dallas and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	17	0	1	4	1	H3288_017_0	3	1			07/31/2019	2020.01	07/31/2019 11:54:03 AM Eastern Daylight Time	08/01/2019 12:19:44 PM Pacific Daylight Time	07/30/2019 07:58:50 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Preferred Plan (PPO)	1	4		1			H3288	17	0	2020	Oklahoma City and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	18	0	1	4	1	H3288_018_0	3	1			07/31/2019	2020.01	07/31/2019 11:54:29 AM Eastern Daylight Time	08/01/2019 12:20:24 PM Pacific Daylight Time	07/30/2019 08:00:01 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice II Plan (PPO)	1	4		1			H3288	18	0	2020	Southeast Non Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	19	0	1	4	1	H3288_019_0	3	1			07/31/2019	2020.01	07/31/2019 11:54:57 AM Eastern Daylight Time	08/01/2019 12:21:03 PM Pacific Daylight Time	07/30/2019 08:01:12 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Preferred Plan (PPO)	1	4		1			H3288	19	0	2020	Tulsa and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	20	0	1	4	1	H3288_020_0	3	1			07/31/2019	2020.01	07/31/2019 11:55:25 AM Eastern Daylight Time	08/01/2019 12:21:46 PM Pacific Daylight Time	07/30/2019 08:02:22 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Core Plan (PPO)	1	4		1			H3288	20	0	2020	Rural Oklahoma		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	21	0	1	4	1	H3288_021_0	3	1			07/31/2019	2020.01	07/31/2019 11:55:54 AM Eastern Daylight Time	08/01/2019 12:22:28 PM Pacific Daylight Time	07/30/2019 08:03:32 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Core Plan (PPO)	1	4		1			H3288	21	0	2020	Tulsa and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	22	0	1	4	1	H3288_022_0	3	1			07/31/2019	2020.01	07/31/2019 11:56:19 AM Eastern Daylight Time	08/01/2019 12:23:07 PM Pacific Daylight Time	07/30/2019 08:04:43 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	1	4		1			H3288	22	0	2020	Travis and Williamson Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	23	0	1	4	1	H3288_023_0	3	1			08/01/2019	2020.01	08/01/2019 05:23:27 PM Eastern Daylight Time	08/01/2019 05:55:15 PM Eastern Daylight Time	07/30/2019 11:05:53 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H3288	23	0	2020	Albany Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	24	0	1	4	1	H3288_024_0	3	1			08/01/2019	2020.01	08/01/2019 05:27:51 PM Eastern Daylight Time	08/01/2019 05:55:50 PM Eastern Daylight Time	07/30/2019 11:07:03 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H3288	24	0	2020	Augusta Metro and Surrounding Counties		2	200	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	25	0	1	4	1	H3288_025_0	3	1			08/01/2019	2020.01	08/01/2019 05:31:51 PM Eastern Daylight Time	08/01/2019 05:56:26 PM Eastern Daylight Time	07/30/2019 11:08:14 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H3288	25	0	2020	Central Georgia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	26	0	1	4	1	H3288_026_0	3	1			08/01/2019	2020.01	08/01/2019 05:32:32 PM Eastern Daylight Time	08/01/2019 05:57:00 PM Eastern Daylight Time	07/30/2019 11:09:24 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H3288	26	0	2020	Columbus Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	27	0	1	4	1	H3288_027_0	3	1			08/01/2019	2020.01	08/01/2019 05:33:12 PM Eastern Daylight Time	08/01/2019 05:57:34 PM Eastern Daylight Time	07/30/2019 11:10:34 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H3288	27	0	2020	Macon Metro and Surrounding Counties		2	200	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	28	0	1	4	1	H3288_028_0	3	1			08/01/2019	2020.01	08/01/2019 05:33:40 PM Eastern Daylight Time	08/01/2019 05:58:08 PM Eastern Daylight Time	07/30/2019 11:11:44 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H3288	28	0	2020	Northeast Georgia Market		2	200	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	29	0	1	4	1	H3288_029_0	3	1			08/01/2019	2020.01	08/01/2019 05:34:06 PM Eastern Daylight Time	08/01/2019 05:58:42 PM Eastern Daylight Time	07/30/2019 11:12:55 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H3288	29	0	2020	Northern Georgia Market		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	30	0	1	4	1	H3288_030_0	3	1			08/01/2019	2020.01	08/01/2019 05:34:50 PM Eastern Daylight Time	08/01/2019 05:59:17 PM Eastern Daylight Time	07/30/2019 11:14:05 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H3288	30	0	2020	Savannah Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	31	0	1	4	1	H3288_031_0	3	1			08/01/2019	2020.01	08/01/2019 05:35:36 PM Eastern Daylight Time	08/01/2019 05:59:51 PM Eastern Daylight Time	07/30/2019 11:15:15 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H3288	31	0	2020	South Georgia Market		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	32	0	1	4	1	H3288_032_0	3	1			08/01/2019	2020.01	08/01/2019 05:36:16 PM Eastern Daylight Time	08/01/2019 06:00:25 PM Eastern Daylight Time	07/30/2019 11:16:24 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H3288	32	0	2020	"Hall County, GA"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	33	0	1	4	1	H3288_033_0	3	1			08/01/2019	2020.01	08/01/2019 05:36:46 PM Eastern Daylight Time	08/01/2019 06:00:58 PM Eastern Daylight Time	07/30/2019 11:17:33 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H3288	33	0	2020	"Cobb and Paulding Counties, GA"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	34	0	1	4	1	H3288_034_0	2	1			07/03/2019	2020.01	07/03/2019 01:30:54 PM Eastern Daylight Time	05/30/2019 01:13:56 AM Eastern Daylight Time				07/03/2019 07:11:03 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basics Plan (PPO)	1	4		1			H3288	34	0	2020	Georgia Market		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3288	35	0	1	4	1	H3288_035_0	3	1			08/01/2019	2020.01	08/01/2019 05:37:34 PM Eastern Daylight Time	08/01/2019 06:01:32 PM Eastern Daylight Time	07/30/2019 11:18:41 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H3288	35	0	2020	"Floyd, Haralson and Polk Counties, GA"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	36	0	1	4	1	H3288_036_0	3	1			07/03/2019	2020.01	07/03/2019 01:33:21 PM Eastern Daylight Time	08/01/2019 06:04:55 PM Eastern Daylight Time	07/30/2019 11:19:50 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	1	4		1			H3288	36	0	2020	Albany Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	37	0	1	4	1	H3288_037_0	3	1			07/03/2019	2020.01	07/03/2019 01:35:14 PM Eastern Daylight Time	08/01/2019 06:05:29 PM Eastern Daylight Time	07/30/2019 11:21:00 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	1	4		1			H3288	37	0	2020	Augusta Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	38	0	1	4	1	H3288_038_0	3	1			07/03/2019	2020.01	07/03/2019 01:37:08 PM Eastern Daylight Time	08/01/2019 06:06:04 PM Eastern Daylight Time	07/30/2019 11:22:09 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	1	4		1			H3288	38	0	2020	Central Georgia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	39	0	1	4	1	H3288_039_0	3	1			07/03/2019	2020.01	07/03/2019 01:38:36 PM Eastern Daylight Time	08/01/2019 06:06:38 PM Eastern Daylight Time	07/30/2019 11:23:18 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	1	4		1			H3288	39	0	2020	Columbus Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	40	0	1	4	1	H3288_040_0	3	1			07/03/2019	2020.01	07/03/2019 01:39:43 PM Eastern Daylight Time	08/01/2019 06:07:12 PM Eastern Daylight Time	07/30/2019 11:24:27 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	1	4		1			H3288	40	0	2020	Macon Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	41	0	1	4	1	H3288_041_0	3	1			07/03/2019	2020.01	07/03/2019 01:41:10 PM Eastern Daylight Time	08/01/2019 06:07:46 PM Eastern Daylight Time	07/30/2019 11:25:36 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	1	4		1			H3288	41	0	2020	Northeast Georgia Market		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	42	0	1	4	1	H3288_042_0	3	1			07/03/2019	2020.01	07/03/2019 01:42:01 PM Eastern Daylight Time	08/01/2019 06:08:20 PM Eastern Daylight Time	07/30/2019 11:26:44 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	1	4		1			H3288	42	0	2020	Northern Georgia Market		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	43	0	1	4	1	H3288_043_0	3	1			07/03/2019	2020.01	07/03/2019 01:42:57 PM Eastern Daylight Time	08/01/2019 06:08:54 PM Eastern Daylight Time	07/30/2019 11:27:53 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	1	4		1			H3288	43	0	2020	Savannah Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	44	0	1	4	1	H3288_044_0	3	1			07/03/2019	2020.01	07/03/2019 01:43:58 PM Eastern Daylight Time	08/01/2019 06:09:27 PM Eastern Daylight Time	07/30/2019 11:29:04 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Preferred Premium Plan (PPO)	1	4		1			H3288	44	0	2020	South Georgia Market		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	45	0	1	4	1	H3288_045_0	3	1			08/01/2019	2020.01	08/01/2019 05:38:06 PM Eastern Daylight Time	08/01/2019 06:10:02 PM Eastern Daylight Time	07/30/2019 11:30:13 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (PPO)	1	4		1			H3288	45	0	2020	Atlanta Metro and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	46	0	1	4	1	H3288_046_0	3	1			07/31/2019	2020.01	07/31/2019 11:43:20 AM Eastern Daylight Time	08/01/2019 12:23:47 PM Pacific Daylight Time	07/30/2019 08:31:24 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H3288	46	0	2020	Central Non Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	47	0	1	4	1	H3288_047_0	5	1			07/31/2019	2020.01	07/31/2019 11:43:51 AM Eastern Daylight Time	08/01/2019 12:24:29 PM Pacific Daylight Time	07/30/2019 08:32:32 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H3288	47	0	2020	Harris County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	48	0	1	4	1	H3288_048_0	3	1			07/31/2019	2020.01	07/31/2019 11:44:20 AM Eastern Daylight Time	08/01/2019 12:25:07 PM Pacific Daylight Time	07/30/2019 08:33:41 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice II Plan (PPO)	1	4		1			H3288	48	0	2020	Central Non Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3288	801	0	1	4	1	H3288_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:43:03 AM Eastern Daylight Time					05/30/2019 06:30:29 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (PPO)	1	4		1			H3288	801	0	2020	Multi-State		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3288	802	0	1	4	1	H3288_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:43:14 AM Eastern Daylight Time					05/30/2019 06:30:29 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (PPO)	1	4		1			H3288	802	0	2020	Multi-State		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnamedicare.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3288	803	0	1	4	1	H3288_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:43:25 AM Eastern Daylight Time					05/30/2019 06:30:29 PM Eastern Daylight Time	AETNA HEALTH AND LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (PPO)	1	4		1			H3288	803	0	2020	Multi-State		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H3291	1	0	1	1	1	H3291_001_0	3	1		1	08/05/2019	2020.01	08/05/2019 03:15:54 PM Central Daylight Time	08/05/2019 12:18:40 PM Central Daylight Time	08/01/2019 09:30:44 AM Central Daylight Time			08/05/2019 04:53:44 PM Central Daylight Time	"PRUITTHEALTH PREMIER, INC."	PruittHealth Premier	www.pruitthealthpremier.com	PruittHealth Premier (HMO I-SNP)	1	1		1			H3291	1	0	2020	Georgia (partial)		2	21421	2			1	1	1				www.pruitthealthpremier.com	www.pruitthealthpremier.com	www.pruitthealthpremier.com	(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3291	2	0	1	1	1	H3291_002_0	4	1	2	1	08/05/2019	2020.01	08/05/2019 03:16:34 PM Central Daylight Time	08/05/2019 12:19:58 PM Central Daylight Time	08/01/2019 09:32:01 AM Central Daylight Time			08/05/2019 04:53:44 PM Central Daylight Time	"PRUITTHEALTH PREMIER, INC."	PruittHealth Premier	www.pruitthealthpremier.com	PruittHealth Premier D-SNP (HMO D-SNP)	1	1		1			H3291	2	0	2020	GA (Clarke County)		2	1349	2			1	3		2		1	www.pruitthealthpremier.com	www.pruitthealthpremier.com	www.pruitthealthpremier.com	(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3293	1	0	1	1	1	H3293_001_0	6	1			06/01/2019	2020.01	06/01/2019 02:54:38 PM Eastern Daylight Time	07/31/2019 11:12:16 AM Central Daylight Time	07/31/2019 11:23:39 AM Central Daylight Time			08/06/2019 11:20:39 AM Central Daylight Time	"MMM OF FLORIDA, INC."	"MMM of Florida, Inc."	www.mmm-fl.com	MMM ELITE DADE (HMO)	1	1		1			H3293	1	0	2020	Counties: Miami-Dade		2		2			2						www.mmm-fl.com	www.mmm-fl.com	www.mmm-fl.com	(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		2					2					2	2			
H3293	2	0	1	1	1	H3293_002_0	6	1			06/01/2019	2020.01	06/01/2019 02:55:07 PM Eastern Daylight Time	07/31/2019 11:13:26 AM Central Daylight Time	07/31/2019 11:28:31 AM Central Daylight Time			08/06/2019 11:20:39 AM Central Daylight Time	"MMM OF FLORIDA, INC."	"MMM of Florida, Inc."	www.mmm-fl.com	MMM ELITE (HMO)	1	1		1			H3293	2	0	2020	"Counties: Broward, Palm Beach"		2		2			2						www.mmm-fl.com	www.mmm-fl.com	www.mmm-fl.com	(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		2					2					2	2			
H3293	3	0	1	1	1	H3293_003_0	6	1			06/02/2019	2020.01	06/02/2019 12:03:17 PM Eastern Daylight Time	07/31/2019 11:14:49 AM Central Daylight Time	07/31/2019 11:29:11 AM Central Daylight Time			08/06/2019 11:20:39 AM Central Daylight Time	"MMM OF FLORIDA, INC."	"MMM of Florida, Inc."	www.mmm-fl.com	MMM EXTRA (HMO)	1	1		1			H3293	3	0	2020	"Counties: Miami-Dade, Broward, Palm Beach"		2		2			2						www.mmm-fl.com	www.mmm-fl.com	www.mmm-fl.com	(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		2					2					2	2			
H3293	4	0	1	1	1	H3293_004_0	6	1	2	1	06/01/2019	2020.01	06/01/2019 02:55:26 PM Eastern Daylight Time	07/31/2019 11:16:36 AM Central Daylight Time	07/31/2019 11:30:22 AM Central Daylight Time			08/06/2019 11:20:39 AM Central Daylight Time	"MMM OF FLORIDA, INC."	"MMM of Florida, Inc."	www.mmm-fl.com	MMM PLATINUM (HMO D-SNP)	1	1		1			H3293	4	0	2020	"Counties: Miami-Dade, Broward, Palm Beach"		2		2			1	3		2		2	www.mmm-fl.com	www.mmm-fl.com	www.mmm-fl.com	(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		2					2					2	2			
H3293	5	0	1	1	1	H3293_005_0	6	1			06/01/2019	2020.01	06/01/2019 02:55:51 PM Eastern Daylight Time	07/31/2019 11:18:45 AM Central Daylight Time	07/31/2019 11:31:15 AM Central Daylight Time			08/06/2019 11:20:39 AM Central Daylight Time	"MMM OF FLORIDA, INC."	"MMM of Florida, Inc."	www.mmm-fl.com	MMM PLUS (HMO)	1	1		1			H3293	5	0	2020	"Counties: Miami-Dade, Broward, Palm Beach"		2		2			2						www.mmm-fl.com	www.mmm-fl.com	www.mmm-fl.com	(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		2					2					2	2			
H3293	6	0	1	1	1	H3293_006_0	6	1	2	1	06/01/2019	2020.01	06/01/2019 02:56:10 PM Eastern Daylight Time	07/31/2019 11:10:42 AM Central Daylight Time	07/31/2019 11:22:29 AM Central Daylight Time			08/06/2019 11:20:39 AM Central Daylight Time	"MMM OF FLORIDA, INC."	"MMM of Florida, Inc."	www.mmm-fl.com	MMM MORE (HMO D-SNP)	1	1		1			H3293	6	0	2020	"Counties: Miami-Dade, Broward, Palm Beach"		2		2			1	3		2		2	www.mmm-fl.com	www.mmm-fl.com	www.mmm-fl.com	(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(844)212-9858		(844)212-9858		(844)212-9859		(844)212-9859		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		(833)523-2620		2					2					2	2			
H3305	7	0	1	2	1	H3305_007_0	9	1			05/29/2019	2020.01	05/29/2019 03:01:06 PM Eastern Daylight Time	05/30/2019 02:44:49 PM Eastern Daylight Time				05/30/2019 02:49:31 PM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP Preferred Gold without Part D (HMO-POS)	1	2		1			H3305	7	0	2020	Western NY (Rochester/Buffalo)		2	10602	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2	2			
H3305	15	0	1	2	1	H3305_015_0	11	1			06/27/2019	2020.01	06/27/2019 01:14:51 PM Eastern Daylight Time	08/05/2019 11:17:32 AM Eastern Daylight Time	08/05/2019 11:18:13 AM Eastern Daylight Time			08/05/2019 12:51:56 PM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP Preferred Gold with Part D (HMO-POS)	1	2		1			H3305	15	0	2020	Western NY (Rochester/Buffalo)		2	108455	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H3305	20	0	1	2	1	H3305_020_0	9	1			05/29/2019	2020.01	05/29/2019 03:01:22 PM Eastern Daylight Time	05/30/2019 02:44:49 PM Eastern Daylight Time				05/30/2019 02:49:31 PM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP Preferred Gold without Part D (HMO-POS)	1	2		1			H3305	20	0	2020	"CNY, Eastern NY, Hudson Valley NY, VT"		2	3192	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2	2			
H3305	21	0	1	2	1	H3305_021_0	10	1			05/30/2019	2020.01	05/30/2019 08:13:34 AM Eastern Daylight Time	08/05/2019 11:17:29 AM Eastern Daylight Time	08/05/2019 11:18:14 AM Eastern Daylight Time			08/05/2019 12:51:56 PM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP Preferred Gold with Part D (HMO-POS)	1	2		1			H3305	21	0	2020	"CNY, Eastern NY, Hudson Valley NY, VT"		2	40518	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H3305	22	0	1	2	1	H3305_022_0	9	1			05/30/2019	2020.01	05/30/2019 08:14:38 AM Eastern Daylight Time	08/05/2019 11:17:29 AM Eastern Daylight Time	08/05/2019 11:18:14 AM Eastern Daylight Time			08/05/2019 12:51:56 PM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP GoldValue with Part D (HMO-POS)	1	2		1			H3305	22	0	2020	"CNY, Eastern NY, Hudson Valley NY, VT"		2	56796	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H3305	30	0	1	2	1	H3305_030_0	10	1			05/30/2019	2020.01	05/30/2019 08:15:40 AM Eastern Daylight Time	08/05/2019 11:17:29 AM Eastern Daylight Time	08/05/2019 11:18:11 AM Eastern Daylight Time			08/05/2019 12:51:56 PM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP GoldSecure with Part D (HMO-POS)	1	2		1			H3305	30	0	2020	Western NY (Rochester/Buffalo)		2	69254	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H3305	32	0	1	2	1	H3305_032_0	8	1			05/30/2019	2020.01	05/30/2019 08:16:40 AM Eastern Daylight Time	08/05/2019 11:17:30 AM Eastern Daylight Time	08/05/2019 11:18:11 AM Eastern Daylight Time			08/05/2019 12:51:56 PM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP GoldSecure with Part D (HMO-POS)	1	2		1			H3305	32	0	2020	"CNY, Eastern NY, Hudson Valley NY, VT"		2	14400	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2	2			
H3305	801	0	1	2	1	H3305_801_0	4	1			05/28/2019	2020.01	05/28/2019 01:02:45 PM Eastern Daylight Time					05/30/2019 08:53:21 AM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.mvphealthcare.com	MVP Preferred Gold - Employer Group (HMO-POS)	1	2		1			H3305	801	0	2020	Employer Group West Region		1	8754	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1				
H3305	803	0	1	2	1	H3305_803_0	4	1			05/28/2019	2020.01	05/28/2019 01:03:12 PM Eastern Daylight Time					05/30/2019 08:53:21 AM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.mvphealthcare.com	MVP Preferred Gold Rx - Employer Group (HMO-POS)	1	2		1			H3305	803	0	2020	Employer Group West Region		1	73554	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		2				
H3305	804	0	1	2	1	H3305_804_0	4	1			05/28/2019	2020.01	05/28/2019 01:03:50 PM Eastern Daylight Time					05/30/2019 08:53:21 AM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.mvphealthcare.com	MVP Preferred Gold Rx - Employer Group (HMO-POS)	1	2		1			H3305	804	0	2020	"Eastern NY, Hudson Valley NY, Vermont"		1	43620	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1				
H3307	2	0	1	1	1	H3307_002_0	5	1			08/02/2019	2020.01	08/02/2019 11:41:41 AM Central Daylight Time	08/02/2019 10:55:51 AM Central Daylight Time	07/30/2019 08:15:18 PM Central Daylight Time			08/06/2019 09:24:31 AM Central Daylight Time	"OXFORD HEALTH PLANS (NY), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H3307	2	0	2020	New York City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3307	12	0	1	1	1	H3307_012_0	6	1			08/02/2019	2020.01	08/02/2019 11:42:04 AM Central Daylight Time	08/02/2019 10:56:25 AM Central Daylight Time	07/30/2019 08:15:56 PM Central Daylight Time			08/06/2019 09:24:31 AM Central Daylight Time	"OXFORD HEALTH PLANS (NY), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H3307	12	0	2020	"Rockland, Orange, and Westchester Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3307	15	0	1	1	1	H3307_015_0	6	1			08/02/2019	2020.01	08/02/2019 11:42:41 AM Central Daylight Time	08/02/2019 10:57:03 AM Central Daylight Time	07/30/2019 08:16:31 PM Central Daylight Time			08/06/2019 09:24:31 AM Central Daylight Time	"OXFORD HEALTH PLANS (NY), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Mosaic (HMO)	1	1		1			H3307	15	0	2020	New York City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)870-9604		(866)870-9604		(800)555-5757		(800)555-5757		(866)870-9604		(866)870-9604		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3307	18	0	1	1	1	H3307_018_0	2	1			07/11/2019	2020.01	07/11/2019 01:58:43 PM Central Daylight Time	06/02/2019 08:35:58 AM Central Daylight Time				07/12/2019 01:16:08 PM Central Daylight Time	"OXFORD HEALTH PLANS (NY), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Essential (HMO)	1	1		1			H3307	18	0	2020	"NYC and Rockland, Orange, and Westchester Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3307	23	0	1	1	1	H3307_023_0	5	1			08/02/2019	2020.01	08/02/2019 11:43:14 AM Central Daylight Time	08/02/2019 10:58:13 AM Central Daylight Time	07/30/2019 08:17:03 PM Central Daylight Time			08/06/2019 09:24:31 AM Central Daylight Time	"OXFORD HEALTH PLANS (NY), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3307	23	0	2020	"Rockland, Orange, and Westchester Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3307	25	0	1	1	1	H3307_025_0	6	1			08/02/2019	2020.01	08/02/2019 11:43:37 AM Central Daylight Time	08/02/2019 10:58:46 AM Central Daylight Time	07/30/2019 08:17:36 PM Central Daylight Time			08/06/2019 09:24:31 AM Central Daylight Time	"OXFORD HEALTH PLANS (NY), INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H3307	25	0	2020	"Dutchess, Putnam, Sullivan and Ulster Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3307	802	0	1	1	1	H3307_802_0	1	1			05/12/2019	2020.01	05/12/2019 07:08:17 PM Central Daylight Time					06/02/2019 05:15:19 PM Central Daylight Time	"OXFORD HEALTH PLANS (NY), INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H3307	802	0	2020	New York Metropolitan Area		1	9708	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H3307	804	0	1	1	1	H3307_804_0	1	1			05/12/2019	2020.01	05/12/2019 07:08:46 PM Central Daylight Time					06/02/2019 05:15:19 PM Central Daylight Time	"OXFORD HEALTH PLANS (NY), INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H3307	804	0	2020	New York Metropolitan Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;15;16b;17a;18a;	2		1					1				
H3307	805	0	1	1	1	H3307_805_0	1	1			05/12/2019	2020.01	05/12/2019 07:10:03 PM Central Daylight Time					06/02/2019 05:15:19 PM Central Daylight Time	"OXFORD HEALTH PLANS (NY), INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H3307	805	0	2020	Select counties in New York		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H3312	2	0	1	1	1	H3312_002_0	3	1			08/01/2019	2020.01	08/01/2019 02:52:16 PM Eastern Daylight Time	08/02/2019 10:28:39 AM Eastern Daylight Time	07/30/2019 11:34:50 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3312	2	0	2020	"Metro (Bronx, Brooklyn, Staten Island)"		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	18	0	1	1	1	H3312_018_0	3	1			07/03/2019	2020.01	07/03/2019 07:46:39 PM Eastern Daylight Time	08/02/2019 10:30:34 AM Eastern Daylight Time	07/30/2019 11:36:00 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3312	18	0	2020	Westchester/Rockland Counties		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	48	0	1	1	1	H3312_048_0	3	1			08/01/2019	2020.01	08/01/2019 09:17:18 AM Eastern Daylight Time	08/02/2019 10:35:52 AM Eastern Daylight Time	07/30/2019 11:37:11 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3312	48	0	2020	Northern Central Upstate NY		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	62	0	1	1	1	H3312_062_0	3	1			08/01/2019	2020.01	08/01/2019 03:05:20 PM Eastern Daylight Time	08/02/2019 10:38:53 AM Eastern Daylight Time	07/30/2019 11:38:21 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3312	62	0	2020	Capital Region and Hudson Valley		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	64	0	1	1	1	H3312_064_0	3	1			07/03/2019	2020.01	07/03/2019 07:46:58 PM Eastern Daylight Time	08/02/2019 10:41:09 AM Eastern Daylight Time	07/30/2019 11:39:30 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3312	64	0	2020	Long Island		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	65	0	1	1	1	H3312_065_0	3	1			08/01/2019	2020.01	08/01/2019 09:15:19 AM Eastern Daylight Time	08/02/2019 10:43:42 AM Eastern Daylight Time	07/30/2019 11:40:39 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3312	65	0	2020	Western NY		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	68	0	1	1	1	H3312_068_0	3	1			07/03/2019	2020.01	07/03/2019 07:28:32 PM Eastern Daylight Time	08/02/2019 10:46:06 AM Eastern Daylight Time	07/30/2019 11:41:49 PM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	1	1		1			H3312	68	0	2020	Metro (NYC and Queens)		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3312	801	0	1	1	1	H3312_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:43:39 AM Eastern Daylight Time					05/30/2019 06:33:00 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H3312	801	0	2020	New York		1	850	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3312	804	0	1	1	1	H3312_804_0	1	1			05/24/2019	2020.01	05/24/2019 09:43:51 AM Eastern Daylight Time					05/30/2019 06:33:00 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H3312	804	0	2020	New York		1	3490	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3312	806	0	1	1	1	H3312_806_0	1	1			05/24/2019	2020.01	05/24/2019 09:44:12 AM Eastern Daylight Time					05/30/2019 06:33:00 PM Eastern Daylight Time	AETNA HEALTH INC. (NY)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H3312	806	0	2020	New York		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3321	1	0	1	20	8	H3321_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:31:23 PM Eastern Daylight Time		05/22/2019 11:52:30 AM Eastern Daylight Time			05/22/2019 01:32:48 PM Eastern Daylight Time	"LORETTO INDEPENDENT LIVING SERVICES, INC."	Independent Living Srvcs Of Central Ny	www.pacecny.org	PACE CNY (PACE)	8	20		1			H3321	1	0	2020	Onondaga County		2		2			2						www.loretto-cny.org	"Independent Living Services of Central New York, Inc"										(888)728-7223		(315)452-5800		(888)728-7223		(315)452-5800										(800)662-1220		(315)452-5800		(800)662-1220		(315)452-5800																
H3321	3	0	1	20	8	H3321_003_0	1	1			05/22/2019	2020.01	05/22/2019 01:31:38 PM Eastern Daylight Time		05/22/2019 11:45:36 AM Eastern Daylight Time			05/22/2019 01:32:48 PM Eastern Daylight Time	"LORETTO INDEPENDENT LIVING SERVICES, INC."	Independent Living Srvcs Of Central Ny	www.pacecny.org	PACE CNY (PACE)	8	20		1			H3321	3	0	2020	Onondaga County		2		2			2						www.loretto-cny.org	"Independent Living Services of Central New York, Inc"										(888)728-7223		(315)452-5800		(888)728-7223		(315)452-5800										(800)662-1220		(315)452-5800		(800)662-1220		(315)452-5800																
H3322	1	0	1	20	8	H3322_001_0	1	1			05/22/2019	2020.01	05/22/2019 04:50:53 PM Eastern Daylight Time		05/21/2019 06:16:06 PM Eastern Daylight Time			05/22/2019 04:52:46 PM Eastern Daylight Time	"SENIOR CARE CONNECTION, INC."	Eddy SeniorCare	www.sphp.com/pace	Senior Care Connection dba Eddy SeniorCare (PACE)	8	20		1			H3322	1	0	2020	"Schenectady County, Albany County, NY"		2		2			2						www.northeasthealth.com	www.northeasthealth.com										(518)382-4567		(518)382-4567		(855)376-7888		(518)382-3290										(518)382-4567		(518)382-4567		(855)376-7888		(518)382-3290																
H3322	2	0	1	20	8	H3322_002_0	1	1			05/22/2019	2020.01	05/22/2019 04:51:19 PM Eastern Daylight Time		05/21/2019 06:16:07 PM Eastern Daylight Time			05/22/2019 04:52:46 PM Eastern Daylight Time	"SENIOR CARE CONNECTION, INC."	Eddy SeniorCare	www.sphp.com/pace	Senior Care Connection dba:  Eddy SeniorCare (PACE)	8	20		1			H3322	2	0	2020	"Schenectady County, Albany County"		2		2			2						www.northeasthealth.com	www.northeasthealth.com										(518)382-4567		(518)382-4567		(855)376-7888		(518)382-3290										(518)382-4567		(518)382-4567		(855)376-7888		(518)382-3290																
H3328	1	0	1	2	1	H3328_001_0	8	1			06/03/2019	2020.01	06/03/2019 10:00:02 AM Eastern Daylight Time	05/31/2019 08:36:20 AM Eastern Daylight Time				06/03/2019 10:12:58 AM Eastern Daylight Time	"THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC."	Fidelis Legacy Plan	www.fideliscare.org	Fidelis Medicare Advantage without Rx (HMO-POS)	1	2		1			H3328	1	0	2020	NY Counties		2	61	2			2						www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3328	2	0	1	1	1	H3328_002_0	9	1	2	1	05/29/2019	2020.01	05/29/2019 02:18:56 PM Eastern Daylight Time	08/02/2019 11:54:36 AM Eastern Daylight Time	08/02/2019 11:54:36 AM Eastern Daylight Time			08/02/2019 12:54:02 PM Eastern Daylight Time	"THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC."	Fidelis Legacy Plan	www.fideliscare.org	Fidelis Dual Advantage (HMO D-SNP)	1	1		1			H3328	2	0	2020	NY Counties		2	1228	2			1	3		1		1	www.fideliscare.org	www.fideliscare.org	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3328	17	0	1	1	1	H3328_017_0	8	1	2	1	06/03/2019	2020.01	06/03/2019 10:00:58 AM Eastern Daylight Time	08/02/2019 11:54:36 AM Eastern Daylight Time	08/02/2019 11:54:36 AM Eastern Daylight Time			08/02/2019 12:54:02 PM Eastern Daylight Time	"THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC."	Fidelis Legacy Plan	www.fideliscare.org	Fidelis Dual Advantage Flex (HMO D-SNP)	1	1		1			H3328	17	0	2020	NY Counties		2	39849	2			1	3		2		2	www.fideliscare.org	www.fideliscare.org	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3328	22	1	1	2	1	H3328_022_1	9	1			05/31/2019	2020.01	05/31/2019 10:17:15 AM Eastern Daylight Time	08/02/2019 11:54:37 AM Eastern Daylight Time	08/02/2019 11:54:37 AM Eastern Daylight Time			08/02/2019 12:54:02 PM Eastern Daylight Time	"THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC."	Fidelis Legacy Plan	www.fideliscare.org	Fidelis Medicare Advantage Flex (HMO-POS)	1	2		1			H3328	22	1	2020	NY Counties	Segment 1	2	6643	2			2						www.fideliscare.org	www.fideliscare.org	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3328	22	2	1	2	1	H3328_022_2	12	1			05/31/2019	2020.01	05/31/2019 10:18:39 AM Eastern Daylight Time	08/02/2019 11:54:37 AM Eastern Daylight Time	08/02/2019 11:54:37 AM Eastern Daylight Time			08/02/2019 12:54:02 PM Eastern Daylight Time	"THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC."	Fidelis Legacy Plan	www.fideliscare.org	Fidelis Medicare Advantage Flex (HMO-POS)	1	2		1			H3328	22	2	2020	NY Counties	Segment 2	2	244	2			2						www.fideliscare.org	www.fideliscare.org	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3328	23	1	1	1	1	H3328_023_1	8	1	2	1	05/29/2019	2020.01	05/29/2019 02:20:30 PM Eastern Daylight Time	08/02/2019 11:54:37 AM Eastern Daylight Time	08/02/2019 11:54:38 AM Eastern Daylight Time			08/02/2019 12:54:02 PM Eastern Daylight Time	"THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC."	Fidelis Legacy Plan	www.fideliscare.org	Fidelis Medicaid Advantage Plus (HMO D-SNP)	1	1		1			H3328	23	1	2020	NY Counties	Segment 1	2	288	2			1	3		1		1	www.fideliscare.org	www.fideliscare.org	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3328	23	2	1	1	1	H3328_023_2	8	1	2	1	05/29/2019	2020.01	05/29/2019 02:20:57 PM Eastern Daylight Time	08/02/2019 11:54:38 AM Eastern Daylight Time	08/02/2019 11:54:38 AM Eastern Daylight Time			08/02/2019 12:54:02 PM Eastern Daylight Time	"THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC."	Fidelis Legacy Plan	www.fideliscare.org	Fidelis Medicaid Advantage Plus (HMO D-SNP)	1	1		1			H3328	23	2	2020	NY Counties	Segment 2	2	38	2			1	3		1		1	www.fideliscare.org	www.fideliscare.org	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3328	24	1	1	1	1	H3328_024_1	9	1			07/31/2019	2020.01	07/31/2019 02:18:27 PM Eastern Daylight Time	08/02/2019 11:54:38 AM Eastern Daylight Time	08/02/2019 11:54:39 AM Eastern Daylight Time			08/02/2019 12:54:02 PM Eastern Daylight Time	"THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC."	Fidelis Legacy Plan	www.fideliscare.org	Fidelis Medicare $0 Premium (HMO)	1	1		1			H3328	24	1	2020	NY Counties	Segment 1	2	3819	2			2						www.fideliscare.org	www.fideliscare.org	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3328	24	2	1	1	1	H3328_024_2	9	1			07/31/2019	2020.01	07/31/2019 02:19:00 PM Eastern Daylight Time	08/02/2019 11:54:39 AM Eastern Daylight Time	08/02/2019 11:54:39 AM Eastern Daylight Time			08/02/2019 12:54:02 PM Eastern Daylight Time	"THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC."	Fidelis Legacy Plan	www.fideliscare.org	Fidelis Medicare $0 Premium (HMO)	1	1		1			H3328	24	2	2020	NY Counties	Segment 2	2	272	2			2						www.fideliscare.org	www.fideliscare.org	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3328	801	0	1	2	1	H3328_801_0	7	1			05/31/2019	2020.01	05/31/2019 04:53:10 PM Eastern Daylight Time					06/03/2019 10:12:58 AM Eastern Daylight Time	"THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC."	Fidelis Legacy Plan	www.fideliscare.org	Fidelis Medicare Advantage Employer without RX (HMO-POS)	1	2		1			H3328	801	0	2020	New York Counties		1	100	2			2						www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3328	802	0	1	2	1	H3328_802_0	7	1			05/31/2019	2020.01	05/31/2019 04:53:44 PM Eastern Daylight Time					06/03/2019 10:12:58 AM Eastern Daylight Time	"THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC."	Fidelis Legacy Plan	www.fideliscare.org	Fidelis Medicare Advantage Employer (HMO-POS)	1	2		1			H3328	802	0	2020	New York Counties		1	100	2			2						www.fideliscare.org	www.fideliscare.org	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3328	803	0	1	2	1	H3328_803_0	7	1			05/31/2019	2020.01	05/31/2019 04:54:10 PM Eastern Daylight Time					06/03/2019 10:12:58 AM Eastern Daylight Time	"THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC."	Fidelis Legacy Plan	www.fideliscare.org	Fidelis Medicare Advantage Employer Non-calendar (HMO-POS)	1	2		1			H3328	803	0	2020	New York Counties		1	100	2			2						www.fideliscare.org	www.fideliscare.org	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3329	1	0	1	20	8	H3329_001_0	1	1			06/03/2019	2020.01	06/03/2019 12:24:24 PM Eastern Daylight Time		06/03/2019 12:18:52 PM Eastern Daylight Time			06/03/2019 12:28:38 PM Eastern Daylight Time	"CENTERLIGHT HEALTHCARE, INC."	CenterLight TeamCare	http://www.centerlighthealthcare.org/	CenterLight Healthcare PACE Dual Eligible (PACE)	8	20		1			H3329	1	0	2020	NYC  and Westchester Counties		2		2			2						N/A	N/A										(877)226-8500		(347)640-6039		(877)226-8500		(347)640-6039										(711)-		(711)-		(711)-		(711)-																
H3329	2	0	1	20	8	H3329_002_0	1	1			06/03/2019	2020.01	06/03/2019 12:26:01 PM Eastern Daylight Time		06/03/2019 12:18:26 PM Eastern Daylight Time			06/03/2019 12:28:38 PM Eastern Daylight Time	"CENTERLIGHT HEALTHCARE, INC."	CenterLight TeamCare	http://www.centerlighthealthcare.org/	CenterLight Healthcare - PACE - Medicare only (PACE)	8	20		1			H3329	2	0	2020	NYC and Westchester Counties		2		2			2						N/A	N/A										(877)226-8500		(347)640-6039		(877)226-8500		(347)640-6039										(711)-		(711)-		(711)-		(711)-																
H3330	21	1	1	1	1	H3330_021_1	8	1			08/05/2019	2020.01	08/05/2019 09:45:38 AM US Eastern Daylight Time	08/01/2019 03:55:04 PM Eastern Daylight Time	07/31/2019 02:20:04 PM Eastern Daylight Time			08/05/2019 05:13:37 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Gold (HMO)	1	1		1			H3330	21	1	2020	"NYC, Long Island and Lower Hudson Valley"	"Brx,Kings, New York, Queens Counties"	2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	21	2	1	1	1	H3330_021_2	6	1			07/22/2019	2020.01	07/22/2019 05:12:02 PM US Eastern Daylight Time	08/01/2019 03:56:40 PM Eastern Daylight Time	07/31/2019 02:21:58 PM Eastern Daylight Time			08/05/2019 04:53:35 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Gold (HMO)	1	1		1			H3330	21	2	2020	"NYC, Long Island and Lower Hudson Valley"	Nassau and Richmond Counties	2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	21	3	1	1	1	H3330_021_3	6	1			07/22/2019	2020.01	07/22/2019 05:12:30 PM US Eastern Daylight Time	08/01/2019 03:58:14 PM Eastern Daylight Time	07/31/2019 02:23:12 PM Eastern Daylight Time			08/05/2019 04:53:35 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Gold (HMO)	1	1		1			H3330	21	3	2020	"NYC, Long Island and Lower Hudson Valley"	Suffolk County	2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	21	4	1	1	1	H3330_021_4	6	1			07/22/2019	2020.01	07/22/2019 05:13:21 PM US Eastern Daylight Time	08/01/2019 03:59:54 PM Eastern Daylight Time	08/02/2019 11:33:52 AM Eastern Daylight Time			08/05/2019 04:53:35 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Gold (HMO)	1	1		1			H3330	21	4	2020	"NYC, Long Island and Lower Hudson Valley"	Lower Hudson Valley Counties	2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	32	1	1	1	1	H3330_032_1	9	1			08/02/2019	2020.01	08/02/2019 03:00:40 PM US Eastern Daylight Time	08/01/2019 04:01:32 PM Eastern Daylight Time	07/31/2019 05:13:28 PM Eastern Daylight Time			08/05/2019 04:53:35 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Essential (HMO)	1	1		1			H3330	32	1	2020	"NYC, Long Island and Lower Hudson Valley"	"Brx,Kings, New York and Queens Counties"	2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	32	2	1	1	1	H3330_032_2	6	1			08/02/2019	2020.01	08/02/2019 03:14:32 PM US Eastern Daylight Time	08/01/2019 04:03:08 PM Eastern Daylight Time	07/31/2019 04:55:32 PM Eastern Daylight Time			08/05/2019 04:53:35 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Essential (HMO)	1	1		1			H3330	32	2	2020	"NYC, Long Island and Lower Hudson Valley"	Nassau and Richmond Counties	2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	32	3	1	1	1	H3330_032_3	6	1			08/09/2019	2020.01	08/09/2019 10:06:50 AM US Eastern Daylight Time	08/09/2019 11:02:17 AM Eastern Daylight Time	07/31/2019 04:57:10 PM Eastern Daylight Time			08/09/2019 11:31:28 AM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Essential (HMO)	1	1		1			H3330	32	3	2020	"NYC, Long Island and Lower Hudson Valley"	Suffolk County	2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	32	4	1	1	1	H3330_032_4	6	1			08/02/2019	2020.01	08/02/2019 03:16:52 PM US Eastern Daylight Time	08/01/2019 04:06:18 PM Eastern Daylight Time	07/31/2019 04:59:24 PM Eastern Daylight Time			08/05/2019 04:53:35 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Essential (HMO)	1	1		1			H3330	32	4	2020	"NYC, Long Island and Lower Hudson Valley"	Lower Hudson Valley	2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	36	0	1	1	1	H3330_036_0	5	1			08/02/2019	2020.01	08/02/2019 02:50:33 PM US Eastern Daylight Time	08/01/2019 04:07:52 PM Eastern Daylight Time	07/31/2019 05:21:40 PM Eastern Daylight Time			08/05/2019 04:53:35 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Value (HMO)	1	1		1			H3330	36	0	2020	"NYC, Long Island and Lower Hudson Valley"		2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	38	0	1	1	1	H3330_038_0	7	1			07/22/2019	2020.01	07/22/2019 05:19:12 PM US Eastern Daylight Time	08/01/2019 04:09:30 PM Eastern Daylight Time	07/31/2019 05:26:24 PM Eastern Daylight Time			08/05/2019 04:53:35 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Gold Plus (HMO)	1	1		1			H3330	38	0	2020	"NYC, Long Island and Lower Hudson Valley"		2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	39	1	1	1	1	H3330_039_1	7	1			08/02/2019	2020.01	08/02/2019 03:19:08 PM US Eastern Daylight Time	08/01/2019 04:11:06 PM Eastern Daylight Time	07/31/2019 05:30:30 PM Eastern Daylight Time			08/05/2019 04:53:35 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Rx Saver (HMO)	1	1		1			H3330	39	1	2020	Hudson Valley	Lower Hudson Valley	2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	39	2	1	1	1	H3330_039_2	6	1			08/02/2019	2020.01	08/02/2019 03:20:18 PM US Eastern Daylight Time	08/01/2019 04:12:44 PM Eastern Daylight Time	07/31/2019 05:33:54 PM Eastern Daylight Time			08/05/2019 04:53:35 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Rx Saver (HMO)	1	1		1			H3330	39	2	2020	Hudson Valley	Upper Hudson Valley	2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	40	0	1	1	1	H3330_040_0	3	1			08/02/2019	2020.01	08/02/2019 03:52:06 PM US Eastern Daylight Time	08/02/2019 10:38:36 AM Eastern Daylight Time	07/31/2019 05:38:52 PM Eastern Daylight Time			08/05/2019 04:53:35 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Part B Saver (HMO)	1	1		1			H3330	40	0	2020	NY State		2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	41	1	1	2	1	H3330_041_1	6	1			07/30/2019	2020.01	07/30/2019 03:22:25 PM Eastern Daylight Time	08/01/2019 04:16:14 PM Eastern Daylight Time	07/31/2019 05:45:04 PM Eastern Daylight Time			08/05/2019 04:53:35 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Go (HMO-POS)	1	2		1			H3330	41	1	2020	"NYC, Long Island and Hudson Valley"	"NYC, Nassau, Hudson Valley"	2		2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	41	2	1	2	1	H3330_041_2	5	1			07/26/2019	2020.01	07/26/2019 12:02:27 PM US Eastern Daylight Time	08/01/2019 04:17:52 PM Eastern Daylight Time	07/31/2019 05:46:22 PM Eastern Daylight Time			08/05/2019 04:53:35 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Go (HMO-POS)	1	2		1			H3330	41	2	2020	"NYC, Long Island and Hudson Valley"	Suffolk County	2	7952	2			2						www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	42	1	1	1	1	H3330_042_1	6	1	2	1	08/02/2019	2020.01	08/02/2019 04:21:08 PM US Eastern Daylight Time	08/06/2019 11:33:06 AM Eastern Daylight Time	07/31/2019 03:13:54 PM Eastern Daylight Time			08/06/2019 12:11:20 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Dual (HMO D-SNP)	1	1		1			H3330	42	1	2020	"NYC, Long Island and Hudson Valley"	"Bronx, Kings, New York and Queens Counties"	2		2			1	3		1		1	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	42	2	1	1	1	H3330_042_2	7	1	2	1	08/02/2019	2020.01	08/02/2019 04:22:08 PM US Eastern Daylight Time	08/06/2019 11:34:52 AM Eastern Daylight Time	07/31/2019 03:55:52 PM Eastern Daylight Time			08/06/2019 12:11:20 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Dual (HMO D-SNP)	1	1		1			H3330	42	2	2020	"NYC, Long Island and Hudson Valley"	Suffolk County	2		2			1	3		1		1	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	42	3	1	1	1	H3330_042_3	6	1	2	1	08/02/2019	2020.01	08/02/2019 05:51:06 PM US Eastern Daylight Time	08/06/2019 11:36:38 AM Eastern Daylight Time	07/31/2019 03:15:32 PM Eastern Daylight Time			08/06/2019 12:11:20 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Dual (HMO D-SNP)	1	1		1			H3330	42	3	2020	"NYC, Long Island and Hudson Valley"	"Richmond, Nassau and Lower Hudson Valley Counties"	2	29473	2			1	3		1		1	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	www.emblemhealth.com/our-plans/medicare	(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	2			
H3330	814	0	1	1	1	H3330_814_0	3	1			06/17/2019	2020.01	06/17/2019 05:27:19 PM Eastern Daylight Time					06/17/2019 05:35:39 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Premier (HMO)	1	1		1			H3330	814	0	2020	New York		1	223000	2			2						emblemhealth.com	emblemhealth.com	www.emblemhealth.com/our-plans/medicare	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;15;	1	7c;7d;7f;7g;7i;14d;18a;	1					1				
H3330	815	0	1	1	1	H3330_815_0	2	1			06/01/2019	2020.01	06/01/2019 06:31:38 PM US Eastern Daylight Time					06/02/2019 04:51:22 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)	1	1		1			H3330	815	0	2020	New York		1	186960	2			2						emblemhealth.com	emblemhealth.com	www.emblemhealth.com/our-plans/medicare	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;15;	1	7c;7d;7f;7g;7i;14d;18a;	1					1				
H3330	819	0	1	1	1	H3330_819_0	3	1			06/17/2019	2020.01	06/17/2019 05:27:32 PM Eastern Daylight Time					06/17/2019 05:35:39 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Premier (HMO)	1	1		1			H3330	819	0	2020	New York		1	6000	2			2						emblemhealth.com	emblemhealth.com	www.emblemhealth.com/our-plans/medicare	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;15;	1	7c;7d;7f;7g;7i;14d;18a;	1					1				
H3330	820	0	1	1	1	H3330_820_0	2	1			06/01/2019	2020.01	06/01/2019 06:34:47 PM US Eastern Daylight Time					06/02/2019 04:51:22 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Choice (HMO)	1	1		1			H3330	820	0	2020	New York		1	500	2			2						emblemhealth.com	emblemhealth.com	www.emblemhealth.com/our-plans/medicare	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;15;	1	7c;7d;7f;7g;7i;14d;18a;	1					1				
H3331	1	0	1	20	8	H3331_001_0	1	1			05/17/2019	2020.01	05/17/2019 01:30:55 PM Eastern Daylight Time		05/17/2019 01:05:18 PM Eastern Daylight Time			05/17/2019 01:33:29 PM Eastern Daylight Time	"INDEPENDENT LIVING FOR SENIORS, INC."	ElderONE an Affiliate of Rochester Regional Health	www.ElderONE.org	ElderONE an Affiliate of Rochester Regional Health (PACE)	8	20		1			H3331	1	0	2020	"Monroe, Wayne, Ontario Counties"		2		2			2						www.rochestergeneral.org/hillhaven	www.rochestergeneral.org										(855)457-4636		(585)922-2831		(855)457-4636		(585)922-2831										(800)662-1220		(585)922-2831		(800)662-1220		(585)922-2831																
H3331	2	0	1	20	8	H3331_002_0	1	1			05/17/2019	2020.01	05/17/2019 01:31:05 PM Eastern Daylight Time		05/17/2019 01:05:02 PM Eastern Daylight Time			05/17/2019 01:33:29 PM Eastern Daylight Time	"INDEPENDENT LIVING FOR SENIORS, INC."	ElderONE an Affiliate of Rochester Regional Health	www.ElderONE.org	ElderONE an Affiliate of Rochester Regional Health (PACE)	8	20		1			H3331	2	0	2020	"Monroe, Wayne, Ontario Counties"		2		2			2						www.rochestergeneral.org/hillhaven	www.rochestergeneral.org										(855)457-4636		(585)922-2831		(855)457-4636		(585)922-2831										(800)662-1220		(585)922-2831		(800)662-1220		(585)922-2831																
H3335	14	0	1	4	1	H3335_014_0	7	1			07/08/2019	2020.01	07/08/2019 04:33:34 PM Eastern Daylight Time	08/05/2019 03:24:16 PM Eastern Daylight Time	08/05/2019 03:24:16 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare BlueSecure (PPO)	1	4		1			H3335	14	0	2020	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		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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			
H3335	15	0	1	4	1	H3335_015_0	7	1			07/08/2019	2020.01	07/08/2019 04:34:38 PM Eastern Daylight Time	08/05/2019 03:24:17 PM Eastern Daylight Time	08/05/2019 03:24:17 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare BlueEnhanced (PPO)	1	4		1			H3335	15	0	2020	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		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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			
H3335	18	0	1	4	1	H3335_018_0	8	1			07/08/2019	2020.01	07/08/2019 04:43:50 PM Eastern Daylight Time	08/05/2019 03:24:18 PM Eastern Daylight Time	08/05/2019 03:24:19 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare BluePlus (PPO)	1	4		1			H3335	18	0	2020	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		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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			
H3335	38	0	1	4	1	H3335_038_0	7	1			07/08/2019	2020.01	07/08/2019 04:35:25 PM Eastern Daylight Time	08/05/2019 03:24:19 PM Eastern Daylight Time	08/05/2019 03:24:20 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare BlueClassic (PPO)	1	4		1			H3335	38	0	2020	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		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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			
H3335	43	0	1	4	1	H3335_043_0	8	1			07/24/2019	2020.01	07/24/2019 09:40:59 AM Eastern Daylight Time	07/11/2019 03:34:00 PM Eastern Daylight Time				07/24/2019 09:43:25 AM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare BlueBasic (PPO)	1	4		1			H3335	43	0	2020	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)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2						2			
H3335	44	0	1	4	1	H3335_044_0	8	1			07/24/2019	2020.01	07/24/2019 09:41:06 AM Eastern Daylight Time	07/11/2019 03:34:30 PM Eastern Daylight Time				07/24/2019 09:43:25 AM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare BlueBasic (PPO)	1	4		1			H3335	44	0	2020	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)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2						2			
H3335	53	0	1	4	1	H3335_053_0	8	1			08/05/2019	2020.01	08/05/2019 08:50:31 AM Eastern Daylight Time	08/05/2019 03:24:22 PM Eastern Daylight Time	08/05/2019 03:24:22 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare BlueEssential (PPO)	1	4		1			H3335	53	0	2020	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		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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			
H3335	801	0	1	4	1	H3335_801_0	4	1			06/01/2019	2020.01	06/01/2019 01:58:53 PM Eastern Daylight Time					06/03/2019 04:51:17 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.UniveraMedicare.com	Univera Medicare PPO Group (PPO)	1	4		1			H3335	801	0	2020	Western New York		1	2250	2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(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			
H3335	811	0	1	4	1	H3335_811_0	4	1			05/21/2019	2020.01	05/21/2019 09:53:12 AM Eastern Daylight Time					06/03/2019 04:51:17 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare Blue PPO Group (PPO)	1	4		1			H3335	811	0	2020	National and Puerto Rico		1	132456	2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(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			
H3335	813	0	1	4	1	H3335_813_0	4	1			05/21/2019	2020.01	05/21/2019 09:53:26 AM Eastern Daylight Time					06/03/2019 04:51:17 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.UniveraMedicare.com	Univera Medicare PPO Group (PPO)	1	4		1			H3335	813	0	2020	Western New York		1	0	2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2						2			
H3335	819	0	1	4	1	H3335_819_0	4	1			05/21/2019	2020.01	05/21/2019 09:53:44 AM Eastern Daylight Time					06/03/2019 04:51:17 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare Blue PPO Group (PPO)	1	4		1			H3335	819	0	2020	National and Puerto Rico		1	0	2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2						2			
H3335	820	0	1	4	1	H3335_820_0	4	1			05/21/2019	2020.01	05/21/2019 09:53:54 AM Eastern Daylight Time					06/03/2019 04:51:17 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare Blue PPO Group Non-Calendar (PPO)	1	4		1			H3335	820	0	2020	National and Puerto Rico		1	0	2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(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			
H3335	822	0	1	4	1	H3335_822_0	4	1			05/21/2019	2020.01	05/21/2019 09:54:02 AM Eastern Daylight Time					06/03/2019 04:51:17 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.UniveraMedicare.com	Univera Medicare PPO Group Non-Calendar (PPO)	1	4		1			H3335	822	0	2020	Western New York		1	0	2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(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			
H3342	19	0	1	4	1	H3342_019_0	7	1			06/25/2019	2020.01	06/25/2019 05:26:45 PM Eastern Daylight Time	08/07/2019 04:06:27 PM Eastern Daylight Time	07/30/2019 08:02:11 PM Eastern Daylight Time			08/07/2019 05:29:02 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE ASSURANCE, INC."	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Access (PPO)	1	4		1			H3342	19	0	2020	Select Counties in New York		2		2			2						https://shop.empireblue.com/medicare	https://shop.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		(844)364-2114		(844)364-2114		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3342	808	0	1	4	1	H3342_808_0	2	1			05/30/2019	2020.01	05/30/2019 04:18:43 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE ASSURANCE, INC."	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	1	4		1			H3342	808	0	2020	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	809	0	1	4	1	H3342_809_0	2	1			05/30/2019	2020.01	05/30/2019 04:18:49 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE ASSURANCE, INC."	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	1	4		1			H3342	809	0	2020	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	810	0	1	4	1	H3342_810_0	2	1			05/30/2019	2020.01	05/30/2019 04:18:55 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE ASSURANCE, INC."	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	1	4		1			H3342	810	0	2020	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	812	0	1	4	1	H3342_812_0	2	1			05/30/2019	2020.01	05/30/2019 04:19:01 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE ASSURANCE, INC."	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	1	4		1			H3342	812	0	2020	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	813	0	2	4	1	H3342_813_0	2	1			05/30/2019	2020.01	05/30/2019 04:19:09 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE ASSURANCE, INC."	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	1	4		2	1		H3342	813	0	2020	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	814	0	2	4	1	H3342_814_0	2	1			05/30/2019	2020.01	05/30/2019 04:19:16 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE ASSURANCE, INC."	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	1	4		2	1		H3342	814	0	2020	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	815	0	2	4	1	H3342_815_0	2	1			05/30/2019	2020.01	05/30/2019 04:19:24 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE ASSURANCE, INC."	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	1	4		2	1		H3342	815	0	2020	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	816	0	2	4	1	H3342_816_0	2	1			05/30/2019	2020.01	05/30/2019 04:19:30 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE ASSURANCE, INC."	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	1	4		2	1		H3342	816	0	2020	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	817	0	1	4	1	H3342_817_0	2	1			05/30/2019	2020.01	05/30/2019 04:19:38 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE ASSURANCE, INC."	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	1	4		1			H3342	817	0	2020	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	818	0	1	4	1	H3342_818_0	2	1			05/30/2019	2020.01	05/30/2019 04:19:46 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE ASSURANCE, INC."	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	1	4		1			H3342	818	0	2020	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	819	0	1	4	1	H3342_819_0	2	1			05/30/2019	2020.01	05/30/2019 04:19:53 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE ASSURANCE, INC."	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	1	4		1			H3342	819	0	2020	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3342	820	0	1	4	1	H3342_820_0	2	1			05/30/2019	2020.01	05/30/2019 04:20:02 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE ASSURANCE, INC."	Empire BlueCross BlueShield	https://shop.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	1	4		1			H3342	820	0	2020	New York		1	600	2			2						https://shop.empireblue.com/medicare	https://shop.empireblue.com/medicare	www.empireblue.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H3344	5	0	1	4	1	H3344_005_0	8	1			07/25/2019	2020.01	07/25/2019 04:42:13 PM Eastern Daylight Time	08/02/2019 12:04:48 PM Eastern Daylight Time	07/30/2019 04:49:48 PM Eastern Daylight Time			08/06/2019 07:05:37 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health Medicare Passport Advantage (PPO)	1	4		1			H3344	5	0	2020	Western New York		2		2			2						www.independentheatlh.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3344	10	0	1	4	1	H3344_010_0	9	1			07/19/2019	2020.01	07/19/2019 10:27:49 AM Eastern Daylight Time	08/05/2019 01:42:00 PM Eastern Daylight Time	07/30/2019 04:50:14 PM Eastern Daylight Time			08/06/2019 07:05:37 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health's Medicare Passport Prime (PPO)	1	4		1			H3344	10	0	2020	Western New York		2		2			2						www.independentheatlh.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3344	801	0	1	4	1	H3344_801_0	1	1			05/29/2019	2020.01	05/29/2019 10:35:38 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health Medicare PPO Base (PPO)	1	4		1			H3344	801	0	2020	IH Network and Medicare Deemed Network		1	21442	2			2						www.independentheatlh.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1									
H3344	804	0	1	4	1	H3344_804_0	1	1			05/29/2019	2020.01	05/29/2019 10:36:04 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health Medicare PPO Base (PPO)	1	4		1			H3344	804	0	2020	IH Network and Medicare Deemed Network		1	17109	2			2						www.independentheatlh.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1									
H3347	2	0	1	1	1	H3347_002_0	3	1	2	1	07/22/2019	2020.01	07/22/2019 10:57:29 AM Eastern Daylight Time	07/31/2019 11:59:48 AM Eastern Daylight Time	07/31/2019 12:21:16 PM Eastern Daylight Time			08/06/2019 02:20:22 PM Eastern Daylight Time	"ELDERPLAN, INC."	Elderplan	www.elderplan.org	Elderplan For Medicaid Beneficiaries (HMO D-SNP)	1	1		1			H3347	2	0	2020	"Brx, Ki, Na, NY, Qu, Wes"		2	61650	2			1	3		2		2	www.caremark.com	www.elderplan.org	www.elderplan.org	(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	2			
H3347	3	0	1	1	1	H3347_003_0	2	1		1	08/01/2019	2020.01	08/01/2019 10:58:50 AM Eastern Daylight Time	07/31/2019 05:04:00 PM Eastern Daylight Time	07/31/2019 12:22:10 PM Eastern Daylight Time			08/01/2019 03:33:29 PM Eastern Daylight Time	"ELDERPLAN, INC."	Elderplan	www.elderplan.org	Elderplan Advantage For Nursing Home Residents (HMO I-SNP)	1	1		1			H3347	3	0	2020	"Brx, Ki, Monr, Na, NY, Put, Qu, Ri, Roc,Suf, Wes"		2	24174	2			1	1	1				www.caremark.com	www.elderplan.org	www.elderplan.org	(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	2			
H3347	7	0	1	1	1	H3347_007_0	4	1	2	1	05/30/2019	2020.01	05/30/2019 05:15:32 PM Eastern Daylight Time	07/31/2019 12:09:41 PM Eastern Daylight Time	07/31/2019 12:22:56 PM Eastern Daylight Time			08/06/2019 02:20:22 PM Eastern Daylight Time	"ELDERPLAN, INC."	Elderplan	www.elderplan.org	Elderplan Plus Long Term Care (HMO D-SNP)	1	1		1			H3347	7	0	2020	"Brx, Ki, Na, NY, Qu, Ri, Wes"		2	22830	2			1	3		2		1	www.caremark.com	www.elderplan.org	www.elderplan.org	(877)891-6447		(718)921-7979		(866)695-8101		(866)695-8101		(877)891-6447		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3347	9	0	1	1	1	H3347_009_0	5	1			07/17/2019	2020.01	07/17/2019 06:57:11 PM Eastern Daylight Time	07/31/2019 12:11:48 PM Eastern Daylight Time	07/31/2019 12:23:41 PM Eastern Daylight Time			08/06/2019 02:20:22 PM Eastern Daylight Time	"ELDERPLAN, INC."	Elderplan	www.elderplan.org	Elderplan Extra Help (HMO)	1	1		1			H3347	9	0	2020	"Brx, Ki, NY, Qu, Wes"		2		2			2						www.caremark.com	www.elderplan.org	www.elderplan.org	(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	2			
H3347	15	0	1	1	1	H3347_015_0	4	1		1	08/01/2019	2020.01	08/01/2019 10:59:55 AM Eastern Daylight Time	07/31/2019 01:18:49 PM Eastern Daylight Time	07/31/2019 12:24:23 PM Eastern Daylight Time			08/01/2019 03:33:29 PM Eastern Daylight Time	"ELDERPLAN, INC."	Elderplan	www.elderplan.org	Elderplan Assist (HMO I-SNP)	1	1		1			H3347	15	0	2020	"Brx, Ki, Monr, Na, NY, Put, Qu, Ri, Roc,Suff, Wes"		2	414	2			1	1	2				www.caremark.com	www.elderplan.org	www.elderplan.org	(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	2			
H3351	1	0	1	2	1	H3351_001_0	7	1			07/24/2019	2020.01	07/24/2019 09:41:29 AM Eastern Daylight Time	07/11/2019 03:35:02 PM Eastern Daylight Time				07/24/2019 09:43:25 AM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.UniveraMedicare.com	Univera SeniorChoice Select (HMO-POS)	1	2		1			H3351	1	0	2020	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)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2	2			
H3351	2	0	1	2	1	H3351_002_0	8	1			07/24/2019	2020.01	07/24/2019 09:41:53 AM Eastern Daylight Time	08/05/2019 03:24:23 PM Eastern Daylight Time	08/05/2019 03:24:24 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.UniveraMedicare.com	Univera SeniorChoice Secure (HMO-POS)	1	2		1			H3351	2	0	2020	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		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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	2			
H3351	6	0	1	2	1	H3351_006_0	7	1			07/08/2019	2020.01	07/08/2019 04:44:04 PM Eastern Daylight Time	08/05/2019 03:24:25 PM Eastern Daylight Time	08/05/2019 03:24:25 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare Blue Choice Optimum (HMO-POS)	1	2		1			H3351	6	0	2020	Metro Rochester Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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	2			
H3351	7	0	1	2	1	H3351_007_0	8	1			07/24/2019	2020.01	07/24/2019 09:41:18 AM Eastern Daylight Time	07/11/2019 03:35:34 PM Eastern Daylight Time				07/24/2019 09:43:25 AM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare Blue Choice Platinum (HMO-POS)	1	2		1			H3351	7	0	2020	Metro Rochester Area		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)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2	2			
H3351	10	0	1	1	1	H3351_010_0	6	1			07/03/2019	2020.01	07/03/2019 12:14:52 PM Eastern Daylight Time	08/05/2019 03:24:27 PM Eastern Daylight Time	08/05/2019 03:24:27 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.UniveraMedicare.com	Univera SeniorChoice Value (HMO)	1	1		1			H3351	10	0	2020	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		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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	2			
H3351	11	0	1	1	1	H3351_011_0	6	1			07/03/2019	2020.01	07/03/2019 12:15:12 PM Eastern Daylight Time	08/05/2019 03:24:28 PM Eastern Daylight Time	08/05/2019 03:24:28 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare Blue Choice Value (HMO)	1	1		1			H3351	11	0	2020	Metro Rochester Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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	2			
H3351	12	0	1	2	1	H3351_012_0	7	1			07/08/2019	2020.01	07/08/2019 04:40:13 PM Eastern Daylight Time	08/05/2019 03:24:29 PM Eastern Daylight Time	08/05/2019 03:24:30 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.UniveraMedicare.com	Univera SeniorChoice Value Plus (HMO-POS)	1	2		1			H3351	12	0	2020	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		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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	2			
H3351	13	0	1	2	1	H3351_013_0	7	1			07/08/2019	2020.01	07/08/2019 04:40:31 PM Eastern Daylight Time	08/05/2019 03:24:30 PM Eastern Daylight Time	08/05/2019 03:24:31 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare Blue Choice Value Plus (HMO-POS)	1	2		1			H3351	13	0	2020	Metro Rochester Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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	2			
H3351	15	0	1	2	1	H3351_015_0	8	1			07/08/2019	2020.01	07/08/2019 04:40:49 PM Eastern Daylight Time	08/05/2019 03:24:31 PM Eastern Daylight Time	08/05/2019 03:24:32 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare Bassett (HMO-POS)	1	2		1			H3351	15	0	2020	East New York		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(844)854-4063		(844)854-4063		(800)659-1986		(800)659-1986		(844)854-4063		(844)854-4063		(800)659-1986		(800)659-1986		(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	2			
H3351	16	0	1	1	1	H3351_016_0	7	1			08/05/2019	2020.01	08/05/2019 08:52:25 AM Eastern Daylight Time	08/05/2019 03:24:32 PM Eastern Daylight Time	08/05/2019 03:24:33 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare Blue Choice Select (HMO)	1	1		1			H3351	16	0	2020	Metro Rochester Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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	2			
H3351	17	0	1	1	1	H3351_017_0	7	1			08/05/2019	2020.01	08/05/2019 11:22:07 AM Eastern Daylight Time	08/05/2019 03:24:34 PM Eastern Daylight Time	08/05/2019 03:24:34 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.UniveraMedicare.com	Univera SeniorChoice Basic (HMO)	1	1		1			H3351	17	0	2020	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		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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	2			
H3351	18	0	1	2	1	H3351_018_0	7	1			08/05/2019	2020.01	08/05/2019 08:54:42 AM Eastern Daylight Time	08/05/2019 03:24:13 PM Eastern Daylight Time	08/05/2019 03:24:14 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare Blue Choice Advanced (HMO-POS)	1	2		1			H3351	18	0	2020	Metro Rochester Area		2		2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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	2			
H3351	19	0	1	2	1	H3351_019_0	7	1			08/05/2019	2020.01	08/05/2019 08:55:38 AM Eastern Daylight Time	08/05/2019 03:24:14 PM Eastern Daylight Time	08/05/2019 03:24:15 PM Eastern Daylight Time			08/05/2019 03:43:39 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.UniveraMedicare.com	Univera SeniorChoice Advanced (HMO-POS)	1	2		1			H3351	19	0	2020	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		(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(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	2			
H3351	801	0	1	2	1	H3351_801_0	4	1			05/21/2019	2020.01	05/21/2019 09:54:33 AM Eastern Daylight Time					06/03/2019 04:51:17 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.UniveraMedicare.com	Univera SeniorChoice - Group (HMO-POS)	1	2		1			H3351	801	0	2020	Western New York		1	2550	2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(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	2			
H3351	802	0	1	2	1	H3351_802_0	4	1			05/21/2019	2020.01	05/21/2019 09:54:49 AM Eastern Daylight Time					06/03/2019 04:51:17 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare Blue Choice - Group (HMO-POS)	1	2		1			H3351	802	0	2020	Metro Rochester Area and Central New York		1	175156	2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(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	2			
H3351	803	0	1	2	1	H3351_803_0	4	1			05/21/2019	2020.01	05/21/2019 09:55:24 AM Eastern Daylight Time					06/03/2019 04:51:17 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.UniveraMedicare.com	Univera SeniorChoice - Group (HMO-POS)	1	2		1			H3351	803	0	2020	Western New York		1	48	2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2	2			
H3351	804	0	1	2	1	H3351_804_0	4	1			05/21/2019	2020.01	05/21/2019 09:55:39 AM Eastern Daylight Time					06/03/2019 04:51:17 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare Blue Choice - Group (HMO-POS)	1	2		1			H3351	804	0	2020	Metro Rochester Area and Central New York		1	1700	2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2	2			
H3351	805	0	1	2	1	H3351_805_0	4	1			05/21/2019	2020.01	05/21/2019 09:55:53 AM Eastern Daylight Time					06/03/2019 04:51:17 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.UniveraMedicare.com	Univera SeniorChoice Group Non-Calendar (HMO-POS)	1	2		1			H3351	805	0	2020	Western New York		1	0	2			2						www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(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	2			
H3351	806	0	1	2	1	H3351_806_0	4	1			05/21/2019	2020.01	05/21/2019 09:55:59 AM Eastern Daylight Time					06/03/2019 04:51:17 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.ExcellusMedicare.com	Medicare Blue Choice Group Non-Calendar (HMO-POS)	1	2		1			H3351	806	0	2020	Metro Rochester Area and Central New York		1	0	2			2						www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577		(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	2			
H3359	1	0	1	1	1	H3359_001_0	7	1			08/06/2019	2020.01	08/06/2019 01:45:04 PM Eastern Daylight Time	08/06/2019 03:34:07 PM Eastern Daylight Time	08/06/2019 03:34:53 PM Eastern Daylight Time			08/06/2019 03:55:42 PM Eastern Daylight Time	"HEALTHFIRST HEALTH PLAN, INC."	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst 65 Plus Plan (HMO)	1	1		1			H3359	1	0	2020	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		(711)-		(711)-		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	19	0	1	1	1	H3359_019_0	8	1			08/06/2019	2020.01	08/06/2019 01:51:24 PM Eastern Daylight Time	08/06/2019 03:35:52 PM Eastern Daylight Time	08/06/2019 03:36:41 PM Eastern Daylight Time			08/06/2019 03:55:42 PM Eastern Daylight Time	"HEALTHFIRST HEALTH PLAN, INC."	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Increased Benefits Plan (HMO)	1	1		1			H3359	19	0	2020	"NYC, Nassau, Some Lower Hudson Valley Counties"		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		(711)-		(711)-		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	21	0	1	1	1	H3359_021_0	8	1	2	1	08/06/2019	2020.01	08/06/2019 01:50:33 PM Eastern Daylight Time	08/06/2019 03:38:13 PM Eastern Daylight Time	08/06/2019 03:38:55 PM Eastern Daylight Time			08/06/2019 03:55:42 PM Eastern Daylight Time	"HEALTHFIRST HEALTH PLAN, INC."	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Life Improvement Plan (HMO D-SNP)	1	1		1			H3359	21	0	2020	"NYC, Nassau, Some Lower Hudson Valley 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		(711)-		(711)-		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	27	0	1	1	1	H3359_027_0	7	1			07/01/2019	2020.01	07/01/2019 06:10:49 PM Eastern Daylight Time	07/11/2019 03:49:47 PM Eastern Daylight Time				07/11/2019 03:50:53 PM Eastern Daylight Time	"HEALTHFIRST HEALTH PLAN, INC."	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Coordinated Benefits Plan (HMO)	1	1		1			H3359	27	0	2020	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	2			
H3359	34	0	1	1	1	H3359_034_0	8	1	2	1	08/06/2019	2020.01	08/06/2019 01:52:14 PM Eastern Daylight Time	08/06/2019 03:39:46 PM Eastern Daylight Time	08/06/2019 03:40:33 PM Eastern Daylight Time			08/06/2019 03:55:42 PM Eastern Daylight Time	"HEALTHFIRST HEALTH PLAN, INC."	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst CompleteCare (HMO D-SNP)	1	1		1			H3359	34	0	2020	"New York City, Nassau, and Westchester Counties"		2		2			1	3		1		1	www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(888)260-1010		(888)260-1010		(888)260-1010		(888)260-1010		(888)260-1010		(888)260-1010		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(711)-		(711)-		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	808	0	1	1	1	H3359_808_0	2	1			07/01/2019	2020.01	07/01/2019 07:03:25 PM Eastern Daylight Time					07/01/2019 07:08:20 PM Eastern Daylight Time	"HEALTHFIRST HEALTH PLAN, INC."	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Employer Group 1 (HMO)	1	1		1			H3359	808	0	2020	United States		1	120	2			2						www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare			(888)260-1010				(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		(711)-		(711)-		(888)542-3821		(888)542-3821		2					2					2	2			
H3359	809	0	1	1	1	H3359_809_0	2	1			07/01/2019	2020.01	07/01/2019 06:07:57 PM Eastern Daylight Time					07/01/2019 07:08:20 PM Eastern Daylight Time	"HEALTHFIRST HEALTH PLAN, INC."	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Employer Group 2 (HMO)	1	1		1			H3359	809	0	2020	United States		1	120	2			2						www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare			(888)260-1010				(877)237-1303										(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821										2					2					2	2			
H3362	16	0	1	1	1	H3362_016_0	5	1			07/12/2019	2020.01	07/12/2019 01:55:28 PM Eastern Daylight Time	06/02/2019 10:22:40 PM Eastern Daylight Time				07/12/2019 02:51:41 PM Eastern Daylight Time	"INDEPENDENT HEALTH ASSOCIATION, INC."	Independent Health	independenthealth.com/medicare	Independent Health Encompass 65 (HMO)	1	1		1			H3362	16	0	2020	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3362	17	0	1	1	1	H3362_017_0	8	1			07/18/2019	2020.01	07/18/2019 04:32:11 PM Eastern Daylight Time	08/02/2019 12:06:30 PM Eastern Daylight Time	07/30/2019 04:50:42 PM Eastern Daylight Time			08/06/2019 07:05:37 AM Eastern Daylight Time	"INDEPENDENT HEALTH ASSOCIATION, INC."	Independent Health	independenthealth.com/medicare	Independent Health Encompass 65 Basic (HMO)	1	1		1			H3362	17	0	2020	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3362	20	0	1	1	1	H3362_020_0	8	1		1	08/02/2019	2020.01	08/02/2019 06:47:43 AM Eastern Daylight Time	08/02/2019 12:07:22 PM Eastern Daylight Time	07/30/2019 04:51:08 PM Eastern Daylight Time			08/06/2019 07:05:37 AM Eastern Daylight Time	"INDEPENDENT HEALTH ASSOCIATION, INC."	Independent Health	independenthealth.com/medicare	Independent Health Medicare Family Choice (HMO I-SNP)	1	1		1			H3362	20	0	2020	Western New York		2		2			1	1	3				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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3362	33	0	1	1	1	H3362_033_0	8	1			07/01/2019	2020.01	07/01/2019 03:05:35 PM Eastern Daylight Time	08/02/2019 12:08:12 PM Eastern Daylight Time	07/30/2019 04:51:34 PM Eastern Daylight Time			08/06/2019 07:05:37 AM Eastern Daylight Time	"INDEPENDENT HEALTH ASSOCIATION, INC."	Independent Health	independenthealth.com/medicare	Independent Health's Encompass 65 Core (HMO)	1	1		1			H3362	33	0	2020	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3362	35	0	1	1	1	H3362_035_0	5	1		1	07/18/2019	2020.01	07/18/2019 04:32:43 PM Eastern Daylight Time	08/02/2019 12:46:38 PM Eastern Daylight Time	07/30/2019 04:52:00 PM Eastern Daylight Time			08/06/2019 07:05:37 AM Eastern Daylight Time	"INDEPENDENT HEALTH ASSOCIATION, INC."	Independent Health	www.independenthealth.com	Independent Health's Assure Advantage (HMO C-SNP)	1	1		1			H3362	35	0	2020	Erie County		2		2			1	4			100		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3362	38	0	1	1	1	H3362_038_0	7	1			06/26/2019	2020.01	06/26/2019 10:19:03 AM Eastern Daylight Time	08/02/2019 12:09:56 PM Eastern Daylight Time	07/30/2019 04:52:28 PM Eastern Daylight Time			08/06/2019 07:05:37 AM Eastern Daylight Time	"INDEPENDENT HEALTH ASSOCIATION, INC."	Independent Health	www.independenthealth.com/medicare	Independent Health's Encompass 65 Element (HMO)	1	1		1			H3362	38	0	2020	Western New York		2		2			2						www.independenthealth.com	www.independenthealth.com/medicare	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3362	801	0	1	1	1	H3362_801_0	1	1			05/29/2019	2020.01	05/29/2019 10:36:50 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	"INDEPENDENT HEALTH ASSOCIATION, INC."	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass (HMO)	1	1		1			H3362	801	0	2020	New York State		1	53188	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1					1				
H3362	807	0	1	2	1	H3362_807_0	1	1			05/29/2019	2020.01	05/29/2019 10:37:18 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	"INDEPENDENT HEALTH ASSOCIATION, INC."	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass (HMO-POS)	1	2		1			H3362	807	0	2020	IH Network and Medicare Deemed Network		1	22380	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1	2		2		1				
H3362	819	0	1	2	1	H3362_819_0	1	1			05/29/2019	2020.01	05/29/2019 10:38:08 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	"INDEPENDENT HEALTH ASSOCIATION, INC."	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass (HMO-POS)	1	2		1			H3362	819	0	2020	IH Network and Medicare Deemed Network		1	3586	2			2						www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;11a;11b;11c;15;16b;	2		1	2		2		1				
H3362	820	0	1	1	1	H3362_820_0	1	1			05/29/2019	2020.01	05/29/2019 10:38:39 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	"INDEPENDENT HEALTH ASSOCIATION, INC."	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass (HMO)	1	1		1			H3362	820	0	2020	New York State		1	54365	2			2						www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;11c;15;16b;	2		1					1				
H3379	1	0	1	1	1	H3379_001_0	5	1			08/02/2019	2020.01	08/02/2019 11:44:59 AM Central Daylight Time	08/02/2019 10:09:09 AM Central Daylight Time	07/30/2019 08:18:11 PM Central Daylight Time			08/06/2019 09:24:31 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW YORK, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3379	1	0	2020	New York City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3379	2	0	1	1	1	H3379_002_0	2	1		1	05/30/2019	2020.01	05/30/2019 11:44:00 AM Central Daylight Time	08/02/2019 10:10:42 AM Central Daylight Time	07/30/2019 08:18:45 PM Central Daylight Time			08/05/2019 05:22:41 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW YORK, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)	1	1		1			H3379	2	0	2020	New York City		2		2			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	2			
H3379	22	0	1	1	1	H3379_022_0	3	1		1	08/05/2019	2020.01	08/05/2019 09:00:56 AM Central Daylight Time	08/05/2019 11:54:48 AM Central Daylight Time	07/30/2019 08:19:22 PM Central Daylight Time			08/05/2019 05:22:41 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW YORK, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)	1	1		1			H3379	22	0	2020	Upstate New York		2		2			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	2			
H3379	39	0	1	1	1	H3379_039_0	3	1			08/02/2019	2020.01	08/02/2019 11:44:45 AM Central Daylight Time	08/02/2019 10:13:47 AM Central Daylight Time	07/30/2019 08:19:58 PM Central Daylight Time			08/06/2019 09:24:31 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW YORK, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H3379	39	0	2020	Syracuse Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3379	40	0	1	1	1	H3379_040_0	3	1			08/02/2019	2020.01	08/02/2019 11:45:37 AM Central Daylight Time	08/02/2019 10:15:17 AM Central Daylight Time	07/30/2019 08:20:31 PM Central Daylight Time			08/06/2019 09:24:31 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW YORK, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H3379	40	0	2020	Buffalo Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3379	41	0	1	1	1	H3379_041_0	3	1			08/02/2019	2020.01	08/02/2019 11:45:59 AM Central Daylight Time	08/02/2019 10:16:46 AM Central Daylight Time	07/30/2019 08:21:06 PM Central Daylight Time			08/06/2019 09:24:31 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW YORK, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H3379	41	0	2020	Monroe and Wayne Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3379	42	0	1	1	1	H3379_042_0	2	1		1	05/30/2019	2020.01	05/30/2019 11:49:10 AM Central Daylight Time	08/02/2019 10:18:11 AM Central Daylight Time	07/30/2019 08:21:40 PM Central Daylight Time			08/05/2019 05:22:41 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW YORK, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 2 (HMO I-SNP)	1	1		1			H3379	42	0	2020	Jefferson County		2		2			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	2			
H3384	13	0	1	1	1	H3384_013_0	4	1			08/05/2019	2020.01	08/05/2019 03:58:02 PM Eastern Daylight Time	08/06/2019 01:08:23 PM Eastern Daylight Time	08/06/2019 01:08:58 PM Eastern Daylight Time			08/06/2019 02:49:22 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	BlueShield Senior Blue 652 (HMO)	1	1		1			H3384	13	0	2020	Northeastern New York		2		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					2	2			
H3384	19	0	1	1	1	H3384_019_0	4	1			08/05/2019	2020.01	08/05/2019 10:42:18 AM Eastern Daylight Time	08/06/2019 01:08:24 PM Eastern Daylight Time	08/06/2019 01:08:59 PM Eastern Daylight Time			08/06/2019 02:49:22 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	BlueCross BlueShield Senior Blue 651 (HMO)	1	1		1			H3384	19	0	2020	Western New York		2		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	2			
H3384	22	0	1	1	1	H3384_022_0	3	1			07/03/2019	2020.01	07/03/2019 02:16:30 PM Eastern Daylight Time	06/02/2019 03:21:17 PM Eastern Daylight Time				07/03/2019 02:22:10 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	BlueCross BlueShield Senior Blue 601 (HMO)	1	1		1			H3384	22	0	2020	Western New York		2		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	2			
H3384	58	0	1	1	1	H3384_058_0	4	1			08/05/2019	2020.01	08/05/2019 10:43:14 AM Eastern Daylight Time	08/06/2019 01:08:26 PM Eastern Daylight Time	08/06/2019 01:09:01 PM Eastern Daylight Time			08/06/2019 02:49:22 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	BlueCross BlueShield Senior Blue Select (HMO)	1	1		1			H3384	58	0	2020	Western New York		2		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	2			
H3384	59	0	1	1	1	H3384_059_0	4	1			08/05/2019	2020.01	08/05/2019 10:39:10 AM Eastern Daylight Time	08/06/2019 01:08:28 PM Eastern Daylight Time	08/06/2019 01:09:02 PM Eastern Daylight Time			08/06/2019 02:49:22 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	BlueShield Freedom Plus (HMO)	1	1		1			H3384	59	0	2020	Northeastern New York		2		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					2	2			
H3384	62	0	1	1	1	H3384_062_0	4	1			08/05/2019	2020.01	08/05/2019 10:43:56 AM Eastern Daylight Time	08/06/2019 01:08:30 PM Eastern Daylight Time	08/06/2019 01:09:03 PM Eastern Daylight Time			08/06/2019 02:49:22 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	BlueCross BlueShield BlueSaver (HMO)	1	1		1			H3384	62	0	2020	Western New York		2		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	2			
H3384	63	0	1	1	1	H3384_063_0	4	1			08/05/2019	2020.01	08/05/2019 10:40:41 AM Eastern Daylight Time	08/06/2019 01:08:32 PM Eastern Daylight Time	08/06/2019 01:09:05 PM Eastern Daylight Time			08/06/2019 02:49:22 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	BlueShield Freedom Value (HMO)	1	1		1			H3384	63	0	2020	Northeastern New York		2		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					2	2			
H3384	64	0	1	1	1	H3384_064_0	4	1			08/05/2019	2020.01	08/05/2019 10:41:19 AM Eastern Daylight Time	08/06/2019 01:08:34 PM Eastern Daylight Time	08/06/2019 01:09:07 PM Eastern Daylight Time			08/06/2019 02:49:22 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	BlueShield Freedom Premier (HMO)	1	1		1			H3384	64	0	2020	Northeastern New York		2		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					2	2			
H3384	805	0	1	1	1	H3384_805_0	1	1			05/31/2019	2020.01	05/31/2019 11:39:48 AM Eastern Daylight Time					05/31/2019 02:55:28 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	HMO Group MA Only Plan (HMO)	1	1		1			H3384	805	0	2020	Western and Northeastern New York		1	0	2			2						www.bcbswny.com	http://www.bcbswny.com/pharmacy	www.nymedicare.com	(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;9a1;9b;9c;11a;11b;11c;15;	2		1					2				
H3384	806	0	1	1	1	H3384_806_0	1	1			05/31/2019	2020.01	05/31/2019 02:53:51 PM Eastern Daylight Time					05/31/2019 02:55:28 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	HMO Group (MA-PD) Calendar Year (HMO)	1	1		1			H3384	806	0	2020	Western and Northeastern New York		1	56183	2			2						www.bcbswny.com	http://www.bcbswny.com/pharmacy	www.nymedicare.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)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;9a1;9b;9c;11a;11b;11c;15;	2		1					2				
H3384	811	0	1	2	1	H3384_811_0	1	1			05/31/2019	2020.01	05/31/2019 11:50:42 AM Eastern Daylight Time					05/31/2019 02:55:28 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	HMOPOS Group (MA-PD) Calendar Year (HMO-POS)	1	2		1			H3384	811	0	2020	Western and Northeastern New York		1	13	2			2						www.bcbswny.com	http://www.bcbswny.com/pharmacy	www.nymedicare.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)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;9a1;9b;9c;11a;11b;11c;15;	2		1	2		2		2				
H3384	812	0	1	2	1	H3384_812_0	1	1			05/31/2019	2020.01	05/31/2019 11:51:43 AM Eastern Daylight Time					05/31/2019 02:55:28 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	HMOPOS Group MA Only Calendar Year (HMO-POS)	1	2		1			H3384	812	0	2020	Western and Northeastern New York		1	0	2			2						www.bcbswny.com	http://www.bcbswny.com/pharmacy	www.nymedicare.com	(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;9a1;9b;9c;11a;11b;11c;15;	2		1	2		2		2				
H3387	10	0	1	1	1	H3387_010_0	2	1	2	1	08/05/2019	2020.01	08/05/2019 03:13:36 PM Central Daylight Time	08/02/2019 10:21:40 AM Central Daylight Time	07/30/2019 08:22:16 PM Central Daylight Time			08/06/2019 12:14:20 PM Central Daylight Time	"UNITEDHEALTHCARE OF NEW YORK, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H3387	10	0	2020	Select Counties in New York		2		2			1	3		1		1	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	2			
H3388	1	0	1	1	1	H3388_001_0	10	1			08/14/2019	2020.01	08/14/2019 02:26:10 PM Eastern Daylight Time	05/31/2019 03:01:38 PM Eastern Daylight Time				08/14/2019 02:41:16 PM Eastern Daylight Time	"CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC."	CDPHP Medicare Advantage		CDPHP Choice (HMO)	1	1		1			H3388	1	0	2020	Greater Capital Region of New York State		2	547	2			2									(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(711)-		(711)-		(711)-		(711)-										2					2					2	1	1	7a;	
H3388	2	0	1	1	1	H3388_002_0	14	1			09/16/2019	2020.01	09/16/2019 11:27:04 AM Eastern Daylight Time	08/02/2019 09:29:46 AM Eastern Daylight Time	07/30/2019 04:53:38 PM Eastern Daylight Time			09/17/2019 01:48:32 PM Eastern Daylight Time	"CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC."	CDPHP Medicare Advantage	http://www.CDPHP.com/medicare	CDPHP Choice Rx (HMO)	1	1		1			H3388	2	0	2020	Greater Capital Region of New York State		2	11778	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7a;	
H3388	4	0	1	1	1	H3388_004_0	15	1			08/14/2019	2020.01	08/14/2019 02:27:56 PM Eastern Daylight Time	07/31/2019 01:31:10 PM Eastern Daylight Time	07/30/2019 04:55:28 PM Eastern Daylight Time			08/14/2019 02:41:16 PM Eastern Daylight Time	"CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC."	CDPHP Medicare Advantage	http://www.CDPHP.com/medicare	CDPHP Value Rx (HMO)	1	1		1			H3388	4	0	2020	Greater Capital Region of New York State		2	11241	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7a;	
H3388	13	0	1	1	1	H3388_013_0	15	1			08/14/2019	2020.01	08/14/2019 02:28:56 PM Eastern Daylight Time	07/31/2019 01:34:02 PM Eastern Daylight Time	07/30/2019 04:56:40 PM Eastern Daylight Time			08/14/2019 02:41:16 PM Eastern Daylight Time	"CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC."	CDPHP Medicare Advantage	http://www.CDPHP.com/medicare	CDPHP Basic RX (HMO)	1	1		1			H3388	13	0	2020	Greater Capital Region of New York State		2	5839	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7a;	
H3388	14	0	1	1	1	H3388_014_0	17	1			09/16/2019	2020.01	09/16/2019 11:29:02 AM Eastern Daylight Time	07/31/2019 01:35:50 PM Eastern Daylight Time	07/30/2019 04:57:54 PM Eastern Daylight Time			09/17/2019 01:48:32 PM Eastern Daylight Time	"CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC."	CDPHP Medicare Advantage	http://www.CDPHP.com/medicare	CDPHP $0 Medicare Rx (HMO)	1	1		1			H3388	14	0	2020	Greater Capital Region of New York State		2	2657	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3388	801	0	1	1	1	H3388_801_0	5	1			06/03/2019	2020.01	06/03/2019 11:38:15 AM Eastern Daylight Time					06/03/2019 03:47:19 PM Eastern Daylight Time	"CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC."	CDPHP Medicare Advantage	http://www.CDPHP.com/medicare	CDPHP Group Medicare Rx (HMO)	1	1		1			H3388	801	0	2020	Greater Capital Region of New York State		1	36	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1b;2;7d;7i;8a;9a1;9b;9d;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;14d;	1					1				
H3388	803	0	1	1	1	H3388_803_0	5	1			05/31/2019	2020.01	05/31/2019 03:34:17 PM Eastern Daylight Time					06/03/2019 03:47:19 PM Eastern Daylight Time	"CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC."	CDPHP Medicare Advantage	http://www.CDPHP.com/medicare	CDPHP Group Medicare Rx (HMO)	1	1		1			H3388	803	0	2020	Greater Capital Region of New York State		1	110926	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1b;2;7d;7g;7i;8a;9a1;9b;9d;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;14d;	1					1				
H3388	804	0	1	1	1	H3388_804_0	5	1			05/31/2019	2020.01	05/31/2019 03:35:09 PM Eastern Daylight Time					06/03/2019 03:47:19 PM Eastern Daylight Time	"CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC."	CDPHP Medicare Advantage	http://www.CDPHP.com/medicare	CDPHP Group Medicare (HMO)	1	1		1			H3388	804	0	2020	Greater Capital Region of New York State		1	3497	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										(711)-		(711)-		(711)-		(711)-										1	1	1b;2;7d;7i;8a;9a1;9b;9d;10a;11a;11b;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;14d;	1					1				
H3404	3	1	1	4	1	H3404_003_1	7	1			07/11/2019	2020.01	07/11/2019 01:29:35 PM Eastern Daylight Time	08/05/2019 09:28:27 AM Eastern Daylight Time	08/05/2019 09:31:31 AM Eastern Daylight Time			08/05/2019 02:03:38 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare PPO Enhanced (PPO)	1	4		1			H3404	3	1	2020	Select North Carolina Counties	PPO Region 1	2	165528	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3404	3	2	1	4	1	H3404_003_2	7	1			07/11/2019	2020.01	07/11/2019 11:37:37 AM Eastern Daylight Time	08/05/2019 09:28:35 AM Eastern Daylight Time	08/05/2019 09:31:36 AM Eastern Daylight Time			08/05/2019 02:03:38 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare PPO Enhanced (PPO)	1	4		1			H3404	3	2	2020	Select North Carolina Counties	PPO Region 2	2	160056	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3404	801	0	1	4	1	H3404_801_0	4	1			05/22/2019	2020.01	05/22/2019 12:53:10 PM Eastern Daylight Time					06/01/2019 02:44:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare PPO EGWP Medical Only (PPO)	1	4		1			H3404	801	0	2020	North Carolina Employer Groups		1	0	2			2						https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;6;7e;7h;8a;8b1;9a1;9b;10a;11a;11b;15;	2		1									
H3404	803	0	1	4	1	H3404_803_0	4	1			05/22/2019	2020.01	05/22/2019 12:53:25 PM Eastern Daylight Time					06/01/2019 02:44:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare PPO EGWP (PPO)	1	4		1			H3404	803	0	2020	North Carolina Employer Groups		1	2388	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;6;7e;7h;8a;8b1;9a1;9b;10a;11a;11b;15;	2		1									
H3404	809	0	1	4	1	H3404_809_0	4	1			05/22/2019	2020.01	05/22/2019 12:53:55 PM Eastern Daylight Time					06/01/2019 02:44:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare PPO EGWP Value (PPO)	1	4		1			H3404	809	0	2020	NC Employer Groups		1	0	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;6;7e;7h;7i;8a;8b1;9a1;9b;10a;11a;11b;15;	2		1									
H3407	1	0	1	1	1	H3407_001_0	5	1	2	1	08/02/2019	2020.01	08/02/2019 11:54:52 AM Mountain Daylight Time	08/05/2019 11:33:58 AM Mountain Daylight Time	07/31/2019 01:12:32 PM Mountain Daylight Time			08/05/2019 10:29:58 AM Mountain Daylight Time	"EL PASO FIRST HEALTH PLANS, INC."	El Paso Health	www.elpasohealth.com	El Paso Health Advantage Dual SNP (HMO D-SNP)	1	1		1			H3407	1	0	2020	El Paso and Hudspeth counties		2		2			1	3		1		1	www.elpasohealth.com	www.elpasohealth.com	www.elpasohealth.com	(833)742-3125		(915)532-3778		(833)742-3125		(915)532-3778		(833)742-3125		(915)532-3778		(833)742-3125		(915)532-3778		(855)532-3740		(915)532-3740		(855)532-3740		(915)532-3740		(855)532-3740		(915)532-3740		(855)532-3740		(915)532-3740		2					2					2	2			
H3416	1	4	1	4	1	H3416_001_4	4	1			08/01/2019	2020.01	08/01/2019 02:31:49 PM Central Daylight Time	08/06/2019 07:53:22 AM Central Daylight Time	08/06/2019 07:53:39 AM Central Daylight Time			08/06/2019 03:43:24 PM Central Daylight Time	"HEALTHPARTNERS UNITYPOINT HEALTH, INC."	HealthPartners UnityPoint Health	healthpartnersunitypointhealth.com	HealthPartners UnityPoint Health Align (PPO)	1	4		1			H3416	1	4	2020	Central Iowa & Western Illinois	"Cedar Rapids, Central IA, and Peoria Areas"	2	17237	2			2						healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3416	1	5	1	4	1	H3416_001_5	4	1			08/01/2019	2020.01	08/01/2019 02:32:45 PM Central Daylight Time	08/06/2019 07:53:21 AM Central Daylight Time	08/06/2019 07:53:39 AM Central Daylight Time			08/06/2019 03:43:24 PM Central Daylight Time	"HEALTHPARTNERS UNITYPOINT HEALTH, INC."	HealthPartners UnityPoint Health	healthpartnersunitypointhealth.com	HealthPartners UnityPoint Health Align (PPO)	1	4		1			H3416	1	5	2020	Central Iowa & Western Illinois	"Fort Dodge, Quad Cities, Waterloo Areas"	2	4997	2			2						healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3416	2	2	1	4	1	H3416_002_2	5	1			08/01/2019	2020.01	08/01/2019 02:34:17 PM Central Daylight Time	08/06/2019 07:53:22 AM Central Daylight Time	08/06/2019 07:53:39 AM Central Daylight Time			08/06/2019 03:43:24 PM Central Daylight Time	"HEALTHPARTNERS UNITYPOINT HEALTH, INC."	HealthPartners UnityPoint Health	healthpartnersunitypointhealth.com	HealthPartners UnityPoint Health Symmetry (PPO)	1	4		1			H3416	2	2	2020	Central Iowa & Western Illinois	"Cedar Rapids, Central IA, and Peoria Areas"	2	9220	2			2						healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3416	2	3	1	4	1	H3416_002_3	5	1			08/01/2019	2020.01	08/01/2019 02:35:22 PM Central Daylight Time	08/06/2019 07:53:22 AM Central Daylight Time	08/06/2019 07:53:39 AM Central Daylight Time			08/06/2019 03:43:24 PM Central Daylight Time	"HEALTHPARTNERS UNITYPOINT HEALTH, INC."	HealthPartners UnityPoint Health	healthpartnersunitypointhealth.com	HealthPartners UnityPoint Health Symmetry (PPO)	1	4		1			H3416	2	3	2020	Central Iowa & Western Illinois	"Fort Dodge, Quad Cities, Waterloo Areas"	2	2013	2			2						healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3416	801	0	1	4	1	H3416_801_0	2	1			05/29/2019	2020.01	05/29/2019 05:08:50 PM Central Daylight Time					05/31/2019 07:24:42 AM Central Daylight Time	"HEALTHPARTNERS UNITYPOINT HEALTH, INC."	HealthPartners UnityPoint Health	healthpartnersunitypointhealth.com	HealthPartners UnityPoint Health Group MAPD CY (PPO)	1	4		1			H3416	801	0	2020	Nationwide		1	0	2			2						healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3416	803	0	1	4	1	H3416_803_0	2	1			05/29/2019	2020.01	05/29/2019 05:08:57 PM Central Daylight Time					05/31/2019 07:24:42 AM Central Daylight Time	"HEALTHPARTNERS UNITYPOINT HEALTH, INC."	HealthPartners UnityPoint Health	healthpartnersunitypointhealth.com	HealthPartners UnityPoint Health Group MA Only (PPO)	1	4		1			H3416	803	0	2020	Nationwide		1	0	2			2						healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	healthpartnersunitypointhealth.com	(888)360-0544		(888)360-0544		(888)360-0796		(888)360-0796										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3418	1	0	1	4	1	H3418_001_0	3	1			08/02/2019	2020.01	08/02/2019 11:47:27 AM Central Daylight Time	08/06/2019 11:28:04 AM Central Daylight Time	07/30/2019 08:22:49 PM Central Daylight Time			08/06/2019 11:46:34 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Mosaic Choice (PPO)	1	4		1			H3418	1	0	2020	New York City Metro Area		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	1	7a;7d;7g;	
H3430	1	0	1	20	8	H3430_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:06:29 PM Eastern Daylight Time		05/17/2019 03:18:03 PM Eastern Daylight Time			05/22/2019 01:13:06 PM Eastern Daylight Time	"SUNCOAST PACE, INC."	"Suncoast PACE, Inc."	www.suncoastpace.org	"Suncoast PACE, Inc. (PACE)"	8	20		1			H3430	1	0	2020	"Suncoast PACE, Inc., Pinellas County"		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	2	0	1	20	8	H3430_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:07:32 PM Eastern Daylight Time		05/17/2019 03:17:48 PM Eastern Daylight Time			05/22/2019 01:13:06 PM Eastern Daylight Time	"SUNCOAST PACE, INC."	"Suncoast PACE, Inc."	www.suncoastpace.org	"Suncoast PACE, Inc. (PACE)"	8	20		1			H3430	2	0	2020	"Suncoast PACE, Inc., Pinellas County"		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																
H3442	1	0	1	4	1	H3442_001_0	5	1			08/05/2019	2020.01	08/05/2019 09:43:46 AM Central Daylight Time	08/02/2019 10:34:00 AM Central Daylight Time	07/30/2019 08:23:23 PM Central Daylight Time			08/06/2019 12:16:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF ILLINOIS	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H3442	1	0	2020	State of Connecticut		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3442	3	0	1	4	1	H3442_003_0	3	1			08/05/2019	2020.01	08/05/2019 09:51:42 AM Central Daylight Time	08/02/2019 10:34:24 AM Central Daylight Time	07/30/2019 08:23:57 PM Central Daylight Time			08/06/2019 12:16:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF ILLINOIS	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H3442	3	0	2020	Boston Metro		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3442	4	0	1	4	1	H3442_004_0	3	1			08/05/2019	2020.01	08/05/2019 03:04:01 PM Central Daylight Time	08/02/2019 10:34:49 AM Central Daylight Time	07/30/2019 08:24:32 PM Central Daylight Time			08/06/2019 12:16:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF ILLINOIS	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H3442	4	0	2020	Outside of Boston Metro		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3447	1	0	1	1	1	H3447_001_0	9	1			08/01/2019	2020.01	08/01/2019 04:24:28 PM Pacific Daylight Time	08/05/2019 06:59:34 AM Pacific Daylight Time	07/30/2019 05:02:49 PM Pacific Daylight Time			08/05/2019 12:45:28 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Local (HMO)	1	1		1			H3447	1	0	2020	"Richmond Metropolitan, West & So. of Richmond Area"		2		2			2						https://shop.anthem.com/medicare	https://shop.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	2			
H3447	3	0	1	1	1	H3447_003_0	9	1		1	08/01/2019	2020.01	08/01/2019 04:26:05 PM Pacific Daylight Time	08/05/2019 06:59:34 AM Pacific Daylight Time	07/30/2019 05:03:26 PM Pacific Daylight Time			08/05/2019 12:45:28 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue COPD (HMO C-SNP)	1	1		1			H3447	3	0	2020	"Richmond Metropolitan, West & So. of Richmond Area"		2		2			1	4			100000000		https://shop.anthem.com/medicare	https://shop.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	2			
H3447	4	0	1	1	1	H3447_004_0	9	1		1	08/01/2019	2020.01	08/01/2019 04:27:06 PM Pacific Daylight Time	08/05/2019 06:59:35 AM Pacific Daylight Time	07/30/2019 05:04:03 PM Pacific Daylight Time			08/05/2019 12:45:28 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes (HMO C-SNP)	1	1		1			H3447	4	0	2020	"Richmond Metropolitan, West & So. of Richmond Area"		2		2			1	4			1E+13		https://shop.anthem.com/medicare	https://shop.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	2			
H3447	5	0	1	1	1	H3447_005_0	8	1			07/29/2019	2020.01	07/29/2019 09:58:14 PM Pacific Daylight Time	08/05/2019 06:59:35 AM Pacific Daylight Time	07/30/2019 05:04:40 PM Pacific Daylight Time			08/05/2019 12:45:28 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Smart Fit (HMO)	1	1		1			H3447	5	0	2020	"Richmond Metropolitan, West & So. of Richmond Area"		2		2			2						https://shop.anthem.com/medicare	https://shop.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	2			
H3447	10	0	1	1	1	H3447_010_0	10	1		1	08/01/2019	2020.01	08/01/2019 04:21:22 PM Pacific Daylight Time	08/05/2019 06:59:36 AM Pacific Daylight Time	07/30/2019 05:05:17 PM Pacific Daylight Time			08/05/2019 12:45:28 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Care On Site (HMO I-SNP)	1	1		1			H3447	10	0	2020	"Richmond Metropolitan, West & So. of Richmond Area"		2		2			1	1	3				https://shop.anthem.com/medicare	https://shop.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	2			
H3447	11	0	1	1	1	H3447_011_0	8	1	2	1	08/01/2019	2020.01	08/01/2019 12:08:12 PM Eastern Daylight Time	08/05/2019 09:59:36 AM Eastern Daylight Time	07/30/2019 08:05:54 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H3447	11	0	2020	Select Counties in Virginia		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)363-0724		(855)363-0724		(844)828-1338		(844)828-1338		(855)363-0724		(855)363-0724		(844)649-4313		(844)649-4313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	12	0	1	1	1	H3447_012_0	8	1	2	1	07/31/2019	2020.01	07/31/2019 09:14:02 AM Eastern Daylight Time	08/05/2019 09:59:36 AM Eastern Daylight Time	07/30/2019 08:06:31 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H3447	12	0	2020	Select Counties in Virginia		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)363-0724		(855)363-0724		(844)828-1338		(844)828-1338		(855)363-0724		(855)363-0724		(844)649-4313		(844)649-4313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	13	0	1	1	1	H3447_013_0	7	1			08/01/2019	2020.01	08/01/2019 12:09:10 PM Eastern Daylight Time	08/05/2019 09:59:37 AM Eastern Daylight Time	07/30/2019 08:07:08 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H3447	13	0	2020	Southern Virginia Counties		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)395-1019		(844)395-1019		(844)828-1338		(844)828-1338		(844)395-1019		(844)395-1019		(844)649-4313		(844)649-4313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	14	0	1	1	1	H3447_014_0	8	1			08/01/2019	2020.01	08/01/2019 12:09:48 PM Eastern Daylight Time	08/05/2019 09:59:37 AM Eastern Daylight Time	07/30/2019 08:07:45 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H3447	14	0	2020	Northern Virginia Counties		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)395-1019		(844)395-1019		(844)828-1338		(844)828-1338		(844)395-1019		(844)395-1019		(844)649-4313		(844)649-4313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	18	0	1	1	1	H3447_018_0	7	1	2	1	07/29/2019	2020.01	07/29/2019 01:55:45 PM Eastern Daylight Time	08/05/2019 09:59:37 AM Eastern Daylight Time	07/30/2019 08:08:21 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H3447	18	0	2020	Select Counties in Missouri		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)879-3611		(844)879-3611		(844)373-7111		(844)373-7111		(844)879-3611		(844)879-3611		(844)373-7110		(844)373-7110		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	19	0	1	1	1	H3447_019_0	7	1			08/02/2019	2020.01	08/02/2019 10:17:23 AM Eastern Daylight Time	08/05/2019 09:59:38 AM Eastern Daylight Time	07/30/2019 08:08:59 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H3447	19	0	2020	Select Counties in Missouri		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8826		(855)251-8826		(844)373-7111		(844)373-7111		(855)251-8826		(855)251-8826		(844)373-7110		(844)373-7110		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	20	0	1	1	1	H3447_020_0	9	1	2	1	07/31/2019	2020.01	07/31/2019 05:41:19 PM Eastern Daylight Time	08/05/2019 09:59:38 AM Eastern Daylight Time	07/30/2019 08:09:36 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H3447	20	0	2020	Indiana		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)533-2021		(844)533-2021		(844)373-7113		(844)373-7113		(844)533-2021		(844)533-2021		(844)373-7112		(844)373-7112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	21	0	1	1	1	H3447_021_0	6	1			07/31/2019	2020.01	07/31/2019 05:42:32 PM Eastern Daylight Time	08/05/2019 09:59:38 AM Eastern Daylight Time	07/30/2019 08:10:13 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H3447	21	0	2020	Select counties in Indiana		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(844)373-7113		(844)373-7113		(855)251-8827		(855)251-8827		(844)373-7112		(844)373-7112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	22	0	1	1	1	H3447_022_0	6	1			07/31/2019	2020.01	07/31/2019 05:50:33 PM Eastern Daylight Time	08/05/2019 09:59:39 AM Eastern Daylight Time	07/30/2019 08:10:50 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H3447	22	0	2020	Select Counties in Indiana		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(844)373-7113		(844)373-7113		(855)251-8827		(855)251-8827		(844)373-7112		(844)373-7112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	23	0	1	1	1	H3447_023_0	6	1			07/31/2019	2020.01	07/31/2019 05:51:33 PM Eastern Daylight Time	08/05/2019 09:59:39 AM Eastern Daylight Time	07/30/2019 08:11:26 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H3447	23	0	2020	Select Counties in Indiana		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(844)373-7113		(844)373-7113		(855)251-8827		(855)251-8827		(844)373-7112		(844)373-7112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	24	0	1	1	1	H3447_024_0	6	1			07/17/2019	2020.01	07/17/2019 12:00:55 PM Eastern Daylight Time	08/05/2019 09:59:26 AM Eastern Daylight Time	07/30/2019 08:12:03 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Extra (HMO)	1	1		1			H3447	24	0	2020	Indiana		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)251-8827		(855)251-8827		(844)373-7113		(844)373-7113		(855)251-8827		(855)251-8827		(844)373-7112		(844)373-7112		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	25	0	1	1	1	H3447_025_0	6	1			08/01/2019	2020.01	08/01/2019 01:24:22 PM Eastern Daylight Time	08/05/2019 09:59:26 AM Eastern Daylight Time	07/30/2019 08:12:40 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H3447	25	0	2020	Select Counties in Virginia		2		2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(844)395-1019		(844)395-1019		(844)828-1338		(844)828-1338		(844)395-1019		(844)395-1019		(844)649-4313		(844)649-4313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	26	0	1	1	1	H3447_026_0	7	1		1	07/30/2019	2020.01	07/30/2019 10:44:22 AM Eastern Daylight Time	08/05/2019 09:59:26 AM Eastern Daylight Time	07/30/2019 08:13:16 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Care On Site (HMO I-SNP)	1	1		1			H3447	26	0	2020	Select Counties in Virginia		2		2			1	1	3				https://shop.anthem.com/medicare	https://shop.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	2			
H3447	27	0	1	1	1	H3447_027_0	6	1			07/16/2019	2020.01	07/16/2019 05:36:30 PM Eastern Daylight Time	08/05/2019 09:59:27 AM Eastern Daylight Time	07/30/2019 08:13:53 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Extra (HMO)	1	1		1			H3447	27	0	2020	Select Counties in Virginia		2		2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(844)395-1019		(844)395-1019		(844)828-1338		(844)828-1338		(844)395-1019		(844)395-1019		(844)649-4313		(844)649-4313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	28	0	1	1	1	H3447_028_0	6	1			07/16/2019	2020.01	07/16/2019 05:47:07 PM Eastern Daylight Time	08/05/2019 09:59:27 AM Eastern Daylight Time	07/30/2019 08:14:29 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Extra (HMO)	1	1		1			H3447	28	0	2020	Select Counties in Virginia		2		2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(844)395-1019		(844)395-1019		(844)828-1338		(844)828-1338		(844)395-1019		(844)395-1019		(844)649-4313		(844)649-4313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	29	0	1	1	1	H3447_029_0	8	1			08/01/2019	2020.01	08/01/2019 05:52:19 AM Eastern Daylight Time	08/05/2019 09:59:27 AM Eastern Daylight Time	07/30/2019 08:15:07 PM Eastern Daylight Time			08/05/2019 04:07:36 PM Eastern Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue Prime (HMO)	1	1		1			H3447	29	0	2020	Roanoke County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)395-1019		(844)395-1019		(844)828-1338		(844)828-1338		(844)395-1019		(844)395-1019		(844)649-4313		(844)649-4313		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3447	802	0	1	1	1	H3447_802_0	1	1			05/29/2019	2020.01	05/29/2019 08:35:55 PM Pacific Daylight Time					05/29/2019 08:53:45 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	https://shop.anthem.com/medicare	Anthem MediBlue EGWP MAPD (HMO)	1	1		1			H3447	802	0	2020	Virginia		1	175	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)295-7811		(855)295-7811		(888)649-5968		(888)649-5968		(855)295-7811		(855)295-7811		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;	1					1				
H3447	804	0	1	1	1	H3447_804_0	3	1			05/30/2019	2020.01	05/30/2019 06:26:41 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	1	1		1			H3447	804	0	2020	Select counties in Virginia		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	805	0	1	1	1	H3447_805_0	4	1			05/30/2019	2020.01	05/30/2019 08:32:35 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	1	1		1			H3447	805	0	2020	Select counties in Virginia		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	806	0	2	1	1	H3447_806_0	3	1			05/30/2019	2020.01	05/30/2019 06:59:22 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3447	806	0	2020	Virginia - Select Counties		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	807	0	2	1	1	H3447_807_0	3	1			05/30/2019	2020.01	05/30/2019 06:59:28 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3447	807	0	2020	Select Virginia Counties		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	808	0	1	1	1	H3447_808_0	3	1			05/16/2019	2020.01	05/16/2019 12:10:43 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	1	1		1			H3447	808	0	2020	Select Virginia Counties		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	809	0	1	1	1	H3447_809_0	3	1			05/16/2019	2020.01	05/16/2019 02:43:07 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	1	1		1			H3447	809	0	2020	Select Virginia Counties		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	810	0	2	1	1	H3447_810_0	3	1			05/30/2019	2020.01	05/30/2019 06:59:50 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3447	810	0	2020	Select Virginia Counties		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	811	0	1	1	1	H3447_811_0	3	1			05/30/2019	2020.01	05/30/2019 07:00:25 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	1	1		1			H3447	811	0	2020	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	812	0	1	1	1	H3447_812_0	3	1			05/16/2019	2020.01	05/16/2019 02:50:18 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	1	1		1			H3447	812	0	2020	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	813	0	2	1	1	H3447_813_0	3	1			05/30/2019	2020.01	05/30/2019 07:00:19 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3447	813	0	2020	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	814	0	2	1	1	H3447_814_0	3	1			05/30/2019	2020.01	05/30/2019 07:00:33 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3447	814	0	2020	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	815	0	1	1	1	H3447_815_0	3	1			05/16/2019	2020.01	05/16/2019 03:18:29 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	1	1		1			H3447	815	0	2020	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	816	0	1	1	1	H3447_816_0	3	1			05/16/2019	2020.01	05/16/2019 03:19:19 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	1	1		1			H3447	816	0	2020	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	817	0	2	1	1	H3447_817_0	3	1			05/30/2019	2020.01	05/30/2019 07:00:48 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3447	817	0	2020	Select Indiana Counties		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	818	0	1	1	1	H3447_818_0	3	1			05/17/2019	2020.01	05/17/2019 06:15:45 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	1	1		1			H3447	818	0	2020	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	819	0	1	1	1	H3447_819_0	3	1			05/17/2019	2020.01	05/17/2019 06:16:06 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	1	1		1			H3447	819	0	2020	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	820	0	2	1	1	H3447_820_0	3	1			05/30/2019	2020.01	05/30/2019 07:01:13 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3447	820	0	2020	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	821	0	2	1	1	H3447_821_0	3	1			05/30/2019	2020.01	05/30/2019 07:01:20 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3447	821	0	2020	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	822	0	1	1	1	H3447_822_0	3	1			05/30/2019	2020.01	05/30/2019 06:56:21 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	1	1		1			H3447	822	0	2020	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	823	0	1	1	1	H3447_823_0	3	1			05/30/2019	2020.01	05/30/2019 06:56:35 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	1	1		1			H3447	823	0	2020	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	824	0	2	1	1	H3447_824_0	3	1			05/30/2019	2020.01	05/30/2019 07:01:42 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3447	824	0	2020	Select Missouri Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	825	0	2	1	1	H3447_825_0	3	1			05/30/2019	2020.01	05/30/2019 07:00:00 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/va/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3447	825	0	2020	Select Virginia Counties		1	600	2			2						www.anthem.com/va/medicare	www.anthem.com/va/medicare	www.anthem.com/va/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	826	0	2	1	1	H3447_826_0	3	1			05/30/2019	2020.01	05/30/2019 07:00:55 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/IN/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3447	826	0	2020	Anthem MediBlue		1	600	2			2						www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	www.anthem.com/IN/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3447	827	0	2	1	1	H3447_827_0	3	1			05/30/2019	2020.01	05/30/2019 07:01:50 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HEALTHKEEPERS, INC."	Anthem HealthKeepers	www.anthem.com/MO/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3447	827	0	2020	Select MO Counties		1	600	2			2						www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	www.anthem.com/MO/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3449	12	0	1	1	1	H3449_012_0	7	1			07/11/2019	2020.01	07/11/2019 01:19:44 PM Eastern Daylight Time	06/01/2019 02:21:57 PM Eastern Daylight Time				07/17/2019 11:39:53 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Medical Only (HMO)	1	1		1			H3449	12	0	2020	Select North Carolina Counties		2	67536	2			2						https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3449	23	1	1	1	1	H3449_023_1	7	1			07/11/2019	2020.01	07/11/2019 01:19:30 PM Eastern Daylight Time	08/05/2019 09:28:49 AM Eastern Daylight Time	08/05/2019 09:31:44 AM Eastern Daylight Time			08/05/2019 02:03:38 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Essential Plus (HMO)	1	1		1			H3449	23	1	2020	Select North Carolina Counties	Essential Plus Region 1	2	59100	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	23	2	1	1	1	H3449_023_2	7	1			07/11/2019	2020.01	07/11/2019 12:05:54 PM Eastern Daylight Time	08/05/2019 09:29:06 AM Eastern Daylight Time	08/05/2019 09:31:52 AM Eastern Daylight Time			08/05/2019 02:03:38 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Essential Plus (HMO)	1	1		1			H3449	23	2	2020	Select North Carolina Counties	Essential Plus Region 2	2	71808	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	23	4	1	1	1	H3449_023_4	7	1			07/11/2019	2020.01	07/11/2019 12:06:08 PM Eastern Daylight Time	08/05/2019 09:29:19 AM Eastern Daylight Time	08/05/2019 09:32:00 AM Eastern Daylight Time			08/05/2019 02:03:38 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Essential Plus (HMO)	1	1		1			H3449	23	4	2020	Select North Carolina Counties	Essential Plus Region 4	2	34740	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	23	5	1	1	1	H3449_023_5	7	1			07/11/2019	2020.01	07/11/2019 12:06:24 PM Eastern Daylight Time	08/05/2019 09:29:33 AM Eastern Daylight Time	08/05/2019 09:32:08 AM Eastern Daylight Time			08/05/2019 02:03:38 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Essential Plus (HMO)	1	1		1			H3449	23	5	2020	Select North Carolina Counties	Essential Plus Region 5	2	91884	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	24	1	1	1	1	H3449_024_1	7	1			07/11/2019	2020.01	07/11/2019 12:06:48 PM Eastern Daylight Time	08/05/2019 09:29:50 AM Eastern Daylight Time	08/05/2019 09:32:14 AM Eastern Daylight Time			08/05/2019 02:03:38 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Enhanced (HMO)	1	1		1			H3449	24	1	2020	Select North Carolina Counties	Enhanced Region 1	2	47724	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	24	2	1	1	1	H3449_024_2	7	1			07/11/2019	2020.01	07/11/2019 12:07:02 PM Eastern Daylight Time	08/05/2019 09:30:05 AM Eastern Daylight Time	08/05/2019 09:32:26 AM Eastern Daylight Time			08/05/2019 02:03:38 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Enhanced (HMO)	1	1		1			H3449	24	2	2020	Select North Carolina Counties	Enhanced Region 2	2	26148	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	24	3	1	1	1	H3449_024_3	7	1			07/11/2019	2020.01	07/11/2019 12:07:28 PM Eastern Daylight Time	08/05/2019 09:30:16 AM Eastern Daylight Time	08/05/2019 09:32:35 AM Eastern Daylight Time			08/05/2019 02:03:38 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Enhanced (HMO)	1	1		1			H3449	24	3	2020	Select North Carolina Counties	Enhanced Region 3	2	97212	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	25	0	1	1	1	H3449_025_0	7	1			07/11/2019	2020.01	07/11/2019 12:07:51 PM Eastern Daylight Time	08/05/2019 09:30:29 AM Eastern Daylight Time	08/05/2019 09:32:42 AM Eastern Daylight Time			08/05/2019 02:03:38 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Essential (HMO)	1	1		1			H3449	25	0	2020	Select North Carolina Counties		2	31656	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	26	0	1	1	1	H3449_026_0	7	1			07/11/2019	2020.01	07/11/2019 12:08:14 PM Eastern Daylight Time	08/05/2019 09:30:44 AM Eastern Daylight Time	08/05/2019 09:32:50 AM Eastern Daylight Time			08/05/2019 02:03:38 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Choice (HMO)	1	1		1			H3449	26	0	2020	Select North Carolina Counties		2	25200	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3449	801	0	1	1	1	H3449_801_0	4	1			05/28/2019	2020.01	05/28/2019 02:56:01 PM Eastern Daylight Time					06/01/2019 02:44:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO EGWP (HMO)	1	1		1			H3449	801	0	2020	North Carolina Employer Groups		1	9612	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-3;6;7e;7h;7i;8a;8b1;9a1;9b;10a;11a;11b;15;16b;	2		1					1				
H3449	805	0	1	1	1	H3449_805_0	4	1			05/22/2019	2020.01	05/22/2019 12:51:13 PM Eastern Daylight Time					06/01/2019 02:44:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO EGWP Medical Only (HMO)	1	1		1			H3449	805	0	2020	North Carolina Employer Groups		1	0	2			2						https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-3;6;7e;7h;7i;8a;8b1;9a1;9b;10a;11a;11b;15;16b;	2		1					1				
H3449	813	0	1	1	1	H3449_813_0	4	1			05/22/2019	2020.01	05/22/2019 12:51:28 PM Eastern Daylight Time					06/01/2019 02:44:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare HMO EGWP Value (HMO)	1	1		1			H3449	813	0	2020	NC Employer Groups		1	0	2			2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy	https://www.bluecrossnc.com/find-a-doctor-or-facility/medicare	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;3-1;3-3;6;7e;7h;7i;8a;8b1;9a1;9b;10a;11a;11b;15;16b;	2		1					1				
H3464	1	0	1	1	1	H3464_001_0	4	1			08/02/2019	2020.01	08/02/2019 11:48:56 AM Central Daylight Time	08/02/2019 11:49:27 AM Central Daylight Time	07/30/2019 08:25:05 PM Central Daylight Time			08/06/2019 10:25:59 AM Central Daylight Time	"UNITEDHEALTHCARE OF ARKANSAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H3464	1	0	2020	Fayetteville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3464	2	0	1	1	1	H3464_002_0	2	1			08/02/2019	2020.01	08/02/2019 11:49:29 AM Central Daylight Time	08/02/2019 11:49:59 AM Central Daylight Time	07/30/2019 08:25:42 PM Central Daylight Time			08/06/2019 10:25:59 AM Central Daylight Time	"UNITEDHEALTHCARE OF ARKANSAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3464	2	0	2020	Fayetteville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3464	3	0	1	1	1	H3464_003_0	3	1			08/02/2019	2020.01	08/02/2019 11:49:53 AM Central Daylight Time	08/02/2019 11:50:33 AM Central Daylight Time	07/30/2019 08:26:14 PM Central Daylight Time			08/06/2019 10:25:59 AM Central Daylight Time	"UNITEDHEALTHCARE OF ARKANSAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H3464	3	0	2020	Little Rock Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3464	4	0	1	1	1	H3464_004_0	3	1			08/02/2019	2020.01	08/02/2019 11:50:13 AM Central Daylight Time	08/02/2019 11:51:05 AM Central Daylight Time	07/30/2019 08:26:49 PM Central Daylight Time			08/06/2019 10:25:59 AM Central Daylight Time	"UNITEDHEALTHCARE OF ARKANSAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3464	4	0	2020	Little Rock Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3464	5	0	1	1	1	H3464_005_0	3	1			08/02/2019	2020.01	08/02/2019 11:50:47 AM Central Daylight Time	08/02/2019 11:51:40 AM Central Daylight Time	07/30/2019 08:27:22 PM Central Daylight Time			08/06/2019 10:25:59 AM Central Daylight Time	"UNITEDHEALTHCARE OF ARKANSAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H3464	5	0	2020	Hot Springs Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3464	6	0	1	1	1	H3464_006_0	3	1			08/02/2019	2020.01	08/02/2019 11:51:10 AM Central Daylight Time	08/02/2019 11:52:12 AM Central Daylight Time	07/30/2019 08:27:57 PM Central Daylight Time			08/06/2019 10:25:59 AM Central Daylight Time	"UNITEDHEALTHCARE OF ARKANSAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3464	6	0	2020	Hot Springs Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3467	1	0	1	1	1	H3467_001_0	3	1		1	08/05/2019	2020.01	08/05/2019 01:41:48 PM Central Daylight Time	08/05/2019 08:54:02 AM Central Daylight Time	08/05/2019 08:39:42 AM Central Daylight Time			08/06/2019 10:01:17 AM Central Daylight Time	"PROCARE ADVANTAGE, LLC"	ProCare Advantage	www.procareadvantageplan.com	ProCare Advantage (HMO I-SNP)	1	1		1			H3467	1	0	2020	Texas (partial)		2	5583	2			1	1	1				www.procareadvantageplan.com	www.procareadvantageplan.com	www.procareadvantageplan.com	(844)206-3719		(844)206-3719		(844)206-3719		(844)206-3719		(844)206-3719		(844)206-3719		(844)206-3719		(844)206-3719		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	1	0	1	1	1	H3471_001_0	7	1			06/27/2019	2020.01	06/27/2019 04:18:18 PM Central Daylight Time	08/05/2019 12:18:27 PM Central Daylight Time	07/30/2019 04:35:41 PM Central Daylight Time			08/06/2019 11:01:21 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW Companion Rx (HMO)	1	1		1			H3471	1	0	2020	"Okanogan, Chelan, Douglas, Grant"		2	36921	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	2	0	1	1	1	H3471_002_0	7	1			06/27/2019	2020.01	06/27/2019 04:18:38 PM Central Daylight Time	08/05/2019 12:20:13 PM Central Daylight Time	07/30/2019 04:36:21 PM Central Daylight Time			08/06/2019 11:01:21 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW Companion Rx Plus (HMO)	1	1		1			H3471	2	0	2020	"Okanogan, Chelan, Douglas, Grant County"		2	6252	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	3	0	1	1	1	H3471_003_0	5	1			06/27/2019	2020.01	06/27/2019 04:18:48 PM Central Daylight Time	05/31/2019 01:55:01 AM Central Daylight Time				06/27/2019 04:55:36 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW Companion HMO (HMO)	1	1		1			H3471	3	0	2020	"Okanogan, Chelan, Douglas, Grant County"		2	3632	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3471	4	0	1	1	1	H3471_004_0	7	1			06/27/2019	2020.01	06/27/2019 04:18:59 PM Central Daylight Time	08/05/2019 12:22:13 PM Central Daylight Time	07/30/2019 04:37:13 PM Central Daylight Time			08/06/2019 11:01:21 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage HMO Rx (HMO)	1	1		1			H3471	4	0	2020	Yakima County		2	12475	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	5	0	1	1	1	H3471_005_0	7	1			06/27/2019	2020.01	06/27/2019 04:20:21 PM Central Daylight Time	08/05/2019 12:23:31 PM Central Daylight Time	07/30/2019 04:38:03 PM Central Daylight Time			08/06/2019 11:01:21 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage HMO Rx Plus (HMO)	1	1		1			H3471	5	0	2020	Yakima County		2	9980	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	6	0	1	1	1	H3471_006_0	5	1			06/27/2019	2020.01	06/27/2019 04:20:41 PM Central Daylight Time	05/31/2019 10:42:12 AM Central Daylight Time				06/27/2019 04:55:36 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage HMO (HMO)	1	1		1			H3471	6	0	2020	Yakima County		2	1235	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3471	10	0	1	1	1	H3471_010_0	7	1			06/27/2019	2020.01	06/27/2019 04:21:01 PM Central Daylight Time	08/05/2019 12:25:48 PM Central Daylight Time	07/30/2019 04:38:40 PM Central Daylight Time			08/06/2019 11:01:21 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW Companion Basic Rx (HMO)	1	1		1			H3471	10	0	2020	"Okanogan, Chelan, Douglas, Grant County"		2	43284	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	13	0	1	2	1	H3471_013_0	7	1			06/27/2019	2020.01	06/27/2019 04:21:10 PM Central Daylight Time	08/05/2019 12:26:49 PM Central Daylight Time	07/30/2019 04:39:14 PM Central Daylight Time			08/06/2019 11:01:21 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage POS Rx (HMO-POS)	1	2		1			H3471	13	0	2020	Yakima County		2	904	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	14	0	1	2	1	H3471_014_0	7	1			06/27/2019	2020.01	06/27/2019 04:21:29 PM Central Daylight Time	08/05/2019 12:28:57 PM Central Daylight Time	07/30/2019 04:40:42 PM Central Daylight Time			08/06/2019 11:01:21 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage POS Rx Plus (HMO-POS)	1	2		1			H3471	14	0	2020	Yakima County		2	1746	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	15	0	1	2	1	H3471_015_0	5	1			06/27/2019	2020.01	06/27/2019 04:21:40 PM Central Daylight Time	05/31/2019 10:43:45 AM Central Daylight Time				06/27/2019 04:55:36 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Health Alliance NW SignalAdvantage POS (HMO-POS)	1	2		1			H3471	15	0	2020	Yakima County		2	198	2			2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)795-6117		(877)795-6117		(877)642-3331		(877)642-3331										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3471	17	0	1	1	1	H3471_017_0	7	1			06/27/2019	2020.01	06/27/2019 04:22:06 PM Central Daylight Time	08/05/2019 12:34:17 PM Central Daylight Time	07/30/2019 04:56:48 PM Central Daylight Time			08/06/2019 11:01:21 AM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	healthalliancemedicare.org	Health Alliance NW Companion Basic Rx 2 (HMO)	1	1		1			H3471	17	0	2020	Grant County		2	14200	2			2						healthalliancemedicare.org	healthalliancemedicare.org	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	801	0	1	1	1	H3471_801_0	3	1			05/23/2019	2020.01	05/23/2019 08:32:39 AM Central Daylight Time					05/31/2019 03:27:41 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	1	1		1			H3471	801	0	2020	Central Washington		1	120	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3471	802	0	1	1	1	H3471_802_0	3	1			05/23/2019	2020.01	05/23/2019 08:32:29 AM Central Daylight Time					05/31/2019 03:27:41 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	1	1		1			H3471	802	0	2020	Central Washington		1	1200	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	803	0	1	1	1	H3471_803_0	3	1			05/23/2019	2020.01	05/23/2019 08:32:21 AM Central Daylight Time					05/31/2019 03:27:41 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO Rx - non calendar year (HMO)	1	1		1			H3471	803	0	2020	Central Washington		1	0	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3471	804	0	1	2	1	H3471_804_0	3	1			05/23/2019	2020.01	05/23/2019 08:32:12 AM Central Daylight Time					05/31/2019 03:27:41 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO-POS (HMO-POS)	1	2		1			H3471	804	0	2020	Central Washington		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3471	805	0	1	2	1	H3471_805_0	4	1			06/19/2019	2020.01	06/19/2019 12:38:42 PM Central Daylight Time					06/19/2019 03:41:45 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO-POS with Rx (HMO-POS)	1	2		1			H3471	805	0	2020	Central Washington		1	0	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1	2		2		1				
H3471	806	0	1	2	1	H3471_806_0	4	1			06/19/2019	2020.01	06/19/2019 12:39:18 PM Central Daylight Time					06/19/2019 03:41:45 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Health Alliance Northwest	www.healthalliancemedicare.org	Medicare Employer HMO-POS with Rx (HMO-POS)	1	2		1			H3471	806	0	2020	Central Washington		1	0	1	1		2						www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)531-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1	2		2		1				
H3473	1	0	1	20	8	H3473_001_0	1	1			05/16/2019	2020.01	05/16/2019 03:15:37 PM Mountain Daylight Time		05/16/2019 02:32:46 PM Mountain Daylight Time			05/16/2019 03:17:20 PM Mountain Daylight Time	"INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC"	InnovAge Virginia PACE - Blue Ridge	www.MyInnovAge.com	Blue Ridge PACE Dual (PACE)	8	20		1			H3473	1	0	2020	Blue Ridge PACE Dual		2		2			2						https://www.granerx.com/	N/A - no formulary										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H3473	2	0	1	20	8	H3473_002_0	1	1			05/16/2019	2020.01	05/16/2019 03:16:17 PM Mountain Daylight Time		05/16/2019 02:32:47 PM Mountain Daylight Time			05/16/2019 03:17:20 PM Mountain Daylight Time	"INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC"	InnovAge Virginia PACE - Blue Ridge	www.MyInnovAge.com	Blue Ridge PACE Medicare Only (PACE)	8	20		1			H3473	2	0	2020	Blue Ridge PACE Medicare Only		2		2			2						https://www.granerx.com/	N/A - no formulary										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H3493	1	0	1	20	8	H3493_001_0	1	1			05/30/2019	2020.01	05/30/2019 07:02:47 PM Eastern Daylight Time		05/30/2019 07:57:48 PM Eastern Daylight Time			05/30/2019 08:01:01 PM Eastern Daylight Time	"LIFE AT LOURDES, INC."	LIFE at Lourdes	www.lourdesnet.org/programs-and-services/life-at-l	"LIFE at Lourdes, Inc (PACE)"	8	20		1			H3493	1	0	2020	LIFE at Lourdes		2		2			2						www.carekinesis.com	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	2	0	1	20	8	H3493_002_0	1	1			05/30/2019	2020.01	05/30/2019 07:03:09 PM Eastern Daylight Time		05/30/2019 07:58:46 PM Eastern Daylight Time			05/30/2019 08:01:01 PM Eastern Daylight Time	"LIFE AT LOURDES, INC."	LIFE at Lourdes	https://www.lourdesnet.org/programs-and-services/l	"LIFE at Lourdes, Inc (PACE)"	8	20		1			H3493	2	0	2020	LIFE at Lourdes		2		2			2						www.carekinesis.com	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																
H3499	1	0	1	1	1	H3499_001_0	4	1			08/01/2019	2020.01	08/01/2019 12:39:01 PM Eastern Daylight Time	08/05/2019 04:17:21 PM Central Daylight Time	08/05/2019 03:13:17 PM Central Daylight Time			08/06/2019 09:35:46 AM Central Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (HMO)	1	1		1			H3499	1	0	2020	Central and Southwest Indiana		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	2	0	1	1	1	H3499_002_0	5	1			08/01/2019	2020.01	08/01/2019 12:39:17 PM Eastern Daylight Time	08/05/2019 04:17:27 PM Central Daylight Time	08/05/2019 03:13:12 PM Central Daylight Time			08/06/2019 09:35:46 AM Central Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (HMO)	1	1		1			H3499	2	0	2020	Northern Indiana		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	5	0	1	1	1	H3499_005_0	5	1	2	1	07/11/2019	2020.01	07/11/2019 09:47:53 AM Eastern Daylight Time	08/05/2019 04:17:16 PM Central Daylight Time	08/05/2019 03:13:14 PM Central Daylight Time			08/06/2019 09:35:46 AM Central Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H3499	5	0	2020	Select Counties Statewide		2		2			1	3		1		1	allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(833)202-4704		(833)202-4704		(877)891-6093		(877)891-6093		(833)202-4704		(833)202-4704		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3499	801	0	1	1	1	H3499_801_0	2	1			05/10/2019	2020.01	05/10/2019 08:45:15 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Group (HMO)	1	1		1			H3499	801	0	2020	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3499	802	0	1	1	1	H3499_802_0	2	1			05/10/2019	2020.01	05/10/2019 08:45:27 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Group (HMO)	1	1		1			H3499	802	0	2020	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3499	803	0	1	1	1	H3499_803_0	2	1			05/10/2019	2020.01	05/10/2019 08:45:35 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Group (HMO)	1	1		1			H3499	803	0	2020	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3517	1	0	1	20	8	H3517_001_0	1	1			05/22/2019	2020.01	05/22/2019 10:07:19 AM Pacific Daylight Time		05/22/2019 10:48:07 AM Pacific Daylight Time			05/22/2019 10:53:33 AM Pacific Daylight Time	"HUMBOLDT SENIOR RESOURCE CENTER, INC."	Redwood Coast PACE	www.humsenior.org	Redwood  Coast PACE-Dual (PACE)	8	20		1			H3517	1	0	2020	Redwood Coast PACE-Dual		2		2			2						www.pharmastarpbm.com	www.pharmastarpbm.com	n/a									(707)443-9747		(707)443-9747		(707)443-9747		(707)443-9747										(711)-		(711)-		(711)-		(711)-																
H3517	2	0	1	20	8	H3517_002_0	1	1			05/22/2019	2020.01	05/22/2019 10:09:01 AM Pacific Daylight Time		05/22/2019 10:48:07 AM Pacific Daylight Time			05/22/2019 10:53:33 AM Pacific Daylight Time	"HUMBOLDT SENIOR RESOURCE CENTER, INC."	Redwood Coast PACE	www.humsenior.org	Redwood Coast PACE-Medicare Only (PACE)	8	20		1			H3517	2	0	2020	Redwood Coast PACE-Medicare Only		2		2			2						www.pharmastarpbm.com	www.pharmastarpbm.com										(707)443-9747		(707)443-9747		(707)443-9747		(707)443-9747										(711)-		(711)-		(711)-		(711)-																
H3528	3	0	1	1	1	H3528_003_0	7	1			06/01/2019	2020.01	06/01/2019 05:43:38 PM Eastern Daylight Time	06/03/2019 04:03:38 PM Eastern Daylight Time				06/03/2019 07:48:23 PM Eastern Daylight Time	"CONNECTICARE, INC."	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Plan 2 (HMO)	1	1		1			H3528	3	0	2020	State of Connecticut		2	17400	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(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	2			
H3528	6	0	1	2	1	H3528_006_0	8	1			07/26/2019	2020.01	07/26/2019 10:43:21 AM Eastern Daylight Time	08/01/2019 01:18:07 PM Eastern Daylight Time	07/31/2019 09:45:34 AM Eastern Daylight Time			08/05/2019 02:44:36 PM Eastern Daylight Time	"CONNECTICARE, INC."	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 1 (HMO-POS)	1	2		1			H3528	6	0	2020	State of Connecticut		2	3000	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(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	1	1	7a;	
H3528	10	0	1	1	1	H3528_010_0	10	1			08/05/2019	2020.01	08/05/2019 12:09:56 PM Eastern Daylight Time	08/01/2019 03:39:31 PM Eastern Daylight Time	07/31/2019 09:50:57 AM Eastern Daylight Time			08/05/2019 02:44:36 PM Eastern Daylight Time	"CONNECTICARE, INC."	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Passage Plan 1 (HMO)	1	1		1			H3528	10	0	2020	State of Connecticut		2	204000	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(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	1	1	7a;	
H3528	11	1	1	2	1	H3528_011_1	9	1			07/17/2019	2020.01	07/17/2019 01:37:04 PM Eastern Daylight Time	08/01/2019 01:19:55 PM Eastern Daylight Time	07/31/2019 09:53:26 AM Eastern Daylight Time			08/05/2019 02:44:36 PM Eastern Daylight Time	"CONNECTICARE, INC."	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 3 (HMO-POS)	1	2		1			H3528	11	1	2020	State of Connecticut	"Hartford, Litchfield, Middlesex, Tolland counties"	2	81585	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(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	1	1	7a;	
H3528	11	2	1	2	1	H3528_011_2	10	1			06/01/2019	2020.01	06/01/2019 06:04:16 PM Eastern Daylight Time	08/01/2019 01:25:54 PM Eastern Daylight Time	07/31/2019 09:57:16 AM Eastern Daylight Time			08/05/2019 02:44:36 PM Eastern Daylight Time	"CONNECTICARE, INC."	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 3 (HMO-POS)	1	2		1			H3528	11	2	2020	State of Connecticut	"Fairfield, New Haven, New London, Windham counties"	2	104415	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(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	1	1	7a;	
H3528	14	0	1	1	1	H3528_014_0	8	1			08/05/2019	2020.01	08/05/2019 08:55:27 AM Eastern Daylight Time	08/01/2019 03:32:30 PM Eastern Daylight Time	07/31/2019 10:05:13 AM Eastern Daylight Time			08/05/2019 02:44:36 PM Eastern Daylight Time	"CONNECTICARE, INC."	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Plan 3 (HMO)	1	1		1			H3528	14	0	2020	State of Connecticut		2	66000	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(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	2			
H3528	15	0	1	2	1	H3528_015_0	8	1			06/01/2019	2020.01	06/01/2019 06:10:26 PM Eastern Daylight Time	08/01/2019 01:37:12 PM Eastern Daylight Time	07/31/2019 09:59:48 AM Eastern Daylight Time			08/05/2019 02:44:36 PM Eastern Daylight Time	"CONNECTICARE, INC."	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Flex Plan 2 (HMO-POS)	1	2		1			H3528	15	0	2020	State of Connecticut		2	19800	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(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	1	1	7a;	
H3528	16	0	1	1	1	H3528_016_0	9	1			06/01/2019	2020.01	06/01/2019 06:14:40 PM Eastern Daylight Time	08/01/2019 01:39:16 PM Eastern Daylight Time	07/31/2019 10:29:24 AM Eastern Daylight Time			08/05/2019 02:44:36 PM Eastern Daylight Time	"CONNECTICARE, INC."	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Choice Plan 1 (HMO)	1	1		1			H3528	16	0	2020	State of Connecticut		2	19500	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(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	1	1	7a;	
H3528	801	0	1	1	1	H3528_801_0	7	1			06/01/2019	2020.01	06/01/2019 06:22:17 PM Eastern Daylight Time					06/03/2019 07:48:23 PM Eastern Daylight Time	"CONNECTICARE, INC."	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Employer Group Plan (HMO)	1	1		1			H3528	801	0	2020	U.S and Territories		1	4339	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(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	1a;1b;2;3-3;3-4;5;6;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;	2		1					1				
H3528	805	0	1	1	1	H3528_805_0	7	1			06/01/2019	2020.01	06/01/2019 06:21:04 PM Eastern Daylight Time					06/03/2019 07:48:23 PM Eastern Daylight Time	"CONNECTICARE, INC."	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Employer Group Plan (HMO)	1	1		1			H3528	805	0	2020	U.S and Territories		1	0	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(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	1a;1b;2;3-3;3-4;5;6;7e;7h;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;	2		1					1				
H3528	806	0	1	2	1	H3528_806_0	7	1			06/01/2019	2020.01	06/01/2019 06:27:22 PM Eastern Daylight Time					06/03/2019 07:48:23 PM Eastern Daylight Time	"CONNECTICARE, INC."	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Employer Group Plan (HMO-POS)	1	2		1			H3528	806	0	2020	U.S and Territories		1	6198	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(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	1a;1b;2;3-3;3-4;5;6;7e;7h;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;	2		1	1	1a;1b;2;3-3;3-4;5;6;7e;7h;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;	2		1				
H3528	807	0	1	2	1	H3528_807_0	7	1			06/01/2019	2020.01	06/01/2019 06:25:43 PM Eastern Daylight Time					06/03/2019 07:48:23 PM Eastern Daylight Time	"CONNECTICARE, INC."	ConnectiCare	www.connecticare.com/medicare	ConnectiCare Employer Group Plan (HMO-POS)	1	2		1			H3528	807	0	2020	U.S and Territories		1	0	2			2						www.connecticare.com/medicare	www.connecticare.com/medicare	www.connecticare.com/medicare	(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	1a;1b;2;3-3;3-4;5;6;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;	2		1	1	1a;1b;2;3-3;3-4;5;6;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;	2		1				
H3533	1	0	1	1	1	H3533_001_0	3	1			08/01/2019	2020.01	08/01/2019 03:42:22 PM Eastern Daylight Time	08/01/2019 04:30:37 PM Eastern Daylight Time	08/02/2019 01:18:12 PM Eastern Daylight Time			08/05/2019 11:12:00 AM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H3533-001 (HMO)	1	1		1			H3533	1	0	2020	"Oneida, Onondaga and Oswego counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	2	0	1	1	1	H3533_002_0	5	1	2	1	07/19/2019	2020.01	07/19/2019 03:18:27 PM Eastern Daylight Time	08/02/2019 03:10:10 PM Eastern Daylight Time	08/02/2019 01:18:13 PM Eastern Daylight Time			08/05/2019 11:12:00 AM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP)	1	1		1			H3533	2	0	2020	Select Counties in New York		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	6	0	1	1	1	H3533_006_0	3	1			08/01/2019	2020.01	08/01/2019 03:45:51 PM Eastern Daylight Time	08/01/2019 04:24:46 PM Eastern Daylight Time	08/02/2019 01:18:13 PM Eastern Daylight Time			08/05/2019 11:12:00 AM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H3533-006 (HMO)	1	1		1			H3533	6	0	2020	Capital Region		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	10	0	1	1	1	H3533_010_0	3	1			07/15/2019	2020.01	07/15/2019 03:40:51 PM Eastern Daylight Time	08/01/2019 04:27:39 PM Eastern Daylight Time	08/02/2019 01:18:13 PM Eastern Daylight Time			08/05/2019 11:12:00 AM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H3533-010 (HMO)	1	1		1			H3533	10	0	2020	Nassau and Suffolk counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	13	0	1	1	1	H3533_013_0	3	1			07/15/2019	2020.01	07/15/2019 03:41:35 PM Eastern Daylight Time	08/02/2019 03:09:09 PM Eastern Daylight Time	08/02/2019 01:18:13 PM Eastern Daylight Time			08/05/2019 11:12:00 AM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H3533-013 (HMO)	1	1		1			H3533	13	0	2020	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	20	0	1	1	1	H3533_020_0	3	1			08/01/2019	2020.01	08/01/2019 03:56:11 PM Eastern Daylight Time	08/01/2019 04:28:40 PM Eastern Daylight Time	08/02/2019 01:18:13 PM Eastern Daylight Time			08/05/2019 11:12:00 AM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H3533-020 (HMO)	1	1		1			H3533	20	0	2020	Southern Tier Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	21	0	1	1	1	H3533_021_0	3	1			07/15/2019	2020.01	07/15/2019 03:43:30 PM Eastern Daylight Time	08/01/2019 04:35:31 PM Eastern Daylight Time	08/02/2019 01:18:13 PM Eastern Daylight Time			08/05/2019 11:12:00 AM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H3533-021 (HMO)	1	1		1			H3533	21	0	2020	New York City		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	23	0	1	1	1	H3533_023_0	3	1			07/15/2019	2020.01	07/15/2019 03:44:17 PM Eastern Daylight Time	08/01/2019 04:36:30 PM Eastern Daylight Time	08/02/2019 01:18:13 PM Eastern Daylight Time			08/05/2019 11:12:00 AM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H3533-023 (HMO)	1	1		1			H3533	23	0	2020	New York City and Long Island		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	27	0	1	1	1	H3533_027_0	3	1			08/01/2019	2020.01	08/01/2019 04:11:28 PM Eastern Daylight Time	08/01/2019 04:44:23 PM Eastern Daylight Time	08/02/2019 01:18:13 PM Eastern Daylight Time			08/05/2019 11:12:00 AM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H3533-027 (HMO)	1	1		1			H3533	27	0	2020	New York City and Long Island		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	29	1	1	1	1	H3533_029_1	7	1	2	1	08/04/2019	2020.01	08/04/2019 05:17:16 PM Eastern Daylight Time	08/01/2019 04:25:43 PM Eastern Daylight Time	08/02/2019 01:18:14 PM Eastern Daylight Time			08/05/2019 11:12:00 AM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H3533-029 (HMO D-SNP)	1	1		1			H3533	29	1	2020	Select Counties in New York City and Long Island	Select Counties in New York City and Long Island	2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	29	2	1	1	1	H3533_029_2	6	1	2	1	07/19/2019	2020.01	07/19/2019 03:24:38 PM Eastern Daylight Time	08/01/2019 05:03:14 PM Eastern Daylight Time	08/02/2019 01:18:14 PM Eastern Daylight Time			08/05/2019 11:12:00 AM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H3533-029 (HMO D-SNP)	1	1		1			H3533	29	2	2020	Select Counties in New York City and Long Island	Bronx County	2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	30	0	1	1	1	H3533_030_0	3	1			07/15/2019	2020.01	07/15/2019 03:46:03 PM Eastern Daylight Time	08/01/2019 05:01:29 PM Eastern Daylight Time	08/02/2019 01:18:14 PM Eastern Daylight Time			08/05/2019 11:12:00 AM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H3533-030 (HMO)	1	1		1			H3533	30	0	2020	Bronx County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3533	802	0	1	1	1	H3533_802_0	1	1			05/29/2019	2020.01	05/29/2019 10:46:06 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H3533	802	0	2020	Select Counties in NY		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3533	803	0	1	1	1	H3533_803_0	1	1			05/29/2019	2020.01	05/29/2019 10:46:36 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H3533	803	0	2020	Select Counties in NY		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3533	805	0	1	1	1	H3533_805_0	1	1			05/29/2019	2020.01	05/29/2019 12:34:06 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H3533	805	0	2020	Select counties in NY		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H3533	806	0	1	1	1	H3533_806_0	1	1			05/29/2019	2020.01	05/29/2019 12:35:44 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH COMPANY OF NEW YORK, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H3533	806	0	2020	Select counties in NY		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H3536	2	0	1	1	1	H3536_002_0	8	1			06/26/2019	2020.01	06/26/2019 12:49:05 PM Pacific Daylight Time	08/05/2019 01:13:03 PM Pacific Daylight Time	08/05/2019 01:16:23 PM Pacific Daylight Time			08/05/2019 01:30:39 PM Pacific Daylight Time	"MATTHEW THORNTON HEALTH PLAN, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H3536	2	0	2020	Select Counties in New Hampshire		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2473		(855)310-2473		(844)368-4243		(844)368-4243		(855)310-2473		(855)310-2473		(844)368-4242		(844)368-4242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3536	4	0	1	1	1	H3536_004_0	8	1			08/01/2019	2020.01	08/01/2019 09:50:41 AM Pacific Daylight Time	08/05/2019 01:13:17 PM Pacific Daylight Time	08/05/2019 01:16:35 PM Pacific Daylight Time			08/05/2019 01:30:39 PM Pacific Daylight Time	"MATTHEW THORNTON HEALTH PLAN, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Coordination Plus (HMO)	1	1		1			H3536	4	0	2020	Select Counties in New Hampshire		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2473		(855)310-2473		(844)467-1557		(844)467-1557		(855)310-2473		(855)310-2473		(844)467-1558		(844)467-1558		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3536	5	0	1	1	1	H3536_005_0	8	1			06/26/2019	2020.01	06/26/2019 12:49:30 PM Pacific Daylight Time	08/05/2019 01:13:51 PM Pacific Daylight Time	08/05/2019 01:16:56 PM Pacific Daylight Time			08/05/2019 01:30:39 PM Pacific Daylight Time	"MATTHEW THORNTON HEALTH PLAN, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Select (HMO)	1	1		1			H3536	5	0	2020	Select Counties in New Hampshire		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2473		(855)310-2473		(844)368-4243		(844)368-4243		(855)310-2473		(855)310-2473		(844)368-4242		(844)368-4242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3536	801	0	1	1	1	H3536_801_0	3	1			05/21/2019	2020.01	05/21/2019 03:24:36 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"MATTHEW THORNTON HEALTH PLAN, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	1	1		1			H3536	801	0	2020	Select counties in New Hampshire		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	802	0	1	1	1	H3536_802_0	3	1			05/21/2019	2020.01	05/21/2019 03:27:55 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"MATTHEW THORNTON HEALTH PLAN, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	1	1		1			H3536	802	0	2020	Select Counties in New Hampshire		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	803	0	2	1	1	H3536_803_0	3	1			05/30/2019	2020.01	05/30/2019 07:32:50 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"MATTHEW THORNTON HEALTH PLAN, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3536	803	0	2020	New Hampshire - Select Counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	804	0	2	1	1	H3536_804_0	3	1			05/30/2019	2020.01	05/30/2019 07:32:56 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"MATTHEW THORNTON HEALTH PLAN, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3536	804	0	2020	Select New Hampshire Counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	805	0	1	1	1	H3536_805_0	3	1			05/21/2019	2020.01	05/21/2019 03:28:16 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"MATTHEW THORNTON HEALTH PLAN, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	1	1		1			H3536	805	0	2020	Select New Hampshire Counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	806	0	1	1	1	H3536_806_0	3	1			05/21/2019	2020.01	05/21/2019 03:28:39 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"MATTHEW THORNTON HEALTH PLAN, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	1	1		1			H3536	806	0	2020	Select New Hampshire Counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	807	0	2	1	1	H3536_807_0	3	1			05/30/2019	2020.01	05/30/2019 07:33:16 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"MATTHEW THORNTON HEALTH PLAN, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3536	807	0	2020	Select New Hampshire Counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3536	808	0	2	1	1	H3536_808_0	3	1			05/30/2019	2020.01	05/30/2019 07:33:25 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"MATTHEW THORNTON HEALTH PLAN, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/nh/medicare	Anthem MediBlue (HMO)	1	1		2	1		H3536	808	0	2020	Select NH counties		1	600	2			2						www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	www.anthem.com/nh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3557	1	0	1	4	1	H3557_001_0	7	1			07/24/2019	2020.01	07/24/2019 02:07:13 PM Eastern Daylight Time	08/06/2019 12:51:39 PM Eastern Daylight Time	08/06/2019 12:51:39 PM Eastern Daylight Time			08/06/2019 12:55:31 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	HealthMate for Medicare (PPO)	1	4		1			H3557	1	0	2020	State of Rhode Island		2	11759	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.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)-		2					2						1	1	7a;	
H3557	801	0	1	4	1	H3557_801_0	3	1			05/31/2019	2020.01	05/31/2019 01:46:12 PM Eastern Daylight Time					06/03/2019 03:06:07 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	HealthMate Coast-to-Coast for Medicare Group (PPO)	1	4		1			H3557	801	0	2020	"RI, Nationwide"		1	24238	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.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	1a;1b;2;5;6;7e;7g;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;15;	2		1									
H3561	1	0	1	1	1	H3561_001_0	4	1	2	1	08/01/2019	2020.01	08/01/2019 03:16:40 PM Pacific Daylight Time	08/05/2019 04:00:03 PM Central Daylight Time	08/05/2019 03:14:23 PM Central Daylight Time			08/06/2019 09:45:42 AM Central Daylight Time	"HEALTH NET COMMUNITY SOLUTIONS, INC."	"HEALTH NET COMMUNITY SOLUTIONS, INC."	ca.healthnetadvantage.com	Health Net Seniority Plus Amber II Premier (HMO D-SNP)	1	1		1			H3561	1	0	2020	Fresno County		2		2			1	3		2		2	ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H3561	2	0	1	1	1	H3561_002_0	4	1			08/01/2019	2020.01	08/01/2019 03:17:10 PM Pacific Daylight Time	08/05/2019 04:00:08 PM Central Daylight Time	08/05/2019 03:14:26 PM Central Daylight Time			08/06/2019 09:45:42 AM Central Daylight Time	"HEALTH NET COMMUNITY SOLUTIONS, INC."	"HEALTH NET COMMUNITY SOLUTIONS, INC."	ca.healthnetadvantage.com	Health Net Seniority Plus Sapphire Premier (HMO)	1	1		1			H3561	2	0	2020	"Ala, Fre, Ker, LA, Ora, SD, SF and Tul Counties"		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H3561	4	0	1	1	1	H3561_004_0	4	1			08/01/2019	2020.01	08/01/2019 03:17:42 PM Pacific Daylight Time	08/05/2019 04:00:14 PM Central Daylight Time	08/05/2019 03:14:15 PM Central Daylight Time			08/06/2019 09:45:42 AM Central Daylight Time	"HEALTH NET COMMUNITY SOLUTIONS, INC."	"HEALTH NET COMMUNITY SOLUTIONS, INC."	ca.healthnetadvantage.com	Health Net Seniority Plus Sapphire Premier (HMO)	1	1		1			H3561	4	0	2020	"Imperial, Riverside, San Bernardino Counties"		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H3561	5	0	1	1	1	H3561_005_0	3	1			08/01/2019	2020.01	08/01/2019 03:18:14 PM Pacific Daylight Time	08/05/2019 04:00:18 PM Central Daylight Time	08/05/2019 03:14:17 PM Central Daylight Time			08/06/2019 09:45:42 AM Central Daylight Time	"HEALTH NET COMMUNITY SOLUTIONS, INC."	"HEALTH NET COMMUNITY SOLUTIONS, INC."	ca.healthnetadvantage.com	Health Net Seniority Plus Sapphire Premier II (HMO)	1	1		1			H3561	5	0	2020	"Ala, Fre, Ker, LA, Ora, SD, SF and Tul Counties"		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H3561	6	0	1	1	1	H3561_006_0	4	1			08/01/2019	2020.01	08/01/2019 03:18:47 PM Pacific Daylight Time	08/05/2019 03:59:59 PM Central Daylight Time	08/05/2019 03:14:20 PM Central Daylight Time			08/06/2019 09:45:42 AM Central Daylight Time	"HEALTH NET COMMUNITY SOLUTIONS, INC."	"HEALTH NET COMMUNITY SOLUTIONS, INC."	ca.healthnetadvantage.com	Health Net Seniority Plus Sapphire Premier II (HMO)	1	1		1			H3561	6	0	2020	"Imperial, Riverside, San Bernardino Counties"		2		2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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	2			
H3561	801	0	1	1	1	H3561_801_0	2	1			05/13/2019	2020.01	05/13/2019 02:42:41 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"HEALTH NET COMMUNITY SOLUTIONS, INC."	"HEALTH NET COMMUNITY SOLUTIONS, INC."	healthnet.com	Health Net Seniority Plus Employer (HMO)	1	1		1			H3561	801	0	2020	California		1	100	2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;17b;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;9a1;9b;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					1				
H3561	802	0	1	1	1	H3561_802_0	2	1			05/13/2019	2020.01	05/13/2019 03:41:28 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"HEALTH NET COMMUNITY SOLUTIONS, INC."	"HEALTH NET COMMUNITY SOLUTIONS, INC."	healthnet.com	Health Net Seniority Plus Employer (HMO)	1	1		1			H3561	802	0	2020	California		1	100	2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;17b;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;9a1;9b;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					1				
H3561	803	0	1	1	1	H3561_803_0	2	1			05/10/2019	2020.01	05/10/2019 09:37:47 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"HEALTH NET COMMUNITY SOLUTIONS, INC."	"HEALTH NET COMMUNITY SOLUTIONS, INC."	healthnet.com	Health Net Seniority Plus Employer (HMO)	1	1		1			H3561	803	0	2020	California		1	100	2			2						ca.healthnetadvantage.com/findadoctor	ca.healthnetadvantage.com/formulary	ca.healthnetadvantage.com/findadoctor	(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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;14a;15;16b;17b;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;9a1;9b;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					1				
H3563	1	0	1	20	8	H3563_001_0	1	1			06/24/2019	2020.01	06/24/2019 11:45:23 AM Pacific Daylight Time		06/24/2019 11:43:34 AM Pacific Daylight Time			06/24/2019 11:47:01 AM Pacific Daylight Time	"GARY AND MARY WEST SENIOR SERVICES, INC."	Gary and Mary West PACE	www.westpace.org	"Gary and Mary West Senior Services, Inc (PACE)"	8	20		1			H3563	1	0	2020	San Diego North County		2		2			2						www.Carekinesis.com	www.westpace.org												(760)280-2232				(760)280-2232												(800)920-7098				(800)920-7098																
H3563	2	0	1	20	8	H3563_002_0	1	1			06/24/2019	2020.01	06/24/2019 11:45:41 AM Pacific Daylight Time		06/24/2019 11:43:59 AM Pacific Daylight Time			06/24/2019 11:47:01 AM Pacific Daylight Time	"GARY AND MARY WEST SENIOR SERVICES, INC."	Gary and Mary West PACE	www.westpace.org	"Gary and Mary West Senior Services, Inc (PACE)"	8	20		1			H3563	2	0	2020	San Diego North County		2		2			2						www.Carekinesis.com	www.westpace.org												(760)280-2232				(760)280-2232												(800)920-7098				(800)920-7098																
H3572	1	0	1	1	1	H3572_001_0	3	1		1	06/03/2019	2020.01	06/03/2019 05:09:46 PM Pacific Daylight Time	08/02/2019 03:07:47 PM Pacific Daylight Time	08/02/2019 03:07:47 PM Pacific Daylight Time			08/02/2019 03:09:46 PM Pacific Daylight Time	"AHF MCO OF GEORGIA, INC."	AHF	www.php-ga.org	PHP (HMO C-SNP)	1	1		1			H3572	1	0	2020	"Fulton County, Georgia"		2		2			1	4			1000000000		www.php-ga.org/provider-find	www.php-ga.org/for-members/drug-benefit/formulary	www.php-ga.org/provider-find	(833)267-6768		(833)267-6768		(833)267-6768		(833)267-6768		(833)267-6769		(833)267-6769		(833)267-6768		(833)267-6768		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	1	0	1	1	1	H3597_001_0	5	1			08/01/2019	2020.01	08/01/2019 05:24:52 PM Eastern Daylight Time	08/02/2019 09:22:19 AM Eastern Daylight Time	07/30/2019 11:43:00 PM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3597	1	0	2020	Southern Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	7	0	1	1	1	H3597_007_0	4	1			08/01/2019	2020.01	08/01/2019 03:10:51 PM Eastern Daylight Time	08/02/2019 09:25:25 AM Eastern Daylight Time	07/30/2019 11:44:09 PM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3597	7	0	2020	Mid Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	9	0	1	1	1	H3597_009_0	4	1			08/01/2019	2020.01	08/01/2019 10:06:32 AM Eastern Daylight Time	08/02/2019 09:30:04 AM Eastern Daylight Time	07/30/2019 11:45:31 PM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3597	9	0	2020	Northern and Additional Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3597	801	0	1	1	1	H3597_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:44:27 AM Eastern Daylight Time					05/30/2019 06:35:04 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H3597	801	0	2020	Maine		1	270	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3597	802	0	1	1	1	H3597_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:44:38 AM Eastern Daylight Time					05/30/2019 06:35:04 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H3597	802	0	2020	Maine		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	http://www.aetnamedicaredocfind.com/	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3597	803	0	1	1	1	H3597_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:44:51 AM Eastern Daylight Time					05/30/2019 06:35:04 PM Eastern Daylight Time	AETNA HEALTH INC. (ME)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H3597	803	0	2020	Maine		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3613	1	0	1	20	8	H3613_001_0	1	1			05/23/2019	2020.01	05/23/2019 09:07:57 AM Eastern Daylight Time		05/23/2019 08:54:21 AM Eastern Daylight Time			05/23/2019 09:10:28 AM Eastern Daylight Time	MCGREGOR PACE	McGregor PACE	http://www.mcgregorpace.org/	McGregor PACE Dual Eligibles (PACE)	8	20		1			H3613	1	0	2020	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	2	0	1	20	8	H3613_002_0	1	1			05/23/2019	2020.01	05/23/2019 09:08:24 AM Eastern Daylight Time		05/23/2019 08:54:51 AM Eastern Daylight Time			05/23/2019 09:10:28 AM Eastern Daylight Time	MCGREGOR PACE	McGregor PACE	http://www.mcgregorpace.org/	McGregor PACE Medicare Only Eligibles (PACE)	8	20		1			H3613	2	0	2020	McGregor PACE Cuyahoga County		2		2			2						http://www.catamaranrx.com/	http://www.catamaranrx.com/										(216)791-3580		(216)791-3580		(216)202-1650		(216)202-1650										(800)325-2223		(800)325-2223		(800)325-2223		(800)325-2223																
H3632	1	0	1	4	1	H3632_001_0	11	1			07/26/2019	2020.01	07/26/2019 02:48:50 PM Central Daylight Time	08/01/2019 09:44:59 AM Central Daylight Time	08/01/2019 09:46:59 AM Central Daylight Time			08/01/2019 11:39:37 AM Central Daylight Time	MEDICA HEALTH PLANS OF WISCONSIN	Medica	medica.com	Medica Advantage Solution with CHI Health (PPO)	1	4		1			H3632	1	0	2020	Select counties in IA and NE		2		2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)398-7374		(952)992-2134		(800)906-5432		(952)992-2345		(866)398-7374		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3653	4	0	1	1	1	H3653_004_0	5	1			07/23/2019	2020.01	07/23/2019 02:51:52 PM Eastern Daylight Time	08/06/2019 10:17:18 AM Eastern Daylight Time	08/06/2019 10:17:18 AM Eastern Daylight Time			08/06/2019 10:21:26 AM Eastern Daylight Time	"PARAMOUNT CARE, INC."	Paramount Elite/Medicare Plans	www.paramounthealthcare.com/medicareplans	Paramount Elite - Enhanced Medical & Drug (HMO)	1	1		1			H3653	4	0	2020	Paramount Elite - Enhanced (Northern OH / SE Mich)		2		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	2			
H3653	15	0	1	1	1	H3653_015_0	5	1			08/04/2019	2020.01	08/04/2019 08:57:31 AM Eastern Daylight Time	08/06/2019 10:17:18 AM Eastern Daylight Time	08/06/2019 10:17:19 AM Eastern Daylight Time			08/06/2019 10:21:26 AM Eastern Daylight Time	"PARAMOUNT CARE, INC."	Paramount Elite/Medicare Plans	www.paramounthealthcare.com/medicareplans	Paramount Elite - Standard Medical & Drug (HMO)	1	1		1			H3653	15	0	2020	Paramount Elite - Standard (Northern OH / SE Mich)		2		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	2			
H3653	18	0	1	1	1	H3653_018_0	4	1			07/10/2019	2020.01	07/10/2019 12:27:59 PM Eastern Daylight Time	05/31/2019 04:46:25 PM Eastern Daylight Time				07/10/2019 01:59:14 PM Eastern Daylight Time	"PARAMOUNT CARE, INC."	Paramount Elite/Medicare Plans	www.paramounthealthcare.com/medicareplans	Paramount Elite - Enhanced Medical Only (HMO)	1	1		1			H3653	18	0	2020	Paramount Elite - Medical Only (North OH/ SE Mich)		2		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	2			
H3653	22	0	1	1	1	H3653_022_0	5	1			08/04/2019	2020.01	08/04/2019 08:59:47 AM Eastern Daylight Time	08/06/2019 10:17:19 AM Eastern Daylight Time	08/06/2019 10:17:20 AM Eastern Daylight Time			08/06/2019 10:21:26 AM Eastern Daylight Time	"PARAMOUNT CARE, INC."	Paramount Elite/Medicare Plans	www.paramounthealthcare.com/medicareplans	Paramount Elite - Prime Medical & Drug (HMO)	1	1		1			H3653	22	0	2020	Paramount Elite - Prime (Northern OH / SE Mich)		2		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	2			
H3653	23	0	1	1	1	H3653_023_0	5	1			07/10/2019	2020.01	07/10/2019 12:31:52 PM Eastern Daylight Time	08/06/2019 10:17:22 AM Eastern Daylight Time	08/06/2019 10:17:23 AM Eastern Daylight Time			08/06/2019 10:21:26 AM Eastern Daylight Time	"PARAMOUNT CARE, INC."	Paramount Elite/Medicare Plans	www.paramounthealthcare.com/medicareplans	Paramount Elite Choice Medical & Drug (HMO)	1	1		1			H3653	23	0	2020	Paramount Elite- Choice (Southwestern Ohio)		2		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	2			
H3653	24	0	1	1	1	H3653_024_0	5	1			08/04/2019	2020.01	08/04/2019 09:02:02 AM Eastern Daylight Time	08/06/2019 10:17:24 AM Eastern Daylight Time	08/06/2019 10:17:25 AM Eastern Daylight Time			08/06/2019 10:21:26 AM Eastern Daylight Time	"PARAMOUNT CARE, INC."	Paramount Elite/Medicare Plans	www.paramounthealthcare.com/medicareplans	Paramount Elite Essential Medical & Drug (HMO)	1	1		1			H3653	24	0	2020	Paramount Elite - Essential (Southwestern Ohio)		2		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	2			
H3653	803	0	1	1	1	H3653_803_0	1	1			05/23/2019	2020.01	05/23/2019 05:36:34 PM Eastern Daylight Time					05/30/2019 10:23:53 AM Eastern Daylight Time	"PARAMOUNT CARE, INC."	Paramount Elite/Medicare Plans	www.paramounthealthcare.com/medicareplans	Paramount Elite - Emp Group A/B No Rx (HMO)	1	1		1			H3653	803	0	2020	Paramount Elite - Emp Group A/B No Rx		1	14208	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	1a;1b;2;5;6;7c;7i;8a;8b1;8b2;9a1;9b;11a;11b;15;	2		1					1				
H3653	806	0	2	1	1	H3653_806_0	1	1			05/23/2019	2020.01	05/23/2019 05:42:26 PM Eastern Daylight Time					05/30/2019 10:23:53 AM Eastern Daylight Time	"PARAMOUNT CARE, INC."	Paramount Elite/Medicare Plans	www.paramounthealthcare.com/medicareplans	Paramount Elite - Emp Group B Only No Rx (HMO)	1	1		2	2		H3653	806	0	2020	Paramount Elite - Emp Group B Only No Rx		1	960	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	1a;1b;2;5;6;7c;7i;8a;8b1;8b2;9a1;9b;11a;11b;15;	2		1					1				
H3653	809	0	1	1	1	H3653_809_0	1	1			05/23/2019	2020.01	05/23/2019 05:48:28 PM Eastern Daylight Time					05/30/2019 10:23:53 AM Eastern Daylight Time	"PARAMOUNT CARE, INC."	Paramount Elite/Medicare Plans	www.paramounthealthcare.com/medicareplans	Paramount Elite-Emp Group A/B Rx (HMO)	1	1		1			H3653	809	0	2020	Paramount Elite-Emp Group A/B Rx		1	780	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	1a;1b;2;5;6;7c;7i;8a;8b1;8b2;9a1;9b;11a;11b;15;	2		1					1				
H3655	32	0	1	1	1	H3655_032_0	6	1			07/31/2019	2020.01	07/31/2019 06:03:52 PM Eastern Daylight Time	08/05/2019 10:01:38 AM Eastern Daylight Time	07/30/2019 06:51:15 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Essential (HMO)	1	1		1			H3655	32	0	2020	Select Counties in Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	33	0	1	1	1	H3655_033_0	7	1	2	1	07/17/2019	2020.01	07/17/2019 12:50:58 PM Eastern Daylight Time	08/05/2019 10:01:39 AM Eastern Daylight Time	07/30/2019 06:51:53 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H3655	33	0	2020	Select Counties in Ohio		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(844)879-3610		(844)879-3610		(844)467-1561		(844)467-1561		(844)879-3610		(844)879-3610		(844)467-1562		(844)467-1562		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	34	0	1	1	1	H3655_034_0	5	1			07/31/2019	2020.01	07/31/2019 06:04:23 PM Eastern Daylight Time	08/05/2019 10:01:39 AM Eastern Daylight Time	07/30/2019 06:52:30 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H3655	34	0	2020	Select Counties in Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	38	0	1	1	1	H3655_038_0	6	1			07/31/2019	2020.01	07/31/2019 06:05:01 PM Eastern Daylight Time	08/05/2019 10:01:39 AM Eastern Daylight Time	07/30/2019 06:53:07 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Prime Select (HMO)	1	1		1			H3655	38	0	2020	Select Counties in Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	40	0	1	1	1	H3655_040_0	6	1			08/02/2019	2020.01	08/02/2019 10:16:09 AM Eastern Daylight Time	08/05/2019 10:01:40 AM Eastern Daylight Time	07/30/2019 06:53:44 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Preferred (HMO)	1	1		1			H3655	40	0	2020	Select Counties in Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	41	0	1	1	1	H3655_041_0	6	1			07/17/2019	2020.01	07/17/2019 01:16:44 PM Eastern Daylight Time	08/05/2019 10:01:40 AM Eastern Daylight Time	07/30/2019 06:54:24 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Extra (HMO)	1	1		1			H3655	41	0	2020	Select Counties in Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7796		(855)690-7796		(800)797-5957		(800)797-5957		(855)690-7796		(855)690-7796		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3655	801	0	1	1	1	H3655_801_0	3	1			05/30/2019	2020.01	05/30/2019 06:49:08 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	1	1		1			H3655	801	0	2020	Ohio		1	3614	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	803	0	1	1	1	H3655_803_0	3	1			05/30/2019	2020.01	05/30/2019 06:49:20 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	1	1		1			H3655	803	0	2020	Ohio		1	240	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	805	0	2	1	1	H3655_805_0	3	1			05/30/2019	2020.01	05/30/2019 07:26:20 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	1	1		2	1		H3655	805	0	2020	Ohio		1	600	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	806	0	2	1	1	H3655_806_0	3	1			05/30/2019	2020.01	05/30/2019 07:26:14 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	1	1		2	1		H3655	806	0	2020	Ohio		1	600	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	807	0	1	1	1	H3655_807_0	3	1			05/22/2019	2020.01	05/22/2019 12:25:48 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	1	1		1			H3655	807	0	2020	Ohio		1	600	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	808	0	1	1	1	H3655_808_0	3	1			05/22/2019	2020.01	05/22/2019 12:17:49 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	1	1		1			H3655	808	0	2020	Ohio		1	600	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	809	0	2	1	1	H3655_809_0	3	1			05/30/2019	2020.01	05/30/2019 07:25:33 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	1	1		2	1		H3655	809	0	2020	Ohio		1	600	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3655	810	0	2	1	1	H3655_810_0	3	1			05/30/2019	2020.01	05/30/2019 07:25:39 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/oh/medicare	Anthem Senior Advantage (HMO)	1	1		2	1		H3655	810	0	2020	Ohio		1	600	2			2						www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	www.anthem.com/oh/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H3660	28	0	1	2	1	H3660_028_0	6	1			07/12/2019	2020.01	07/12/2019 12:16:22 PM Eastern Daylight Time	07/31/2019 04:43:56 PM Eastern Daylight Time	07/31/2019 11:34:26 AM Eastern Daylight Time			08/05/2019 04:19:53 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Emerald (HMO-POS)	1	2		1			H3660	28	0	2020	Northeast Ohio		2		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	2			
H3660	29	0	1	2	1	H3660_029_0	5	1			07/12/2019	2020.01	07/12/2019 12:17:45 PM Eastern Daylight Time	07/31/2019 04:47:34 PM Eastern Daylight Time	07/31/2019 11:35:58 AM Eastern Daylight Time			08/05/2019 04:19:53 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Sapphire (HMO-POS)	1	2		1			H3660	29	0	2020	Northeast Ohio		2		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	2			
H3660	44	0	1	1	1	H3660_044_0	5	1			07/12/2019	2020.01	07/12/2019 12:17:30 PM Eastern Daylight Time	07/31/2019 04:50:34 PM Eastern Daylight Time	07/31/2019 01:00:34 PM Eastern Daylight Time			08/05/2019 04:19:53 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Ruby (HMO)	1	1		1			H3660	44	0	2020	Northeast Ohio		2		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	2			
H3660	47	0	1	1	1	H3660_047_0	5	1			07/12/2019	2020.01	07/12/2019 12:18:15 PM Eastern Daylight Time	07/31/2019 04:53:48 PM Eastern Daylight Time	07/31/2019 01:02:28 PM Eastern Daylight Time			08/05/2019 04:19:53 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Ruby (HMO)	1	1		1			H3660	47	0	2020	Northwest Ohio		2		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	2			
H3660	48	0	1	2	1	H3660_048_0	5	1			07/12/2019	2020.01	07/12/2019 12:18:44 PM Eastern Daylight Time	07/31/2019 05:01:24 PM Eastern Daylight Time	07/31/2019 01:47:18 PM Eastern Daylight Time			08/05/2019 04:19:53 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Sapphire (HMO-POS)	1	2		1			H3660	48	0	2020	Northwest Ohio		2		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	2			
H3660	50	0	1	1	1	H3660_050_0	5	1			07/12/2019	2020.01	07/12/2019 12:19:10 PM Eastern Daylight Time	07/31/2019 05:05:48 PM Eastern Daylight Time	07/31/2019 11:25:18 AM Eastern Daylight Time			08/05/2019 04:19:53 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Topaz (HMO)	1	1		1			H3660	50	0	2020	Northeast Ohio		2		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	2			
H3660	52	1	1	1	1	H3660_052_1	4	1			07/12/2019	2020.01	07/12/2019 12:19:35 PM Eastern Daylight Time	05/29/2019 06:13:40 PM Eastern Daylight Time				07/12/2019 12:27:20 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Amber (HMO)	1	1		1			H3660	52	1	2020	Northeast and Northwest Ohio	Northeast Ohio	2		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	2			
H3660	52	2	1	1	1	H3660_052_2	4	1			07/12/2019	2020.01	07/12/2019 12:19:57 PM Eastern Daylight Time	05/29/2019 06:15:54 PM Eastern Daylight Time				07/12/2019 12:27:20 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Amber (HMO)	1	1		1			H3660	52	2	2020	Northeast and Northwest Ohio	Northwest Ohio	2		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	2			
H3660	53	1	1	1	1	H3660_053_1	5	1			07/12/2019	2020.01	07/12/2019 12:20:37 PM Eastern Daylight Time	07/31/2019 05:16:14 PM Eastern Daylight Time	07/31/2019 11:27:24 AM Eastern Daylight Time			08/05/2019 04:19:53 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Garnet (HMO)	1	1		1			H3660	53	1	2020	Northeast Ohio	"Summit, Stark, Portage, Medina and Wayne Counties"	2		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	2			
H3660	53	2	1	1	1	H3660_053_2	5	1			07/12/2019	2020.01	07/12/2019 12:21:00 PM Eastern Daylight Time	07/31/2019 05:18:34 PM Eastern Daylight Time	07/31/2019 11:31:24 AM Eastern Daylight Time			08/05/2019 04:19:53 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Garnet (HMO)	1	1		1			H3660	53	2	2020	Northeast Ohio	Non Core Northeast Ohio	2		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	2			
H3660	801	0	1	1	1	H3660_801_0	3	1			05/17/2019	2020.01	05/17/2019 03:39:50 PM Eastern Daylight Time					05/31/2019 07:47:04 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan with Part D (HMO)	1	1		1			H3660	801	0	2020	Nationwide Service Area		1	1668	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		1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		2					1				
H3660	802	0	1	1	1	H3660_802_0	3	1			05/17/2019	2020.01	05/17/2019 03:45:16 PM Eastern Daylight Time					05/31/2019 07:47:04 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan without Part D (HMO)	1	1		1			H3660	802	0	2020	Nationwide Service Area		1	90	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										1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		2					1				
H3660	805	0	1	2	1	H3660_805_0	3	1			05/22/2019	2020.01	05/22/2019 08:10:00 PM Eastern Daylight Time					05/31/2019 07:47:04 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan with Part D (HMO-POS)	1	2		1			H3660	805	0	2020	Nationwide Service Area		1	2544	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		1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1				
H3660	806	0	1	2	1	H3660_806_0	3	1			05/22/2019	2020.01	05/22/2019 08:10:23 PM Eastern Daylight Time					05/31/2019 07:47:04 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan without Part D (HMO-POS)	1	2		1			H3660	806	0	2020	Nationwide Service Area		1	60	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										1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1	1	1a;1b;2;7d;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;	2		1				
H3664	14	0	1	2	1	H3664_014_0	3	1			07/18/2019	2020.01	07/18/2019 01:47:38 PM Eastern Daylight Time	05/31/2019 08:59:41 AM Eastern Daylight Time				07/18/2019 01:49:33 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Basic - MA Only (HMO-POS)	1	2		1			H3664	14	0	2020	Operating in 12 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	2			
H3664	17	0	1	2	1	H3664_017_0	4	1			08/01/2019	2020.01	08/01/2019 02:29:43 PM Eastern Daylight Time	08/02/2019 04:36:57 PM Eastern Daylight Time	08/02/2019 04:36:57 PM Eastern Daylight Time			08/02/2019 04:38:15 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Plus (HMO-POS)	1	2		1			H3664	17	0	2020	Operating in 12 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	2			
H3664	20	0	1	2	1	H3664_020_0	4	1			08/02/2019	2020.01	08/02/2019 04:23:24 PM Eastern Daylight Time	08/02/2019 04:36:57 PM Eastern Daylight Time	08/02/2019 04:36:58 PM Eastern Daylight Time			08/02/2019 04:38:15 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Classic (HMO-POS)	1	2		1			H3664	20	0	2020	Operating in 12 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	2			
H3664	21	0	1	2	1	H3664_021_0	4	1			08/02/2019	2020.01	08/02/2019 04:23:41 PM Eastern Daylight Time	08/02/2019 04:36:56 PM Eastern Daylight Time	08/02/2019 04:36:56 PM Eastern Daylight Time			08/02/2019 04:38:15 PM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Aultimate (HMO-POS)	1	2		1			H3664	21	0	2020	Operating in 12 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	2			
H3664	801	0	1	2	1	H3664_801_0	1	1			04/24/2019	2020.01	04/24/2019 11:49:14 AM Eastern Daylight Time					05/31/2019 09:05:26 AM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Employer Group HMO  - CY (HMO-POS)	1	2		1			H3664	801	0	2020	National Service Area		1	5988	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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	2		2		1				
H3664	802	0	1	2	1	H3664_802_0	1	1			04/24/2019	2020.01	04/24/2019 11:49:31 AM Eastern Daylight Time					05/31/2019 09:05:26 AM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Employer Group HMO MA-Only (HMO-POS)	1	2		1			H3664	802	0	2020	National Service Area		1	864	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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	2		2		1				
H3664	803	0	1	2	1	H3664_803_0	1	1			05/17/2019	2020.01	05/17/2019 04:41:45 PM Eastern Daylight Time					05/31/2019 09:05:26 AM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Employer Group - Non CY (HMO-POS)	1	2		1			H3664	803	0	2020	National Service Area		1	0	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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	2		2		1				
H3664	805	0	2	2	1	H3664_805_0	1	1			04/24/2019	2020.01	04/24/2019 11:50:01 AM Eastern Daylight Time					05/31/2019 09:05:26 AM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	Part B Only MA-PD (HMO-POS)	1	2		2	2		H3664	805	0	2020	Part B Only MA-PD National Service Area		1	0	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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	2		2		1				
H3664	806	0	2	2	1	H3664_806_0	1	1			05/17/2019	2020.01	05/17/2019 04:37:12 PM Eastern Daylight Time					05/31/2019 09:05:26 AM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	Part B Only MA (HMO-POS)	1	2		2	2		H3664	806	0	2020	Part B Only MA National Service Area		1	0	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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	2		2		1				
H3664	807	0	1	2	1	H3664_807_0	1	1			05/17/2019	2020.01	05/17/2019 04:43:02 PM Eastern Daylight Time					05/31/2019 09:05:26 AM Eastern Daylight Time	AULTCARE HEALTH INSURING CORPORATION	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Employer Group HMO - CY (HMO-POS)	1	2		1			H3664	807	0	2020	National Service Area		1	73476	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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	2		2		1				
H3668	13	0	1	1	1	H3668_013_0	3	1			07/03/2019	2020.01	07/03/2019 01:31:27 PM Eastern Daylight Time	06/03/2019 01:39:10 PM Eastern Daylight Time				07/03/2019 03:18:34 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold Medical Only (HMO)	1	1		1			H3668	13	0	2020	"Central, Southeast and Southwest OH"		2		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)-										2					2					2	2			
H3668	14	0	1	1	1	H3668_014_0	5	1			07/03/2019	2020.01	07/03/2019 01:31:47 PM Eastern Daylight Time	07/31/2019 12:36:08 PM Eastern Daylight Time	07/31/2019 03:47:34 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold Southeast OH Classic Preferred (HMO)	1	1		1			H3668	14	0	2020	Southeast Ohio		2		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	2			
H3668	15	0	1	1	1	H3668_015_0	5	1			07/03/2019	2020.01	07/03/2019 01:32:07 PM Eastern Daylight Time	07/31/2019 12:37:02 PM Eastern Daylight Time	07/31/2019 03:48:06 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold Southeast OH Essential Care (HMO)	1	1		1			H3668	15	0	2020	Southeast Ohio		2		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	2			
H3668	16	0	1	1	1	H3668_016_0	6	1			07/03/2019	2020.01	07/03/2019 01:32:23 PM Eastern Daylight Time	07/31/2019 12:38:38 PM Eastern Daylight Time	07/31/2019 03:48:38 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold Southwest OH Classic Preferred (HMO)	1	1		1			H3668	16	0	2020	Greater Cincinnati and Champaign County Ohio		2		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	2			
H3668	17	0	1	1	1	H3668_017_0	6	1			07/03/2019	2020.01	07/03/2019 01:32:37 PM Eastern Daylight Time	07/31/2019 12:39:42 PM Eastern Daylight Time	07/31/2019 03:49:10 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold Southwest OH Essential Care (HMO)	1	1		1			H3668	17	0	2020	Greater Cincinnati and Champaign County Ohio		2		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	2			
H3668	18	1	1	1	1	H3668_018_1	6	1			07/03/2019	2020.01	07/03/2019 01:34:25 PM Eastern Daylight Time	07/31/2019 12:46:18 PM Eastern Daylight Time	07/31/2019 03:49:42 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold Classic Preferred (HMO)	1	1		1			H3668	18	1	2020	Greater Central Ohio	Greater Columbus Ohio	2		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	2			
H3668	18	2	1	1	1	H3668_018_2	6	1			07/03/2019	2020.01	07/03/2019 01:34:42 PM Eastern Daylight Time	07/31/2019 12:48:52 PM Eastern Daylight Time	07/31/2019 03:50:14 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold Classic Preferred (HMO)	1	1		1			H3668	18	2	2020	Greater Central Ohio	Greater Dayton Ohio	2		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	2			
H3668	18	3	1	1	1	H3668_018_3	6	1			07/03/2019	2020.01	07/03/2019 01:35:00 PM Eastern Daylight Time	07/31/2019 12:49:50 PM Eastern Daylight Time	07/31/2019 03:50:46 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold Classic Preferred (HMO)	1	1		1			H3668	18	3	2020	Greater Central Ohio	Southern Ohio	2		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	2			
H3668	19	1	1	1	1	H3668_019_1	6	1			07/03/2019	2020.01	07/03/2019 01:35:17 PM Eastern Daylight Time	07/31/2019 12:51:00 PM Eastern Daylight Time	07/31/2019 03:51:18 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	1	1		1			H3668	19	1	2020	Greater Central Ohio	Greater Columbus Ohio	2		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	2			
H3668	19	2	1	1	1	H3668_019_2	6	1			07/03/2019	2020.01	07/03/2019 01:35:41 PM Eastern Daylight Time	07/31/2019 12:52:02 PM Eastern Daylight Time	07/31/2019 03:51:50 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	1	1		1			H3668	19	2	2020	Greater Central Ohio	Greater Dayton Ohio	2		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	2			
H3668	19	3	1	1	1	H3668_019_3	6	1			07/03/2019	2020.01	07/03/2019 01:41:49 PM Eastern Daylight Time	07/31/2019 12:53:04 PM Eastern Daylight Time	07/31/2019 03:52:22 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	1	1		1			H3668	19	3	2020	Greater Central Ohio	Southern Ohio	2		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	2			
H3668	20	0	1	1	1	H3668_020_0	6	1			07/03/2019	2020.01	07/03/2019 01:41:33 PM Eastern Daylight Time	07/31/2019 12:54:08 PM Eastern Daylight Time	07/31/2019 03:52:54 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	1	1		1			H3668	20	0	2020	Greater Toledo Ohio		2		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	2			
H3668	21	0	1	1	1	H3668_021_0	6	1			07/03/2019	2020.01	07/03/2019 01:42:07 PM Eastern Daylight Time	07/31/2019 12:55:08 PM Eastern Daylight Time	07/31/2019 03:53:26 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold True Advantage (HMO)	1	1		1			H3668	21	0	2020	Greater Toledo Ohio		2		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	2			
H3668	22	0	1	1	1	H3668_022_0	6	1			07/03/2019	2020.01	07/03/2019 01:46:24 PM Eastern Daylight Time	07/31/2019 12:56:30 PM Eastern Daylight Time	07/31/2019 03:53:56 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold True Advantage (HMO)	1	1		1			H3668	22	0	2020	Greater Columbus Ohio		2		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	2			
H3668	23	0	1	1	1	H3668_023_0	6	1			07/03/2019	2020.01	07/03/2019 01:48:28 PM Eastern Daylight Time	07/31/2019 12:57:30 PM Eastern Daylight Time	07/31/2019 03:54:28 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold True Advantage (HMO)	1	1		1			H3668	23	0	2020	Greater Dayton Ohio		2		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	2			
H3668	24	0	1	1	1	H3668_024_0	6	1			07/03/2019	2020.01	07/03/2019 01:48:13 PM Eastern Daylight Time	07/31/2019 12:58:46 PM Eastern Daylight Time	07/31/2019 03:54:58 PM Eastern Daylight Time			08/02/2019 03:33:42 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	MediGold True Advantage (HMO)	1	1		1			H3668	24	0	2020	Greater Cincinnati and Champaign County Ohio		2		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	2			
H3668	801	0	1	1	1	H3668_801_0	1	1			06/01/2019	2020.01	06/01/2019 10:50:37 PM Eastern Daylight Time					06/02/2019 03:35:07 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	EGWP MediGold Medical Only (HMO)	1	1		1			H3668	801	0	2020	"Central, Southeast and Southwest OH"		1	12	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	1a;1b;2;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3668	802	0	1	1	1	H3668_802_0	1	1			06/01/2019	2020.01	06/01/2019 11:01:44 PM Eastern Daylight Time					06/02/2019 03:35:07 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	EGWP MediGold Classic (HMO)	1	1		1			H3668	802	0	2020	"Central, Southeast and Southwest OH"		1	10596	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	1a;1b;2;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3668	803	0	1	1	1	H3668_803_0	1	1			06/01/2019	2020.01	06/01/2019 11:03:38 PM Eastern Daylight Time					06/02/2019 03:35:07 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	EGWP MediGold Custom (HMO)	1	1		1			H3668	803	0	2020	"Central, Southeast and Southwest OH"		1	2964	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	1a;1b;2;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3668	804	0	1	1	1	H3668_804_0	1	1			06/01/2019	2020.01	06/01/2019 11:04:05 PM Eastern Daylight Time					06/02/2019 03:35:07 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	EGWP MediGold Classic (HMO)	1	1		1			H3668	804	0	2020	"Central, Southeast and Southwest OH"		1	12	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	1a;1b;2;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3668	805	0	1	1	1	H3668_805_0	1	1			06/01/2019	2020.01	06/01/2019 11:04:22 PM Eastern Daylight Time					06/02/2019 03:35:07 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	EGWP MediGold Southeast OH Medical Only (HMO)	1	1		1			H3668	805	0	2020	Southeast Ohio		1	12	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	1a;1b;2;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3668	806	0	1	1	1	H3668_806_0	1	1			06/01/2019	2020.01	06/01/2019 11:05:16 PM Eastern Daylight Time					06/02/2019 03:35:07 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	EGWP MediGold Southeast OH Classic (HMO)	1	1		1			H3668	806	0	2020	Southeast Ohio		1	12	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	1a;1b;2;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3668	807	0	1	1	1	H3668_807_0	1	1			06/01/2019	2020.01	06/01/2019 11:05:37 PM Eastern Daylight Time					06/02/2019 03:35:07 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	EGWP MediGold Southeast OH Custom (HMO)	1	1		1			H3668	807	0	2020	Southeast Ohio		1	12	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	1a;1b;2;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3668	808	0	1	1	1	H3668_808_0	1	1			06/01/2019	2020.01	06/01/2019 11:09:13 PM Eastern Daylight Time					06/02/2019 03:35:07 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	EGWP MediGold Southwest OH Medical Only (HMO)	1	1		1			H3668	808	0	2020	Southwest Ohio		1	12	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	1a;1b;2;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3668	809	0	1	1	1	H3668_809_0	1	1			06/01/2019	2020.01	06/01/2019 11:04:56 PM Eastern Daylight Time					06/02/2019 03:35:07 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	EGWP MediGold Southwest OH Classic (HMO)	1	1		1			H3668	809	0	2020	Southwest Ohio		1	12	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	1a;1b;2;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3668	810	0	1	1	1	H3668_810_0	1	1			06/01/2019	2020.01	06/01/2019 11:04:43 PM Eastern Daylight Time					06/02/2019 03:35:07 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN, INC."	MediGold	www.MediGold.com	EGWP MediGold Southwest OH Custom (HMO)	1	1		1			H3668	810	0	2020	Southwest Ohio		1	12	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	1a;1b;2;8a;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3672	13	0	1	1	1	H3672_013_0	5	1			07/08/2019	2020.01	07/08/2019 09:17:56 AM Eastern Daylight Time	08/01/2019 11:28:24 AM Eastern Daylight Time	07/31/2019 11:52:18 AM Eastern Daylight Time			08/01/2019 12:13:52 PM Eastern Daylight Time	"THE HEALTH PLAN OF WEST VIRGINIA, INC."	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Option II (HMO)	1	1		1			H3672	13	0	2020	East Central Ohio		2	33000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3672	14	0	1	1	1	H3672_014_0	4	1			07/08/2019	2020.01	07/08/2019 09:18:05 AM Eastern Daylight Time	07/02/2019 01:29:59 PM Eastern Daylight Time				07/22/2019 12:44:54 PM Eastern Daylight Time	"THE HEALTH PLAN OF WEST VIRGINIA, INC."	The Health Plan	www.healthplan.org/medicare	"The Health Plan SecureCare - Option I, MA Only (HMO)"	1	1		1			H3672	14	0	2020	East Central Ohio		2	6000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3672	18	0	1	1	1	H3672_018_0	6	1			07/31/2019	2020.01	07/31/2019 03:55:19 PM Eastern Daylight Time	08/01/2019 11:25:28 AM Eastern Daylight Time	07/31/2019 11:52:19 AM Eastern Daylight Time			08/01/2019 12:13:52 PM Eastern Daylight Time	"THE HEALTH PLAN OF WEST VIRGINIA, INC."	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Option IV (HMO)	1	1		1			H3672	18	0	2020	East Central Ohio		2	30000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3672	19	0	1	1	1	H3672_019_0	4	1	2	1	07/31/2019	2020.01	07/31/2019 04:06:56 PM Eastern Daylight Time	08/01/2019 11:29:46 AM Eastern Daylight Time	07/31/2019 11:52:19 AM Eastern Daylight Time			08/01/2019 12:13:52 PM Eastern Daylight Time	"THE HEALTH PLAN OF WEST VIRGINIA, INC."	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare SNP (HMO D-SNP)	1	1		1			H3672	19	0	2020	"Southeastern Ohio, West Virginia"		2	8000	2			1	3		2		2	www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3672	20	0	1	1	1	H3672_020_0	5	1			07/08/2019	2020.01	07/08/2019 09:17:17 AM Eastern Daylight Time	08/01/2019 11:31:26 AM Eastern Daylight Time	07/31/2019 11:52:20 AM Eastern Daylight Time			08/01/2019 12:13:52 PM Eastern Daylight Time	"THE HEALTH PLAN OF WEST VIRGINIA, INC."	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Option II (HMO)	1	1		1			H3672	20	0	2020	"Southeastern OH, West Virginia"		2	75000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3672	21	0	1	1	1	H3672_021_0	3	1			07/08/2019	2020.01	07/08/2019 09:16:58 AM Eastern Daylight Time	05/30/2019 01:11:26 PM Eastern Daylight Time				07/10/2019 02:32:56 PM Eastern Daylight Time	"THE HEALTH PLAN OF WEST VIRGINIA, INC."	The Health Plan	www.healthplan.org/medicare	"The Health Plan SecureCare - Option I, MA Only (HMO)"	1	1		1			H3672	21	0	2020	"Southeastern OH, West Virginia"		2	6000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3672	23	0	1	1	1	H3672_023_0	5	1			07/08/2019	2020.01	07/08/2019 09:16:47 AM Eastern Daylight Time	08/01/2019 11:32:53 AM Eastern Daylight Time	07/31/2019 11:52:20 AM Eastern Daylight Time			08/01/2019 12:13:52 PM Eastern Daylight Time	"THE HEALTH PLAN OF WEST VIRGINIA, INC."	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare Capitol Plan (HMO)	1	1		1			H3672	23	0	2020	Kanawha and Surrounding Counties		2	2000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3672	24	0	1	1	1	H3672_024_0	4	1			07/08/2019	2020.01	07/08/2019 09:16:33 AM Eastern Daylight Time	07/02/2019 12:42:47 PM Eastern Daylight Time				07/22/2019 12:44:54 PM Eastern Daylight Time	"THE HEALTH PLAN OF WEST VIRGINIA, INC."	The Health Plan	www.healthplan.org/medicare	"The Health Plan SecureCare Capitol Plan, MA Only (HMO)"	1	1		1			H3672	24	0	2020	Kanawha and Surrounding Counties		2	100	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3672	25	0	1	1	1	H3672_025_0	7	1			07/08/2019	2020.01	07/08/2019 09:16:23 AM Eastern Daylight Time	08/01/2019 11:34:03 AM Eastern Daylight Time	07/31/2019 11:52:21 AM Eastern Daylight Time			08/01/2019 12:13:52 PM Eastern Daylight Time	"THE HEALTH PLAN OF WEST VIRGINIA, INC."	The Health Plan	www.healthplan.org/medicare	WVU Medicine - The Health Plan SecureCare (HMO)	1	1		1			H3672	25	0	2020	WVU Medicine Service Area		2	33000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7a;7d;8a1;8b1;8b3;9a1;9b;	
H3672	805	0	1	1	1	H3672_805_0	1	1			05/29/2019	2020.01	05/29/2019 11:57:47 AM Eastern Daylight Time					05/30/2019 03:36:30 PM Eastern Daylight Time	"THE HEALTH PLAN OF WEST VIRGINIA, INC."	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureCare - Employer (HMO)	1	1		1			H3672	805	0	2020	"East Ohio and West Virginia, National"		1	12000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	1	0	1	1	1	H3706_001_0	7	1			07/23/2019	2020.01	07/23/2019 02:30:37 PM Central Daylight Time	08/05/2019 04:21:12 PM Central Daylight Time	08/01/2019 06:45:39 AM Central Daylight Time			08/06/2019 03:02:05 PM Central Daylight Time	"GLOBALHEALTH, INC."	GlobalHealth	www.GlobalHealth.com/medicare	Generations Classic (HMO)	1	1		1			H3706	1	0	2020	Oklahoma (Partial)		2		2			2						www.GlobalHealth.com/pharmacy-directories	www.GlobalHealth.com/medicare/member-materials	www.GlobalHealth.com/provider-search	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(866)494-3927		(405)280-5555		(844)280-5555		(405)280-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	9	0	1	1	1	H3706_009_0	6	1			07/23/2019	2020.01	07/23/2019 02:30:09 PM Central Daylight Time	06/02/2019 05:09:22 PM Central Daylight Time				07/23/2019 02:31:55 PM Central Daylight Time	"GLOBALHEALTH, INC."	GlobalHealth	www.GlobalHealth.com/medicare	Generations Value (HMO)	1	1		1			H3706	9	0	2020	Oklahoma (Partial)		2		2			2						www.GlobalHealth.com/pharmacy-directories	www.GlobalHealth.com/medicare/member-materials	www.GlobalHealth.com/provider-search	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3706	18	0	1	1	1	H3706_018_0	9	1			08/09/2019	2020.01	08/09/2019 01:32:50 PM Central Daylight Time	08/05/2019 04:24:09 PM Central Daylight Time	08/01/2019 06:46:32 AM Central Daylight Time			08/09/2019 01:33:31 PM Central Daylight Time	"GLOBALHEALTH, INC."	GlobalHealth	www.GlobalHealth.com/medicare	Generations Select (HMO)	1	1		1			H3706	18	0	2020	Oklahoma (Partial)		2		2			2						www.GlobalHhealth.com/pharmacy-directories	www.GlobalHealth.com/medicare/member-materials	www.GlobalHealth.com/provider-search	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(866)494-3927		(405)280-5555		(844)280-5555		(405)280-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3706	803	0	1	1	1	H3706_803_0	4	1			05/14/2019	2020.01	05/14/2019 09:52:23 AM Central Daylight Time					06/03/2019 03:41:26 PM Central Daylight Time	"GLOBALHEALTH, INC."	GlobalHealth	www.GlobalHealth.com/medicare	Generations EGHP CY (HMO)	1	1		1			H3706	803	0	2020	Oklahoma (Partial)		1	25200	2			2						www.GlobalHealth.com/pharmacy-directories	www.GlobalHealth.com/medicare/member-materials	www.GlobalHealth.com/provider-search	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;8b2;9a1;9b;11a;11b;12;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;8b2;9a1;9b;12;	1					1				
H3706	804	0	1	1	1	H3706_804_0	4	1			05/14/2019	2020.01	05/14/2019 09:52:48 AM Central Daylight Time					06/03/2019 03:41:26 PM Central Daylight Time	"GLOBALHEALTH, INC."	GlobalHealth	www.GlobalHealth.com/medicare	Generations EGHP Non CY (HMO)	1	1		1			H3706	804	0	2020	Oklahoma (Partial)		1	0	2			2						www.GlobalHealth.com/pharmacy-directories	www.GlobalHealth.com/medicare/member-materials	www.GlobalHealth.com/provider-search	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;8b2;9a1;9b;11a;11b;12;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;8b2;9a1;9b;12;	1					1				
H3706	807	0	1	1	1	H3706_807_0	4	1			05/14/2019	2020.01	05/14/2019 09:53:05 AM Central Daylight Time					06/03/2019 03:41:26 PM Central Daylight Time	"GLOBALHEALTH, INC."	GlobalHealth	www.GlobalHealth.com/medicare	Generations EGHP MA only (HMO)	1	1		1			H3706	807	0	2020	Oklahoma (Partial)		1	0	2			2						www.GlobalHealth.com/pharmacy-directories	www.GlobalHealth.com/medicare/member-materials	www.GlobalHealth.com/provider-search	(844)280-5555		(405)280-5555		(844)280-5555		(405)280-5555										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;8b2;9a1;9b;11a;11b;12;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;8b2;9a1;9b;12;	1					1				
H3708	1	0	1	1	1	H3708_001_0	2	1		1	08/01/2019	2020.01	08/01/2019 05:51:58 PM Central Daylight Time	08/01/2019 02:18:27 PM Central Daylight Time	07/30/2019 05:11:21 PM Central Daylight Time			08/05/2019 04:53:13 PM Central Daylight Time	"OKLAHOMA SUPERIOR SELECT, INC."	American Health Advantage of Oklahoma	ok.amhealthplans.com	American Health Advantage of Oklahoma (HMO I-SNP)	1	1		1			H3708	1	0	2020	Central and East Oklahoma		2	4967	2			1	1	3				ok.amhealthplans.com	ok.amhealthplans.com	ok.amhealthplans.com	(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(866)583-4649		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2	2			
H3725	1	0	1	4	1	H3725_001_0	6	1			07/25/2019	2020.01	07/25/2019 05:06:28 PM Central Daylight Time	08/02/2019 04:22:41 PM Central Daylight Time	08/02/2019 04:51:16 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF ILLINOIS	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex Plus (PPO)	1	4		1			H3725	1	0	2020	Cook and Kane Counties		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-7735		(844)221-7735		(833)412-6735		(833)412-6735		(844)221-7735		(844)221-7735		(833)412-6735		(833)412-6735		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3748	1	0	1	1	1	H3748_001_0	4	1			07/31/2019	2020.01	07/31/2019 03:46:22 PM Eastern Daylight Time	08/02/2019 09:44:00 AM Eastern Daylight Time	07/30/2019 11:46:40 PM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	"AETNA BETTER HEALTH OF WASHINGTON, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3748	1	0	2020	Spokane County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3748	2	0	1	1	1	H3748_002_0	3	1			07/03/2019	2020.01	07/03/2019 02:35:27 PM Eastern Daylight Time	08/02/2019 09:57:08 AM Eastern Daylight Time	07/30/2019 11:47:50 PM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	"AETNA BETTER HEALTH OF WASHINGTON, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO)	1	1		1			H3748	2	0	2020	Spokane County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3748	3	0	1	1	1	H3748_003_0	3	1			07/31/2019	2020.01	07/31/2019 03:46:42 PM Eastern Daylight Time	08/02/2019 10:01:19 AM Eastern Daylight Time	07/30/2019 11:49:00 PM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	"AETNA BETTER HEALTH OF WASHINGTON, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plus Plan (HMO)	1	1		1			H3748	3	0	2020	Puget Sound		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3748	4	0	1	1	1	H3748_004_0	3	1			07/03/2019	2020.01	07/03/2019 02:36:11 PM Eastern Daylight Time	08/02/2019 10:03:58 AM Eastern Daylight Time	07/30/2019 11:50:10 PM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	"AETNA BETTER HEALTH OF WASHINGTON, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plus Plan (HMO)	1	1		1			H3748	4	0	2020	Puget Sound		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3748	801	0	1	1	1	H3748_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:45:06 AM Eastern Daylight Time					05/30/2019 06:37:31 PM Eastern Daylight Time	"AETNA BETTER HEALTH OF WASHINGTON, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H3748	801	0	2020	Washington		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3748	802	0	1	1	1	H3748_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:45:16 AM Eastern Daylight Time					05/30/2019 06:37:31 PM Eastern Daylight Time	"AETNA BETTER HEALTH OF WASHINGTON, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H3748	802	0	2020	Washington		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3748	803	0	1	1	1	H3748_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:45:28 AM Eastern Daylight Time					05/30/2019 06:37:31 PM Eastern Daylight Time	"AETNA BETTER HEALTH OF WASHINGTON, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H3748	803	0	2020	Washington		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3749	1	0	1	2	1	H3749_001_0	2	1			08/02/2019	2020.01	08/02/2019 12:16:22 PM Central Daylight Time	08/02/2019 11:52:47 AM Central Daylight Time	07/30/2019 08:28:30 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF OKLAHOMA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO-POS)	1	2		1			H3749	1	0	2020	Oklahoma City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3749	17	0	1	2	1	H3749_017_0	2	1			08/02/2019	2020.01	08/02/2019 12:16:48 PM Central Daylight Time	08/02/2019 11:53:20 AM Central Daylight Time	07/30/2019 08:29:05 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF OKLAHOMA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO-POS)	1	2		1			H3749	17	0	2020	Tulsa Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3749	18	0	1	2	1	H3749_018_0	3	1			08/02/2019	2020.01	08/02/2019 12:17:18 PM Central Daylight Time	08/02/2019 11:53:53 AM Central Daylight Time	07/30/2019 08:29:39 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF OKLAHOMA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS)	1	2		1			H3749	18	0	2020	Oklahoma City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3749	20	0	1	2	1	H3749_020_0	3	1			08/02/2019	2020.01	08/02/2019 12:17:42 PM Central Daylight Time	08/02/2019 11:54:28 AM Central Daylight Time	07/30/2019 08:30:13 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF OKLAHOMA, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS)	1	2		1			H3749	20	0	2020	Tulsa Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3749	801	0	1	1	1	H3749_801_0	1	1			05/12/2019	2020.01	05/12/2019 07:10:33 PM Central Daylight Time					06/02/2019 05:18:05 PM Central Daylight Time	"UNITEDHEALTHCARE OF OKLAHOMA, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H3749	801	0	2020	OK Employer Sponsored Plan Service Area		1	552	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H3749	803	0	1	1	1	H3749_803_0	1	1			05/12/2019	2020.01	05/12/2019 07:10:58 PM Central Daylight Time					06/02/2019 05:18:05 PM Central Daylight Time	"UNITEDHEALTHCARE OF OKLAHOMA, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H3749	803	0	2020	OK Employer Sponsored Plan Service Area		1	7044	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H3749	804	0	1	1	1	H3749_804_0	1	1			05/12/2019	2020.01	05/12/2019 07:11:43 PM Central Daylight Time					06/02/2019 05:18:05 PM Central Daylight Time	"UNITEDHEALTHCARE OF OKLAHOMA, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H3749	804	0	2020	OK Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H3755	1	0	1	1	1	H3755_001_0	6	1			06/28/2019	2020.01	06/28/2019 07:42:22 AM Eastern Daylight Time	08/01/2019 02:21:50 PM Eastern Daylight Time	08/01/2019 10:31:42 AM Eastern Daylight Time			08/06/2019 01:45:01 PM Eastern Daylight Time	"COMMUNITY CARE HMO, INC"	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Platinum (HMO)	1	1		1			H3755	1	0	2020	"Counties CG, CK, MC, MU, NO, OS, TU, WG, WS"		2		2			2						www.ccok.com	www.ccok.com	www.ccok.com	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(877)293-8628		(918)594-5211		(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	2			
H3755	2	0	1	1	1	H3755_002_0	4	1			06/28/2019	2020.01	06/28/2019 07:11:49 AM Eastern Daylight Time	06/02/2019 11:42:04 PM Eastern Daylight Time				06/28/2019 07:55:59 AM Eastern Daylight Time	"COMMUNITY CARE HMO, INC"	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Silver (HMO)	1	1		1			H3755	2	0	2020	"Counties CG, CK, MC, MU, NO, OS, TU, WG, WS"		2		2			2								www.ccok.com	(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	2			
H3755	4	0	1	1	1	H3755_004_0	6	1			06/28/2019	2020.01	06/28/2019 07:43:11 AM Eastern Daylight Time	08/01/2019 03:01:18 PM Eastern Daylight Time	08/01/2019 10:36:14 AM Eastern Daylight Time			08/06/2019 01:45:01 PM Eastern Daylight Time	"COMMUNITY CARE HMO, INC"	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Platinum Plus (HMO)	1	1		1			H3755	4	0	2020	"Counties CG, CK, MC, MU, NO, OS, TU, WG, WS"		2		2			2						www.ccok.com	www.ccok.com	www.ccok.com	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(877)293-8628		(918)594-5211		(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	2			
H3755	5	0	1	1	1	H3755_005_0	6	1			06/28/2019	2020.01	06/28/2019 07:44:01 AM Eastern Daylight Time	08/01/2019 03:08:04 PM Eastern Daylight Time	08/01/2019 10:41:30 AM Eastern Daylight Time			08/06/2019 01:45:01 PM Eastern Daylight Time	"COMMUNITY CARE HMO, INC"	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Silver Plus (HMO)	1	1		1			H3755	5	0	2020	"Counties CG, CK, MC, MU, NO, OS, TU, WG, WS"		2		2			2						www.ccok.com	www.ccok.com	www.ccok.com	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(877)293-8628		(918)594-5211		(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	2			
H3755	801	0	1	1	1	H3755_801_0	4	1			06/18/2019	2020.01	06/18/2019 07:20:13 AM Eastern Daylight Time					06/18/2019 07:25:51 AM Eastern Daylight Time	"COMMUNITY CARE HMO, INC"	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health EGHP+D (HMO)	1	1		1			H3755	801	0	2020	"Counties CG, CK, MC, MU, NO, OS, TU, WG, WS"		1	24162	2			2						www.ccok.com	www.ccok.com	www.ccok.com	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(877)293-8628		(918)594-5211		(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		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9d;10a;11a;11b;12;14a;14d;14e2;14e6;15;16b;	1	5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9d;12;14a;14d;14e2;16b;	1					1				
H3777	1	2	1	1	1	H3777_001_2	14	1			08/06/2019	2020.01	08/06/2019 07:20:08 AM Eastern Daylight Time	08/06/2019 11:12:11 AM Eastern Daylight Time	08/02/2019 05:16:24 PM Eastern Daylight Time			08/06/2019 11:50:06 AM Eastern Daylight Time	"EXPERIENCE HEALTH, INC."	"Experience Health, Inc."	www.experiencehealthnc.com	Experience Health Medicare Advantage (HMO)	1	1		1			H3777	1	2	2020	Triangle and surrounding area	Durham Region	2	10848	2			2						www.experiencehealthnc.com	www.experiencehealthnc.com		(833)777-7394		(984)364-3974				(984)364-3974		(833)777-7394		(984)364-3974		(833)777-7394		(984)364-3974		(833)397-4584		(984)364-3974		(833)397-4584		(984)364-3974		(833)397-4584		(984)364-3974		(833)397-4584		(984)364-3974		2					2					2	2			
H3777	1	3	1	1	1	H3777_001_3	14	1			08/06/2019	2020.01	08/06/2019 07:21:11 AM Eastern Daylight Time	08/06/2019 11:14:10 AM Eastern Daylight Time	08/02/2019 05:17:08 PM Eastern Daylight Time			08/06/2019 11:50:06 AM Eastern Daylight Time	"EXPERIENCE HEALTH, INC."	"Experience Health, Inc."	www.experiencehealthnc.com	Experience Health Medicare Advantage (HMO)	1	1		1			H3777	1	3	2020	Triangle and surrounding area	Orange Region	2	5808	2			2						www.experiencehealthnc.com	www.experiencehealthnc.com		(833)777-7394		(984)364-3974				(984)364-3974		(833)777-7394		(984)364-3974		(833)777-7394		(984)364-3974		(833)397-4584		(984)364-3974		(833)397-4584		(984)364-3974		(833)397-4584		(984)364-3974		(833)397-4584		(984)364-3974		2					2					2	2			
H3777	1	4	1	1	1	H3777_001_4	14	1			08/06/2019	2020.01	08/06/2019 07:21:36 AM Eastern Daylight Time	08/06/2019 11:12:57 AM Eastern Daylight Time	08/02/2019 05:17:51 PM Eastern Daylight Time			08/06/2019 11:50:06 AM Eastern Daylight Time	"EXPERIENCE HEALTH, INC."	"Experience Health, Inc."	www.experiencehealthnc.com	Experience Health Medicare Advantage (HMO)	1	1		1			H3777	1	4	2020	Triangle and surrounding area	Raleigh Region	2	28255	2			2						www.experiencehealthnc.com	www.experiencehealthnc.com		(833)777-7394		(984)364-3974				(984)364-3974		(833)777-7394		(984)364-3974		(833)777-7394		(984)364-3974		(833)397-4584		(984)364-3974		(833)397-4584		(984)364-3974		(833)397-4584		(984)364-3974		(833)397-4584		(984)364-3974		2					2					2	2			
H3794	2	0	1	1	1	H3794_002_0	3	1	2	1	07/11/2019	2020.01	07/11/2019 05:32:04 PM Central Daylight Time	08/02/2019 11:55:02 AM Central Daylight Time	07/30/2019 08:30:52 PM Central Daylight Time			08/06/2019 12:14:20 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP1 (HMO D-SNP)	1	1		1			H3794	2	0	2020	Select Counties in Wisconsin		2		2			1	3		1		1	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	2			
H3800	1	0	1	1	1	H3800_001_0	15	1		1	08/06/2019	2020.01	08/06/2019 10:47:35 AM Eastern Daylight Time	08/06/2019 12:47:42 AM Eastern Daylight Time	08/06/2019 12:47:42 AM Eastern Daylight Time			08/06/2019 11:04:13 AM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Provider Partners Illinois Advantage Plan	www.pphealthplan.com	Provider Partners Illinois Advantage Plan (HMO I-SNP)	1	1		1			H3800	1	0	2020	Illinois (partial)		2	9322	2			1	1	1				www.pphealthplan.com	www.pphealthplan.com	www.pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3805	1	0	1	1	1	H3805_001_0	3	1			07/12/2019	2020.01	07/12/2019 09:07:37 AM Central Daylight Time	08/02/2019 11:55:34 AM Central Daylight Time	07/30/2019 08:31:27 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H3805	1	0	2020	Select counties in Western Oregon		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	7	0	1	1	1	H3805_007_0	3	1			07/12/2019	2020.01	07/12/2019 09:07:48 AM Central Daylight Time	08/02/2019 11:56:09 AM Central Daylight Time	07/30/2019 08:32:00 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H3805	7	0	2020	"Benton, Lane, and Linn counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	15	0	1	1	1	H3805_015_0	3	1			07/12/2019	2020.01	07/12/2019 09:07:58 AM Central Daylight Time	08/02/2019 11:56:40 AM Central Daylight Time	07/30/2019 08:32:35 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	1	1		1			H3805	15	0	2020	Select counties in Western Washington		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	16	0	1	1	1	H3805_016_0	3	1			07/12/2019	2020.01	07/12/2019 09:08:39 AM Central Daylight Time	08/02/2019 11:57:14 AM Central Daylight Time	07/30/2019 08:33:11 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3805	16	0	2020	Clark and Cowlitz counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	17	0	1	1	1	H3805_017_0	3	1			07/12/2019	2020.01	07/12/2019 09:08:51 AM Central Daylight Time	08/02/2019 11:57:48 AM Central Daylight Time	07/30/2019 08:33:44 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3805	17	0	2020	King county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	19	0	1	1	1	H3805_019_0	3	1			07/12/2019	2020.01	07/12/2019 09:09:01 AM Central Daylight Time	08/02/2019 11:58:23 AM Central Daylight Time	07/30/2019 08:34:23 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3805	19	0	2020	Kitsap and Pierce Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	20	0	1	1	1	H3805_020_0	3	1			07/12/2019	2020.01	07/12/2019 09:09:15 AM Central Daylight Time	08/02/2019 11:58:54 AM Central Daylight Time	07/30/2019 08:34:58 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3805	20	0	2020	Island and Snohomish counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	21	0	1	1	1	H3805_021_0	3	1			07/12/2019	2020.01	07/12/2019 09:09:25 AM Central Daylight Time	08/02/2019 11:59:29 AM Central Daylight Time	07/30/2019 08:35:35 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H3805	21	0	2020	Skagit and Whatcom Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	22	1	1	1	1	H3805_022_1	3	1			07/12/2019	2020.01	07/12/2019 09:09:35 AM Central Daylight Time	08/02/2019 11:59:59 AM Central Daylight Time	07/30/2019 08:36:08 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3805	22	1	2020	Select counties in Western Oregon	Select counties in Western Oregon	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	22	2	1	1	1	H3805_022_2	3	1			07/12/2019	2020.01	07/12/2019 09:09:45 AM Central Daylight Time	08/02/2019 12:00:33 PM Central Daylight Time	07/30/2019 08:36:44 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3805	22	2	2020	Select counties in Western Oregon	Marion and Polk counties	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	23	1	1	1	1	H3805_023_1	3	1			07/12/2019	2020.01	07/12/2019 09:09:55 AM Central Daylight Time	08/02/2019 12:01:05 PM Central Daylight Time	07/30/2019 08:37:17 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3805	23	1	2020	"Benton, Lane, and Linn counties"	Benton and Lane counties	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	23	2	1	1	1	H3805_023_2	3	1			07/12/2019	2020.01	07/12/2019 09:10:06 AM Central Daylight Time	08/02/2019 12:01:44 PM Central Daylight Time	07/30/2019 08:37:53 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3805	23	2	2020	"Benton, Lane, and Linn counties"	Linn county	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	24	1	1	1	1	H3805_024_1	3	1			07/12/2019	2020.01	07/12/2019 09:10:15 AM Central Daylight Time	08/02/2019 12:02:20 PM Central Daylight Time	07/30/2019 08:38:27 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H3805	24	1	2020	Select counties in western Washington	King county	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	24	2	1	1	1	H3805_024_2	3	1			07/12/2019	2020.01	07/12/2019 09:10:24 AM Central Daylight Time	08/02/2019 12:02:53 PM Central Daylight Time	07/30/2019 08:39:02 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H3805	24	2	2020	Select counties in western Washington	"Cowlitz, Lewis, and Pierce counties"	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	24	3	1	1	1	H3805_024_3	3	1			07/12/2019	2020.01	07/12/2019 09:10:35 AM Central Daylight Time	08/02/2019 12:03:26 PM Central Daylight Time	07/30/2019 08:39:37 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H3805	24	3	2020	Select counties in western Washington	"Clark, Snohomish, and Thurston counties"	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	25	1	1	1	1	H3805_025_1	3	1			07/12/2019	2020.01	07/12/2019 09:10:56 AM Central Daylight Time	08/02/2019 12:03:58 PM Central Daylight Time	07/30/2019 08:40:07 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3805	25	1	2020	Thurston and Lewis Counties	Lewis county	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	25	2	1	1	1	H3805_025_2	3	1			07/12/2019	2020.01	07/12/2019 09:11:08 AM Central Daylight Time	08/02/2019 12:04:29 PM Central Daylight Time	07/30/2019 08:40:41 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H3805	25	2	2020	Thurston and Lewis Counties	Thurston county	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	29	0	1	1	1	H3805_029_0	3	1			07/12/2019	2020.01	07/12/2019 09:11:18 AM Central Daylight Time	08/02/2019 12:05:02 PM Central Daylight Time	07/30/2019 08:41:15 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H3805	29	0	2020	Yakima county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	30	0	1	1	1	H3805_030_0	3	1			07/12/2019	2020.01	07/12/2019 09:11:28 AM Central Daylight Time	08/02/2019 12:05:33 PM Central Daylight Time	07/30/2019 08:41:51 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO)	1	1		1			H3805	30	0	2020	Clark county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	32	0	1	1	1	H3805_032_0	3	1			07/12/2019	2020.01	07/12/2019 09:11:38 AM Central Daylight Time	08/02/2019 12:06:07 PM Central Daylight Time	07/30/2019 08:42:28 PM Central Daylight Time			08/06/2019 09:42:32 AM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO)	1	1		1			H3805	32	0	2020	Snohomish county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H3805	801	0	1	1	1	H3805_801_0	1	1			05/12/2019	2020.01	05/12/2019 07:12:23 PM Central Daylight Time					06/02/2019 05:19:44 PM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H3805	801	0	2020	OR Employer Sponsored Plan Service Area		1	2004	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3805	803	0	1	1	1	H3805_803_0	1	1			05/12/2019	2020.01	05/12/2019 07:12:44 PM Central Daylight Time					06/02/2019 05:19:44 PM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H3805	803	0	2020	OR Employer Sponsored Plan Service Area		1	2004	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3805	804	0	1	1	1	H3805_804_0	1	1			05/12/2019	2020.01	05/12/2019 07:13:08 PM Central Daylight Time					06/02/2019 05:19:44 PM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H3805	804	0	2020	OR Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3805	805	0	1	1	1	H3805_805_0	1	1			05/12/2019	2020.01	05/12/2019 07:13:45 PM Central Daylight Time					06/02/2019 05:19:44 PM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H3805	805	0	2020	Select counties in Washington		1	0	2			2						9999	www.UHCMedicareSolutions.com	610097	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3805	806	0	1	1	1	H3805_806_0	1	1			05/12/2019	2020.01	05/12/2019 07:14:21 PM Central Daylight Time					06/02/2019 05:19:44 PM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H3805	806	0	2020	Select counties in Washington		1	3024	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3805	807	0	1	1	1	H3805_807_0	1	1			05/12/2019	2020.01	05/12/2019 07:14:53 PM Central Daylight Time					06/02/2019 05:19:44 PM Central Daylight Time	"UNITEDHEALTHCARE OF OREGON, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H3805	807	0	2020	Select counties in Washington		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3809	1	0	1	20	8	H3809_001_0	1	1			05/31/2019	2020.01	05/31/2019 09:42:42 AM Pacific Daylight Time		05/22/2019 01:47:46 PM Pacific Daylight Time			05/31/2019 09:45:07 AM Pacific Daylight Time	PROVIDENCE HEALTH & SERVICES - OREGON	Providence ElderPlace Portland	www.providence.org/elderplace	Providence ElderPlace Portland (dual eligible) (PACE)	8	20		1			H3809	1	0	2020	Portland Metro area and North Coast		2		2			2						http://oregon.providence.org/our-services/p/providence-long-term-care-pharmacy-for-clinicians-hp/ove	http://oregon.providence.org/our-services/p/providence-elderplace-prescription-medications/										(855)415-6048		(503)215-6556		(855)415-6048		(503)215-6556										(800)848-4442		(503)215-6556		(800)848-4442		(503)215-6556																
H3809	2	0	1	20	8	H3809_002_0	1	1			05/31/2019	2020.01	05/31/2019 09:43:09 AM Pacific Daylight Time		05/22/2019 01:47:46 PM Pacific Daylight Time			05/31/2019 09:45:07 AM Pacific Daylight Time	PROVIDENCE HEALTH & SERVICES - OREGON	Providence ElderPlace Portland	www.providence.org/elderplace	Providence ElderPlace Portland (private pay) (PACE)	8	20		1			H3809	2	0	2020	Portland Metro area and North Coast		2		2			2						http://oregon.providence.org/our-services/p/providence-long-term-care-pharmacy-for-clinicians-hp/ove	http://oregon.providence.org/our-services/p/providence-elderplace-prescription-medications/										(855)415-6048		(503)215-6556		(855)415-6048		(503)215-6556										(800)848-4442		(503)215-6556		(800)848-4442		(503)215-6556																
H3810	1	0	1	1	1	H3810_001_0	6	1			07/19/2019	2020.01	07/19/2019 10:35:05 AM Pacific Daylight Time	07/12/2019 10:44:39 AM Pacific Daylight Time				07/19/2019 10:36:47 AM Pacific Daylight Time	"ALLCARE HEALTH PLAN, INC."	AllCare Advantage	www.AllCareHealth.com/Advantage	AllCare Advantage Gold (HMO)	1	1		1			H3810	1	0	2020	"Counties:  JO, JA, DO*"		2	3318	2			2						www.AllCareHealth.com/Advantage/Pharmacy	www.AllCareHealth.com/medicare/allcare-advantage-2017/lookup-tools/formulary-search	www.AllCareHealth.com/Advantage/Providers	(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	2			
H3810	3	0	1	1	1	H3810_003_0	7	1			07/30/2019	2020.01	07/30/2019 04:51:49 PM Pacific Daylight Time	08/05/2019 04:11:43 PM Pacific Daylight Time	08/05/2019 04:11:44 PM Pacific Daylight Time			08/05/2019 04:14:12 PM Pacific Daylight Time	"ALLCARE HEALTH PLAN, INC."	AllCare Advantage	www.AllCareHealth.com/Advantage	AllCare Advantage Gold Plus Rx (HMO)	1	1		1			H3810	3	0	2020	"Counties: JO, JA, DO*"		2	12995	2			2						www.AllCareHealth.com/Advantage/Pharmacy	www.AllCareHealth.com/Advantage/Formulary	www.AllCareHealth.com/Advantage/Providers	(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	2			
H3810	20	0	1	1	1	H3810_020_0	7	1			08/05/2019	2020.01	08/05/2019 04:12:39 PM Pacific Daylight Time	08/05/2019 04:11:44 PM Pacific Daylight Time	08/05/2019 04:11:44 PM Pacific Daylight Time			08/05/2019 04:14:12 PM Pacific Daylight Time	"ALLCARE HEALTH PLAN, INC."	AllCare Advantage	www.AllCareHealth.com/Advantage	AllCare Advantage Preferred Rx (HMO)	1	1		1			H3810	20	0	2020	"Josephine, Jackson, Douglas*"		2	23997	2			2						www.AllCareHealth.com/Advantage/Pharmacy	www.AllCareHealth.com/Advantage/Formulary	www.AllCareHealth.com/Advantage/Providers	(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	2			
H3810	21	0	1	1	1	H3810_021_0	6	1			07/19/2019	2020.01	07/19/2019 10:35:10 AM Pacific Daylight Time	07/12/2019 10:44:39 AM Pacific Daylight Time				07/19/2019 10:36:47 AM Pacific Daylight Time	"ALLCARE HEALTH PLAN, INC."	AllCare Advantage	www.AllCareHealth.com/Advantage	AllCare Advantage Focus (HMO)	1	1		1			H3810	21	0	2020	"Josephine, Jackson, Douglas*"		2	2513	2			2						www.AllCareHealth.com/Advantage/Pharmacy	www.AllCareHealth.com/medicare/allcare-advantage-2017/lookup-tools/formulary-search	www.AllCareHealth.com/Advantage/Providers	(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	2			
H3810	22	0	1	1	1	H3810_022_0	7	1			07/19/2019	2020.01	07/19/2019 10:34:29 AM Pacific Daylight Time	08/05/2019 04:11:44 PM Pacific Daylight Time	08/05/2019 04:11:44 PM Pacific Daylight Time			08/05/2019 04:14:12 PM Pacific Daylight Time	"ALLCARE HEALTH PLAN, INC."	AllCare Advantage	www.AllCareHealth.com/Advantage	AllCare Advantage Focus Rx (HMO)	1	1		1			H3810	22	0	2020	"Josephine, Jackson, Douglas*"		2	1842	2			2						www.AllCareHealth.com/Advantage/Pharmacy	www.AllCareHealth.com/Advantage/Formulary	www.AllCareHealth.com/Advantage/Providers	(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	2			
H3811	1	0	1	1	1	H3811_001_0	5	1			07/09/2019	2020.01	07/09/2019 04:11:23 PM Pacific Daylight Time	07/23/2019 08:52:26 AM Pacific Daylight Time				07/23/2019 11:46:18 AM Pacific Daylight Time	"SAMARITAN HEALTH PLANS, INC."	Samaritan Advantage Health Plan	https://medicare.samhealthplans.org	Samaritan Advantage Conventional Plan (HMO)	1	1		1			H3811	1	0	2020	"Benton, Lincoln and Linn counties"		2		2			2						https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	(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	2			
H3811	2	0	1	1	1	H3811_002_0	6	1			07/09/2019	2020.01	07/09/2019 04:11:13 PM Pacific Daylight Time	08/05/2019 04:17:08 PM Pacific Daylight Time	08/05/2019 04:16:58 PM Pacific Daylight Time			08/05/2019 04:26:16 PM Pacific Daylight Time	"SAMARITAN HEALTH PLANS, INC."	Samaritan Advantage Health Plan	https://medicare.samhealthplans.org	Samaritan Advantage Premier Plan (HMO)	1	1		1			H3811	2	0	2020	"Benton, Lincoln and Linn counties"		2		2			2						https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	(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	2			
H3811	3	0	1	1	1	H3811_003_0	7	1	2	1	07/09/2019	2020.01	07/09/2019 04:11:46 PM Pacific Daylight Time	08/05/2019 04:17:17 PM Pacific Daylight Time	08/05/2019 04:16:43 PM Pacific Daylight Time			08/05/2019 04:29:05 PM Pacific Daylight Time	"SAMARITAN HEALTH PLANS, INC."	Samaritan Advantage Health Plan	https://medicare.samhealthplans.org	Samaritan Advantage Special Needs Plan (HMO D-SNP)	1	1		1			H3811	3	0	2020	"Benton, Linn and Lincoln counties"		2		2			1	3		2		2	https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	(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	2			
H3811	9	0	1	1	1	H3811_009_0	6	1			07/09/2019	2020.01	07/09/2019 04:12:31 PM Pacific Daylight Time	08/05/2019 04:17:23 PM Pacific Daylight Time	08/05/2019 04:16:51 PM Pacific Daylight Time			08/05/2019 04:30:45 PM Pacific Daylight Time	"SAMARITAN HEALTH PLANS, INC."	Samaritan Advantage Health Plan	https://medicare.samhealthplans.org	Samaritan Advantage Premier Plan Plus (HMO)	1	1		1			H3811	9	0	2020	"Benton, Lincoln, and Linn counties"		2		2			2						https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	https://medicare.samhealthplans.org	(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	2			
H3813	1	0	1	4	1	H3813_001_0	4	1			05/31/2019	2020.01	05/31/2019 11:57:42 AM Pacific Daylight Time	06/01/2019 10:45:00 AM Pacific Daylight Time				06/01/2019 09:50:23 PM Pacific Daylight Time	"MODA HEALTH PLAN, INC."	"Moda Health Plan, Inc."	www.modahealth.com/medicare	Moda Health PPO (PPO)	1	4		1			H3813	1	0	2020	State of Oregon		2	26390	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						2			
H3813	6	0	1	4	1	H3813_006_0	6	1			05/31/2019	2020.01	05/31/2019 11:58:23 AM Pacific Daylight Time	08/06/2019 11:02:03 AM Pacific Daylight Time	08/06/2019 11:02:00 AM Pacific Daylight Time			08/06/2019 04:33:07 PM Pacific Daylight Time	"MODA HEALTH PLAN, INC."	"Moda Health Plan, Inc."	www.modahealth.com/medicare	Moda Health PPORX (PPO)	1	4		1			H3813	6	0	2020	Eastern Oregon		2	12804	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			
H3813	7	0	1	4	1	H3813_007_0	6	1			05/31/2019	2020.01	05/31/2019 12:28:16 PM Pacific Daylight Time	08/06/2019 11:01:57 AM Pacific Daylight Time	08/06/2019 11:01:53 AM Pacific Daylight Time			08/06/2019 04:33:07 PM Pacific Daylight Time	"MODA HEALTH PLAN, INC."	"Moda Health Plan, Inc."	www.modahealth.com/medicare	Moda Health PPORX Enhanced (PPO)	1	4		1			H3813	7	0	2020	Jackson and Josephine counties		2	513	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			
H3813	9	0	1	4	1	H3813_009_0	6	1			05/31/2019	2020.01	05/31/2019 12:28:34 PM Pacific Daylight Time	08/06/2019 11:01:54 AM Pacific Daylight Time	08/06/2019 11:01:49 AM Pacific Daylight Time			08/06/2019 04:33:07 PM Pacific Daylight Time	"MODA HEALTH PLAN, INC."	"Moda Health Plan, Inc."	www.modahealth.com/medicare	Moda Health PPORX Enhanced (PPO)	1	4		1			H3813	9	0	2020	Greater Portland Metro		2	18000	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			
H3813	10	0	1	4	1	H3813_010_0	6	1			05/31/2019	2020.01	05/31/2019 11:59:17 AM Pacific Daylight Time	08/06/2019 11:01:48 AM Pacific Daylight Time	08/06/2019 11:01:44 AM Pacific Daylight Time			08/06/2019 04:33:07 PM Pacific Daylight Time	"MODA HEALTH PLAN, INC."	"Moda Health Plan, Inc."	www.modahealth.com/medicare	Moda Health Central PPORX (PPO)	1	4		1			H3813	10	0	2020	Central Oregon		2	21144	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			
H3813	11	0	1	4	1	H3813_011_0	6	1			05/31/2019	2020.01	05/31/2019 11:59:28 AM Pacific Daylight Time	08/06/2019 11:01:42 AM Pacific Daylight Time	08/06/2019 11:01:38 AM Pacific Daylight Time			08/06/2019 04:33:07 PM Pacific Daylight Time	"MODA HEALTH PLAN, INC."	"Moda Health Plan, Inc."	www.modahealth.com/medicare	Moda Health NW PPORX (PPO)	1	4		1			H3813	11	0	2020	Northwest Oregon		2	35184	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			
H3813	12	0	1	4	1	H3813_012_0	6	1			05/31/2019	2020.01	05/31/2019 11:59:45 AM Pacific Daylight Time	08/06/2019 11:01:36 AM Pacific Daylight Time	08/06/2019 11:01:33 AM Pacific Daylight Time			08/06/2019 04:33:07 PM Pacific Daylight Time	"MODA HEALTH PLAN, INC."	"Moda Health Plan, Inc."	www.modahealth.com/medicare	Moda Health Southern PPORX (PPO)	1	4		1			H3813	12	0	2020	Southern Oregon		2	8004	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			
H3813	13	0	1	4	1	H3813_013_0	6	1			05/31/2019	2020.01	05/31/2019 11:59:54 AM Pacific Daylight Time	08/06/2019 11:01:30 AM Pacific Daylight Time	08/06/2019 11:01:24 AM Pacific Daylight Time			08/06/2019 04:33:07 PM Pacific Daylight Time	"MODA HEALTH PLAN, INC."	"Moda Health Plan, Inc."	www.modahealth.com/medicare	Moda Health Metro PPORX (PPO)	1	4		1			H3813	13	0	2020	Greater Portland Metro		2	12240	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			
H3814	7	0	1	1	1	H3814_007_0	7	1	2	1	08/05/2019	2020.01	08/05/2019 09:16:43 AM Pacific Daylight Time	08/06/2019 01:01:52 PM Pacific Daylight Time	08/06/2019 01:59:36 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Special Needs Plan (HMO D-SNP)	1	1		1			H3814	7	0	2020	Douglas and Klamath Counties		2	24168	2			1	3		2		2	atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H3815	1	0	1	1	1	H3815_001_0	4	1			07/02/2019	2020.01	07/02/2019 12:07:10 PM Pacific Daylight Time	07/31/2019 11:23:52 AM Pacific Daylight Time	07/31/2019 01:06:32 PM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan My Choice (HMO)	1	1		1			H3815	1	0	2020	"LA, Orange, San Bernardino & Riverside Counties"		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	6	0	1	1	1	H3815_006_0	4	1			07/02/2019	2020.01	07/02/2019 12:07:32 PM Pacific Daylight Time	07/31/2019 11:25:20 AM Pacific Daylight Time	07/31/2019 09:32:26 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan My Choice (HMO)	1	1		1			H3815	6	0	2020	"Stanislaus, San Joaquin Counties"		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	7	0	1	1	1	H3815_007_0	4	1			07/02/2019	2020.01	07/02/2019 12:07:51 PM Pacific Daylight Time	07/31/2019 11:27:06 AM Pacific Daylight Time	07/31/2019 09:35:00 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan My Choice (HMO)	1	1		1			H3815	7	0	2020	Santa Clara County		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	8	0	1	1	1	H3815_008_0	5	1			07/12/2019	2020.01	07/12/2019 01:40:43 PM Pacific Daylight Time	07/31/2019 11:28:20 AM Pacific Daylight Time	07/31/2019 09:38:08 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Platinum (HMO)	1	1		1			H3815	8	0	2020	Los Angeles and Orange Counties		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	9	0	1	1	1	H3815_009_0	5	1			07/12/2019	2020.01	07/12/2019 01:47:41 PM Pacific Daylight Time	07/31/2019 11:29:50 AM Pacific Daylight Time	07/31/2019 09:41:54 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan CalPlus (HMO)	1	1		1			H3815	9	0	2020	"RV, SB, ST, San Joaquin, SC, LA, OC, SD, Marin"		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	10	0	1	1	1	H3815_010_0	4	1		1	07/02/2019	2020.01	07/02/2019 12:10:22 PM Pacific Daylight Time	07/31/2019 11:31:12 AM Pacific Daylight Time	07/31/2019 09:44:18 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Heart & Diabetes (HMO C-SNP)	1	1		1			H3815	10	0	2020	Los Angeles and Orange Counties		2		2			1	4			10		www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	11	0	1	1	1	H3815_011_0	4	1			07/02/2019	2020.01	07/02/2019 12:11:09 PM Pacific Daylight Time	07/31/2019 11:32:26 AM Pacific Daylight Time	07/31/2019 09:47:02 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan AllCare Preferred Plan (HMO)	1	1		1			H3815	11	0	2020	Stanislaus County		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	13	0	1	1	1	H3815_013_0	4	1			07/02/2019	2020.01	07/02/2019 12:11:40 PM Pacific Daylight Time	07/31/2019 11:33:44 AM Pacific Daylight Time	07/31/2019 09:49:28 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan smartHMO (HMO)	1	1		1			H3815	13	0	2020	Los Angeles County		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	15	0	1	1	1	H3815_015_0	4	1			07/02/2019	2020.01	07/02/2019 12:12:00 PM Pacific Daylight Time	07/31/2019 11:34:54 AM Pacific Daylight Time	07/31/2019 09:53:38 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Platinum (HMO)	1	1		1			H3815	15	0	2020	San Bernardino and Riverside Counties		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	16	0	1	1	1	H3815_016_0	5	1			07/12/2019	2020.01	07/12/2019 01:47:05 PM Pacific Daylight Time	07/31/2019 11:36:06 AM Pacific Daylight Time	07/31/2019 09:59:22 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Platinum (HMO)	1	1		1			H3815	16	0	2020	San Diego		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	18	0	1	1	1	H3815_018_0	6	1			07/12/2019	2020.01	07/12/2019 01:44:58 PM Pacific Daylight Time	07/31/2019 11:37:16 AM Pacific Daylight Time	07/31/2019 10:02:26 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Platinum (HMO)	1	1		1			H3815	18	0	2020	Marin County		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	19	0	1	1	1	H3815_019_0	3	1			07/02/2019	2020.01	07/02/2019 12:14:07 PM Pacific Daylight Time	07/31/2019 01:16:34 PM Pacific Daylight Time	07/31/2019 10:05:00 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Sutter Advantage (HMO)	1	1		1			H3815	19	0	2020	"Sacramento, Placer & Yolo Counties"		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	20	0	1	1	1	H3815_020_0	3	1			07/02/2019	2020.01	07/02/2019 12:14:33 PM Pacific Daylight Time	07/31/2019 01:30:46 PM Pacific Daylight Time	07/31/2019 10:08:26 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Sutter Advantage (HMO)	1	1		1			H3815	20	0	2020	Santa Clara County		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	21	0	1	1	1	H3815_021_0	3	1			07/02/2019	2020.01	07/02/2019 12:15:04 PM Pacific Daylight Time	07/31/2019 01:32:02 PM Pacific Daylight Time	07/31/2019 10:10:42 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Sutter Advantage (HMO)	1	1		1			H3815	21	0	2020	Santa Cruz County		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	22	0	1	1	1	H3815_022_0	3	1			07/02/2019	2020.01	07/02/2019 12:15:44 PM Pacific Daylight Time	07/31/2019 01:33:22 PM Pacific Daylight Time	07/31/2019 10:13:12 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Sutter Advantage (HMO)	1	1		1			H3815	22	0	2020	San Mateo County		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	23	0	1	1	1	H3815_023_0	3	1			07/02/2019	2020.01	07/02/2019 12:16:00 PM Pacific Daylight Time	07/31/2019 01:34:36 PM Pacific Daylight Time	07/31/2019 10:15:28 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Sutter Advantage (HMO)	1	1		1			H3815	23	0	2020	Sonoma County		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	24	0	1	1	1	H3815_024_0	3	1			07/02/2019	2020.01	07/02/2019 12:16:17 PM Pacific Daylight Time	07/31/2019 01:36:38 PM Pacific Daylight Time	07/31/2019 10:18:10 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Sutter Advantage (HMO)	1	1		1			H3815	24	0	2020	San Francisco County		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	25	0	1	1	1	H3815_025_0	4	1			07/02/2019	2020.01	07/02/2019 12:16:34 PM Pacific Daylight Time	07/31/2019 11:46:14 AM Pacific Daylight Time	07/31/2019 10:21:26 AM Pacific Daylight Time			08/01/2019 06:28:57 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Platinum (HMO)	1	1		1			H3815	25	0	2020	San Joaquin County		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3815	801	0	1	1	1	H3815_801_0	1	1			05/31/2019	2020.01	05/31/2019 04:34:55 PM Pacific Daylight Time					06/01/2019 03:58:13 PM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (HMO)	1	1		1			H3815	801	0	2020	Southern California and Northern California		1	6000	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3817	8	1	1	4	1	H3817_008_1	11	1			07/18/2019	2020.01	07/18/2019 10:08:28 PM Mountain Daylight Time	08/05/2019 10:28:14 AM Mountain Daylight Time	07/31/2019 11:05:37 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	1	4		1			H3817	8	1	2020	"Select Counties in Oregon/Clark Co, WA"	Metro	2	162815	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						2			
H3817	8	2	1	4	1	H3817_008_2	12	1			08/08/2019	2020.01	08/08/2019 11:57:39 AM Mountain Daylight Time	08/05/2019 10:29:33 AM Mountain Daylight Time	07/31/2019 11:12:24 AM Mountain Daylight Time			08/08/2019 12:14:33 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	1	4		1			H3817	8	2	2020	"Select Counties in Oregon/Clark Co, WA"	Non-Metro	2	162815	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						2			
H3817	9	1	1	4	1	H3817_009_1	11	1			07/18/2019	2020.01	07/18/2019 09:59:56 PM Mountain Daylight Time	08/05/2019 10:30:50 AM Mountain Daylight Time	07/31/2019 11:18:14 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	1	4		1			H3817	9	1	2020	"Select Counties in Oregon/Clark Co, WA"	Metro	2	53301	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						2			
H3817	9	2	1	4	1	H3817_009_2	11	1			07/18/2019	2020.01	07/18/2019 10:00:15 PM Mountain Daylight Time	08/05/2019 10:32:06 AM Mountain Daylight Time	07/31/2019 11:24:47 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	1	4		1			H3817	9	2	2020	"Select Counties in Oregon/Clark Co, WA"	Non-Metro	2	53301	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						2			
H3817	10	0	1	4	1	H3817_010_0	10	1			07/18/2019	2020.01	07/18/2019 10:00:46 PM Mountain Daylight Time	07/05/2019 02:33:59 PM Mountain Daylight Time				07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	1	4		1			H3817	10	0	2020	"Select Counties in Oregon/Clark Co, WA"		2	49727	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						2			
H3817	11	1	1	4	1	H3817_011_1	11	1			07/18/2019	2020.01	07/18/2019 10:01:07 PM Mountain Daylight Time	08/05/2019 10:34:35 AM Mountain Daylight Time	07/31/2019 11:26:47 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	1	4		1			H3817	11	1	2020	"Select Counties in Oregon/Clark Co, WA"	Metro	2	13074	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						2			
H3817	11	2	1	4	1	H3817_011_2	11	1			07/18/2019	2020.01	07/18/2019 10:01:26 PM Mountain Daylight Time	08/05/2019 10:35:49 AM Mountain Daylight Time	07/31/2019 11:28:53 AM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	1	4		1			H3817	11	2	2020	"Select Counties in Oregon/Clark Co, WA"	Non-Metro	2	68106	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						2			
H3817	801	0	1	4	1	H3817_801_0	3	1			07/18/2019	2020.01	07/18/2019 10:01:57 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage (PPO)	1	4		1			H3817	801	0	2020	Nationwide except territories		1	25068	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)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H3817	802	0	1	4	1	H3817_802_0	3	1			07/18/2019	2020.01	07/18/2019 10:02:15 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	1	4		1			H3817	802	0	2020	Nationwide except territories		1	30641	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)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H3817	803	0	1	4	1	H3817_803_0	3	1			07/18/2019	2020.01	07/18/2019 10:02:35 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx 02 (PPO)	1	4		1			H3817	803	0	2020	Nationwide except Territories		1	12	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)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H3817	804	0	1	4	1	H3817_804_0	3	1			07/18/2019	2020.01	07/18/2019 10:08:48 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx 03 (PPO)	1	4		1			H3817	804	0	2020	Nationwide except Territories		1	12	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)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H3822	1	0	1	1	1	H3822_001_0	5	1			06/26/2019	2020.01	06/26/2019 10:34:27 AM Mountain Daylight Time	08/06/2019 01:24:28 PM Mountain Daylight Time	08/06/2019 01:24:32 PM Mountain Daylight Time			08/06/2019 02:45:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.getblueil.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	1	1		1			H3822	1	0	2020	"Cook, DuPage, Will and Kane counties"		2	193895	2			2						www.getblueil.com/mapd/pharmacies	www.getblueil.com/mapd/druglist	www.getblueil.com/mapd/providers	(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	2			
H3822	2	0	1	1	1	H3822_002_0	4	1			06/26/2019	2020.01	06/26/2019 10:38:05 AM Mountain Daylight Time	08/06/2019 01:24:28 PM Mountain Daylight Time	08/06/2019 01:24:32 PM Mountain Daylight Time			08/06/2019 02:45:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.getbluenm.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	1	1		1			H3822	2	0	2020	"Bernalillo, Sandoval, Torrance and Valencia cntys"		2	76030	2			2						www.getbluenm.com/mapd/pharmacies	www.getbluenm.com/mapd/druglist	www.getbluenm.com/mapd/providers	(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	2			
H3822	6	0	1	1	1	H3822_006_0	5	1	2	1	08/06/2019	2020.01	08/06/2019 02:25:55 PM Mountain Daylight Time	08/06/2019 01:24:30 PM Mountain Daylight Time	08/06/2019 01:24:34 PM Mountain Daylight Time			08/06/2019 02:45:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.getbluenm.com/dsnp	Blue Cross Medicare Advantage Dual Care (HMO D-SNP)	1	1		1			H3822	6	0	2020	"Bernalillo, Sandoval, Torrance and Valencia"		2	9840	2			1	3		2		2	www.getbluenm.com/dsnp/pharmacies	www.getbluenm.com/dsnp/druglist	www.getbluenm.com/dsnp/providers	(877)688-1813		(877)688-1813		(877)583-8129		(877)583-8129		(877)688-1813		(877)688-1813		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3822	7	0	1	2	1	H3822_007_0	5	1			06/27/2019	2020.01	06/27/2019 08:18:00 AM Mountain Daylight Time	08/06/2019 01:24:30 PM Mountain Daylight Time	08/06/2019 01:24:34 PM Mountain Daylight Time			08/06/2019 02:45:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.getblueil.com/mapd	Blue Cross Medicare Advantage Basic Plus (HMO-POS)	1	2		1			H3822	7	0	2020	"Cook, DuPage, Kane and Will counties"		2	55997	2			2						www.getblueil.com/mapd/pharmacies	www.getblueil.com/mapd/druglist	www.getblueil.com/mapd/providers	(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	2			
H3822	8	0	1	2	1	H3822_008_0	5	1			06/27/2019	2020.01	06/27/2019 08:17:29 AM Mountain Daylight Time	08/06/2019 01:24:30 PM Mountain Daylight Time	08/06/2019 01:24:34 PM Mountain Daylight Time			08/06/2019 02:45:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.getblueil.com/mapd	Blue Cross Medicare Advantage Premier Plus (HMO-POS)	1	2		1			H3822	8	0	2020	"Cook, DuPage, Kane and Will counties"		2	17484	2			2						www.getblueil.com/mapd/pharmacies	www.getblueil.com/mapd/druglist	www.getblueil.com/mapd/providers	(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	2			
H3822	801	0	1	1	1	H3822_801_0	2	1			05/29/2019	2020.01	05/29/2019 04:22:58 PM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.hcsc.com	BlueCross Medicare Advantage (HMO)	1	1		1			H3822	801	0	2020	State of Illinois		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H3822	802	0	1	1	1	H3822_802_0	2	1			05/29/2019	2020.01	05/29/2019 04:23:19 PM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.hcsc.com	BlueCross Medicare Advantage (HMO)	1	1		1			H3822	802	0	2020	State of New Mexico		1	42742	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H3822	805	0	1	1	1	H3822_805_0	2	1			05/29/2019	2020.01	05/29/2019 04:23:57 PM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.hcsc.com	BlueCross Medicare Advantage (HMO)	1	1		1			H3822	805	0	2020	State of Illinois		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H3822	806	0	1	1	1	H3822_806_0	2	1			05/29/2019	2020.01	05/29/2019 04:24:11 PM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.hcsc.com	BlueCross Medicare Advantage (HMO)	1	1		1			H3822	806	0	2020	State of New Mexico		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H3822	809	0	1	1	1	H3822_809_0	2	1			05/29/2019	2020.01	05/29/2019 04:24:26 PM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.hcsc.com	BlueCross Medicare Advantage (HMO)	1	1		1			H3822	809	0	2020	State of Illinois		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H3822	810	0	1	1	1	H3822_810_0	2	1			05/29/2019	2020.01	05/29/2019 04:24:50 PM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.hcsc.com	BlueCross Medicare Advantage (HMO)	1	1		1			H3822	810	0	2020	State of New Mexico		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H3822	813	0	1	1	1	H3822_813_0	2	1			05/29/2019	2020.01	05/29/2019 04:25:17 PM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.hcsc.com	Blue Cross Medicare Advantage (HMO)	1	1		1			H3822	813	0	2020	State of MT		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H3822	814	0	1	1	1	H3822_814_0	2	1			05/29/2019	2020.01	05/29/2019 04:25:30 PM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.hcsc.com	Blue Cross Medicare Advantage (HMO)	1	1		1			H3822	814	0	2020	State of MT		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H3822	815	0	1	1	1	H3822_815_0	2	1			05/29/2019	2020.01	05/29/2019 04:26:25 PM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.hcsc.com	Blue Cross Medicare Advantage (HMO)	1	1		1			H3822	815	0	2020	State of MT		1	1	2			2						www.myprime.com	www.myprime.com	www.hcsc.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H3832	7	0	1	4	1	H3832_007_0	5	1			08/02/2019	2020.01	08/02/2019 02:37:56 AM Hawaiian Standard Time	08/02/2019 03:19:08 AM Hawaiian Standard Time	07/30/2019 11:12:20 AM Hawaiian Standard Time			08/02/2019 09:16:10 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage Standard (PPO)	1	4		1			H3832	7	0	2020	"Hawaii, Kalawao, Kauai and Maui counties"		2	26724	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	8	0	1	4	1	H3832_008_0	5	1			07/16/2019	2020.01	07/16/2019 10:33:01 AM Hawaiian Standard Time	08/02/2019 03:22:26 AM Hawaiian Standard Time	07/30/2019 11:18:24 AM Hawaiian Standard Time			08/02/2019 09:19:25 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage Standard Plus (PPO)	1	4		1			H3832	8	0	2020	"Hawaii, Kalawao, Kauai and Maui counties"		2	60091	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	9	0	1	4	1	H3832_009_0	5	1			08/02/2019	2020.01	08/02/2019 04:06:06 AM Hawaiian Standard Time	08/02/2019 03:26:40 AM Hawaiian Standard Time	07/30/2019 11:21:18 AM Hawaiian Standard Time			08/02/2019 09:22:32 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage Complete (PPO)	1	4		1			H3832	9	0	2020	Honolulu County		2	41031	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	10	0	1	4	1	H3832_010_0	6	1			09/12/2019	2020.01	09/12/2019 07:10:41 AM Hawaiian Standard Time	08/02/2019 03:30:17 AM Hawaiian Standard Time	07/30/2019 11:24:18 AM Hawaiian Standard Time			09/12/2019 07:55:09 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage Complete Plus (PPO)	1	4		1			H3832	10	0	2020	Honolulu County		2	153314	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	11	0	1	4	1	H3832_011_0	6	1	2	1	07/01/2019	2020.01	07/01/2019 07:48:17 AM Hawaiian Standard Time	08/07/2019 05:34:54 AM Hawaiian Standard Time	07/30/2019 11:35:37 AM Hawaiian Standard Time			08/07/2019 05:37:10 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage Dual Care (PPO D-SNP)	1	4		1			H3832	11	0	2020	"Hawaii, Kalawao, Kauai, Maui and Honolulu counties"		2	8136	2			1	3		1		1	www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3832	801	0	1	4	1	H3832_801_0	2	1			05/28/2019	2020.01	05/28/2019 08:21:06 AM Hawaiian Standard Time					05/30/2019 10:55:37 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage EGWP with Drug CY (PPO)	1	4		1			H3832	801	0	2020	National		1	56612	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8a;8b1;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14a;15;	2		1									
H3832	802	0	1	4	1	H3832_802_0	2	1			05/24/2019	2020.01	05/24/2019 12:40:27 PM Hawaiian Standard Time					05/30/2019 10:57:32 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage EGWP with Drug NCY (PPO)	1	4		1			H3832	802	0	2020	National		1	0	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14a;15;	2		1									
H3832	805	0	1	4	1	H3832_805_0	2	1			05/24/2019	2020.01	05/24/2019 12:41:10 PM Hawaiian Standard Time					05/30/2019 10:59:19 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage EGWP CY (PPO)	1	4		1			H3832	805	0	2020	National		1	27525	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14a;15;	2		1									
H3832	807	0	1	4	1	H3832_807_0	2	1			05/24/2019	2020.01	05/24/2019 02:42:17 PM Hawaiian Standard Time					05/30/2019 11:01:24 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	HMSA Akamai Advantage	www.hmsa.com/advantage	HMSA Akamai Advantage Union Group Plan MAPD (PPO)	1	4		1			H3832	807	0	2020	National		1	57921	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;15;	2		1									
H3864	2	0	1	1	1	H3864_002_0	3	1			07/12/2019	2020.01	07/12/2019 07:09:32 AM Pacific Daylight Time	06/03/2019 01:29:54 PM Pacific Daylight Time				07/12/2019 08:30:40 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials 2 (HMO)	1	1		1			H3864	2	0	2020	"Central, Eastern, Mid-Columbia Gorge, Lane"		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	6	0	1	1	1	H3864_006_0	7	1			07/11/2019	2020.01	07/11/2019 11:11:38 AM Pacific Daylight Time	07/31/2019 11:49:14 AM Pacific Daylight Time	07/31/2019 01:00:38 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 6 (HMO)	1	1		1			H3864	6	0	2020	"Central, Eastern Oregon and Mid-Columbia Gorge"		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	14	0	1	2	1	H3864_014_0	6	1			07/11/2019	2020.01	07/11/2019 11:12:29 AM Pacific Daylight Time	07/31/2019 11:50:50 AM Pacific Daylight Time	07/31/2019 01:01:18 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Choice Rx 14 (HMO-POS)	1	2		1			H3864	14	0	2020	"Central, Eastern Oregon and Mid-Columbia Gorge"		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	21	0	1	1	1	H3864_021_0	5	1			07/11/2019	2020.01	07/11/2019 11:13:17 AM Pacific Daylight Time	07/31/2019 11:52:08 AM Pacific Daylight Time	07/31/2019 01:01:58 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 21 (HMO)	1	1		1			H3864	21	0	2020	Eastern Idaho		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	24	0	1	2	1	H3864_024_0	5	1			07/11/2019	2020.01	07/11/2019 11:13:59 AM Pacific Daylight Time	07/31/2019 11:53:54 AM Pacific Daylight Time	07/31/2019 01:02:38 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Choice Rx 24 (HMO-POS)	1	2		1			H3864	24	0	2020	Southwest and Southern Idaho		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	27	0	1	1	1	H3864_027_0	6	1			07/11/2019	2020.01	07/11/2019 11:14:40 AM Pacific Daylight Time	07/31/2019 11:55:06 AM Pacific Daylight Time	07/31/2019 01:03:18 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 27 (HMO)	1	1		1			H3864	27	0	2020	"Central, Eastern Oregon and Mid-Columbia Gorge"		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	29	0	1	2	1	H3864_029_0	8	1			07/11/2019	2020.01	07/11/2019 11:15:28 AM Pacific Daylight Time	07/31/2019 11:56:26 AM Pacific Daylight Time	07/31/2019 01:03:56 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Choice Rx 29 (HMO-POS)	1	2		1			H3864	29	0	2020	Yellowstone County		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	30	0	1	1	1	H3864_030_0	4	1			07/11/2019	2020.01	07/11/2019 11:16:04 AM Pacific Daylight Time	06/03/2019 01:30:28 PM Pacific Daylight Time				07/12/2019 08:30:40 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare 30 (HMO)	1	1		1			H3864	30	0	2020	Yellowstone County		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	32	0	1	1	1	H3864_032_0	6	1			07/11/2019	2020.01	07/11/2019 11:16:48 AM Pacific Daylight Time	07/31/2019 11:58:16 AM Pacific Daylight Time	07/31/2019 01:04:36 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 32 (HMO)	1	1		1			H3864	32	0	2020	Southwest Idaho		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	33	0	1	1	1	H3864_033_0	6	1			07/11/2019	2020.01	07/11/2019 11:17:24 AM Pacific Daylight Time	07/31/2019 11:59:28 AM Pacific Daylight Time	07/31/2019 01:05:18 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 33 (HMO)	1	1		1			H3864	33	0	2020	Spokane County		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	34	0	1	1	1	H3864_034_0	6	1			07/11/2019	2020.01	07/11/2019 11:18:00 AM Pacific Daylight Time	07/31/2019 12:00:42 PM Pacific Daylight Time	07/31/2019 01:06:02 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 34 (HMO)	1	1		1			H3864	34	0	2020	Pierce County		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	35	0	1	1	1	H3864_035_0	3	1			07/11/2019	2020.01	07/11/2019 11:18:36 AM Pacific Daylight Time	06/03/2019 01:30:47 PM Pacific Daylight Time				07/12/2019 08:30:40 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare 35 (HMO)	1	1		1			H3864	35	0	2020	Spokane and Pierce Counties		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	36	0	1	1	1	H3864_036_0	6	1			07/11/2019	2020.01	07/11/2019 11:19:21 AM Pacific Daylight Time	07/31/2019 12:02:04 PM Pacific Daylight Time	07/31/2019 01:06:46 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 36 (HMO)	1	1		1			H3864	36	0	2020	Lane County		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	37	0	1	1	1	H3864_037_0	6	1			07/11/2019	2020.01	07/11/2019 11:20:02 AM Pacific Daylight Time	07/31/2019 12:03:20 PM Pacific Daylight Time	07/31/2019 01:07:24 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 37 (HMO)	1	1		1			H3864	37	0	2020	Clark County		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	38	0	1	1	1	H3864_038_0	6	1			07/11/2019	2020.01	07/11/2019 11:20:37 AM Pacific Daylight Time	07/31/2019 12:05:00 PM Pacific Daylight Time	07/31/2019 01:08:06 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 38 (HMO)	1	1		1			H3864	38	0	2020	Clark County		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	39	0	1	1	1	H3864_039_0	6	1			07/11/2019	2020.01	07/11/2019 11:21:10 AM Pacific Daylight Time	07/31/2019 12:06:18 PM Pacific Daylight Time	07/31/2019 01:08:40 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 39 (HMO)	1	1		1			H3864	39	0	2020	Portland Area		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	40	0	1	1	1	H3864_040_0	6	1			07/11/2019	2020.01	07/11/2019 11:21:48 AM Pacific Daylight Time	07/31/2019 12:07:34 PM Pacific Daylight Time	07/31/2019 01:39:34 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 40 (HMO)	1	1		1			H3864	40	0	2020	Portland Area		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	41	0	1	1	1	H3864_041_0	6	1			07/11/2019	2020.01	07/11/2019 11:23:06 AM Pacific Daylight Time	07/31/2019 12:08:56 PM Pacific Daylight Time	07/31/2019 01:30:10 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 41 (HMO)	1	1		1			H3864	41	0	2020	"Coos, Curry and Lane Counties"		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	801	0	1	1	1	H3864_801_0	1	1			06/02/2019	2020.01	06/02/2019 09:10:32 AM Pacific Daylight Time					06/02/2019 05:13:23 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials 801 (HMO)	1	1		1			H3864	801	0	2020	"Statewide - Oregon, Idaho, Montana and Washington"		1	1200	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	803	0	1	1	1	H3864_803_0	2	1			06/17/2019	2020.01	06/17/2019 01:04:42 PM Pacific Daylight Time					06/17/2019 02:01:22 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 803 (HMO)	1	1		1			H3864	803	0	2020	"Statewide - Oregon, Idaho, Montana and Washington"		1	14916	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	805	0	1	2	1	H3864_805_0	1	1			06/02/2019	2020.01	06/02/2019 09:10:07 AM Pacific Daylight Time					06/02/2019 05:13:23 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials 805 (HMO-POS)	1	2		1			H3864	805	0	2020	"Statewide - Oregon, Idaho, Montana and Washington"		1	1200	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3864	806	0	1	2	1	H3864_806_0	1	1			06/02/2019	2020.01	06/02/2019 09:10:00 AM Pacific Daylight Time					06/02/2019 05:13:23 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 806 (HMO-POS)	1	2		1			H3864	806	0	2020	"Statewide - Oregon, Idaho, Montana and Washington"		1	1200	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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	2			
H3890	1	0	1	4	1	H3890_001_0	10	1			08/02/2019	2020.01	08/02/2019 09:20:35 AM Eastern Daylight Time	08/02/2019 12:05:06 PM Eastern Daylight Time	08/01/2019 10:19:26 AM Eastern Daylight Time			08/05/2019 11:13:24 AM Eastern Daylight Time	"HOPKINS HEALTH ADVANTAGE, INC."	Johns Hopkins HealthCare	https://www.hopkinsmedicare.com/	Johns Hopkins Advantage MD (PPO)	1	4		1			H3890	1	0	2020	Counties: AA BL BC CV CR FR HW SS WH WC WR		2	43547	2			2						https://www.hopkinsmedicare.com/	https://www.hopkinsmedicare.com/	https://www.hopkinsmedicare.com/	(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3890	2	0	1	4	1	H3890_002_0	10	1			08/02/2019	2020.01	08/02/2019 09:16:29 AM Eastern Daylight Time	08/02/2019 12:06:24 PM Eastern Daylight Time	08/01/2019 10:19:52 AM Eastern Daylight Time			08/05/2019 11:13:24 AM Eastern Daylight Time	"HOPKINS HEALTH ADVANTAGE, INC."	Johns Hopkins HealthCare	https://www.hopkinsmedicare.com/	Johns Hopkins Advantage MD Plus (PPO)	1	4		1			H3890	2	0	2020	Counties: AA BL BC CV CR FR HW SS WH WC WR		2	70515	2			2						https://www.hopkinsmedicare.com/	https://www.hopkinsmedicare.com/	https://www.hopkinsmedicare.com/	(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3890	4	0	1	4	1	H3890_004_0	11	1			08/02/2019	2020.01	08/02/2019 09:16:42 AM Eastern Daylight Time	08/02/2019 12:07:34 PM Eastern Daylight Time	08/01/2019 10:20:20 AM Eastern Daylight Time			08/05/2019 11:13:24 AM Eastern Daylight Time	"HOPKINS HEALTH ADVANTAGE, INC."	Johns Hopkins HealthCare	https://www.hopkinsmedicare.com/	Johns Hopkins Advantage MD Premier (PPO)	1	4		1			H3890	4	0	2020	Montgomery County		2	3581	2			2						https://www.hopkinsmedicare.com/	https://www.hopkinsmedicare.com/	https://www.hopkinsmedicare.com/	(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3890	801	0	1	4	1	H3890_801_0	7	1			05/30/2019	2020.01	05/30/2019 11:46:35 AM Eastern Daylight Time					06/03/2019 08:12:03 AM Eastern Daylight Time	"HOPKINS HEALTH ADVANTAGE, INC."	Johns Hopkins HealthCare	www.hopkinsmedicare.com	Johns Hopkins Advantage MD Group Plan CY (PPO)	1	4		1			H3890	801	0	2020	"DC, DE, FL, GA, MD, NC, PA, SC, VA"		1	1200	2			2						www.hopkinsmedicare.com	www.hopkinsmedicare.com	www.hopkinsmedicare.com	(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		1									
H3890	802	0	1	4	1	H3890_802_0	7	1			05/30/2019	2020.01	05/30/2019 11:45:59 AM Eastern Daylight Time					06/03/2019 08:12:03 AM Eastern Daylight Time	"HOPKINS HEALTH ADVANTAGE, INC."	Johns Hopkins HealthCare	www.hopkinsmedicare.com	Johns Hopkins Advantage MD Group Plan Non-CY (PPO)	1	4		1			H3890	802	0	2020	"DC, DE, FL, GA, MD, NC, PA, SC, VA"		1	0	2			2						www.hopkinsmedicare.com	www.hopkinsmedicare.com	www.hopkinsmedicare.com	(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9b;11a;11b;11c;15;16b;	2		1									
H3890	803	0	1	4	1	H3890_803_0	7	1			05/30/2019	2020.01	05/30/2019 11:47:32 AM Eastern Daylight Time					06/03/2019 08:12:03 AM Eastern Daylight Time	"HOPKINS HEALTH ADVANTAGE, INC."	Johns Hopkins HealthCare	www.hopkinsmedicare.com	Johns Hopkins Advantage MD Group Plan MA Only (PPO)	1	4		1			H3890	803	0	2020	"DC, DE, FL, GA, MD, NC, PA, SC, VA"		1	0	2			2						www.hopkinsmedicare.com	www.hopkinsmedicare.com	www.hopkinsmedicare.com	(877)293-5325		(877)293-5325		(888)403-7682		(888)403-7682										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		1									
H3907	2	0	1	1	1	H3907_002_0	12	1			07/18/2019	2020.01	07/18/2019 05:08:15 PM Eastern Daylight Time	06/02/2019 09:10:10 AM Eastern Daylight Time				07/19/2019 09:51:04 AM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC for Life HMO No Rx (HMO)	1	1		1			H3907	2	0	2020	Western and North Eastern Pennsylvania		2	204442	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(711)-		(711)-		(711)-		(711)-										2					2					2	1	11	7b;	7b1;
H3907	6	0	1	1	1	H3907_006_0	14	1			07/18/2019	2020.01	07/18/2019 05:08:53 PM Eastern Daylight Time	08/02/2019 02:02:19 PM Eastern Daylight Time	07/31/2019 01:19:06 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Rx Enhanced (HMO)	1	1		1			H3907	6	0	2020	Western and North Eastern PA		2	48327	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	7b;	7b1;
H3907	29	0	1	1	1	H3907_029_0	12	1			08/02/2019	2020.01	08/02/2019 04:38:05 PM Eastern Daylight Time	08/05/2019 05:01:32 PM Eastern Daylight Time	07/31/2019 01:21:18 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Rx (HMO)	1	1		1			H3907	29	0	2020	"Western, Central, and North Eastern PA"		2	814156	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	7b;	7b1;
H3907	37	0	1	1	1	H3907_037_0	12	1			08/02/2019	2020.01	08/02/2019 04:14:23 PM Eastern Daylight Time	08/05/2019 05:03:59 PM Eastern Daylight Time	07/31/2019 01:25:22 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Deductible with Rx (HMO)	1	1		1			H3907	37	0	2020	"Western, Central, and North Eastern PA"		2	568401	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7b;	
H3907	44	0	1	1	1	H3907_044_0	8	1			07/03/2019	2020.01	07/03/2019 11:28:59 AM Eastern Daylight Time	08/06/2019 01:26:00 PM Eastern Daylight Time	07/31/2019 01:29:00 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Deductible with Rx (HMO)	1	1		1			H3907	44	0	2020	"Bucks, Chester, Delaware, Montgomery, Philadelphia"		2	2462	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7b;	
H3907	45	0	1	1	1	H3907_045_0	9	1			08/06/2019	2020.01	08/06/2019 05:31:16 PM Eastern Daylight Time	08/05/2019 11:11:12 PM Eastern Daylight Time	07/31/2019 03:24:18 PM Eastern Daylight Time			08/06/2019 06:35:37 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Premier Rx (HMO)	1	1		1			H3907	45	0	2020	Berks County		2	6245	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(844)870-2231		(844)870-2231		(844)703-2379		(844)703-2379		(844)870-2231		(844)870-2231		(844)703-2379		(844)703-2379		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7b;	
H3907	46	0	1	1	1	H3907_046_0	8	1			08/06/2019	2020.01	08/06/2019 03:23:05 PM Eastern Daylight Time	08/05/2019 11:14:30 PM Eastern Daylight Time	07/31/2019 03:26:12 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Premier Rx (HMO)	1	1		1			H3907	46	0	2020	South Western and North Central Pennsylvania		2	66995	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7b;	
H3907	47	0	1	1	1	H3907_047_0	8	1			07/03/2019	2020.01	07/03/2019 11:30:22 AM Eastern Daylight Time	08/05/2019 11:17:26 PM Eastern Daylight Time	07/31/2019 01:30:20 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Rx (HMO)	1	1		1			H3907	47	0	2020	Berks County		2	1110	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(844)870-2231		(844)870-2231		(844)703-2379		(844)703-2379		(844)870-2231		(844)870-2231		(844)703-2379		(844)703-2379		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	7b;	7b1;
H3907	48	0	1	1	1	H3907_048_0	8	1			07/03/2019	2020.01	07/03/2019 11:30:43 AM Eastern Daylight Time	08/06/2019 01:31:28 PM Eastern Daylight Time	07/31/2019 01:32:04 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Rx (HMO)	1	1		1			H3907	48	0	2020	"Bucks, Chester, Delaware, Montgomery, Philadelphia"		2	401	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	11	7b;	7b1;
H3907	49	0	1	1	1	H3907_049_0	8	1			08/06/2019	2020.01	08/06/2019 02:51:35 PM Eastern Daylight Time	08/05/2019 11:24:48 PM Eastern Daylight Time	07/31/2019 01:33:54 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Rx Choice (HMO)	1	1		1			H3907	49	0	2020	Western Pennsylvania		2	74939	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7b;	
H3907	50	0	1	1	1	H3907_050_0	8	1			08/06/2019	2020.01	08/06/2019 01:32:50 PM Eastern Daylight Time	08/05/2019 11:27:32 PM Eastern Daylight Time	07/31/2019 03:28:26 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Premier Rx (HMO)	1	1		1			H3907	50	0	2020	"Erie, Lawrence, Mercer, Venango Counties"		2	5403	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7b;	
H3907	51	0	1	1	1	H3907_051_0	8	1			08/02/2019	2020.01	08/02/2019 06:20:16 PM Eastern Daylight Time	08/05/2019 11:31:44 PM Eastern Daylight Time	07/31/2019 03:29:58 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Premier Rx (HMO)	1	1		1			H3907	51	0	2020	Westmoreland County		2	8170	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7k;8a1;8a2;8b1;8b2;8b3;9a1;9a2;9b;9c;16b;17a;18a;	
H3907	52	0	1	1	1	H3907_052_0	9	1			08/06/2019	2020.01	08/06/2019 05:32:05 PM Eastern Daylight Time	08/05/2019 11:34:38 PM Eastern Daylight Time	07/31/2019 03:31:56 PM Eastern Daylight Time			08/06/2019 06:35:37 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC for Life HMO Premier Rx (HMO)	1	1		1			H3907	52	0	2020	"Cumberland, Dauphin, Lancaster, and York Counties"		2	5389	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7b;	
H3907	801	0	1	1	1	H3907_801_0	5	1			05/29/2019	2020.01	05/29/2019 09:49:10 AM Eastern Daylight Time					06/02/2019 04:00:18 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC Employer Group (HMO)	1	1		1			H3907	801	0	2020	Western Pennsylvania		1	106227	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;7c;7i;7k;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1					1				
H3907	802	0	1	1	1	H3907_802_0	5	1			05/28/2019	2020.01	05/28/2019 04:24:07 PM Eastern Daylight Time					06/02/2019 04:00:18 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC Employer Group Rx (HMO)	1	1		1			H3907	802	0	2020	Western Pennsylvania		1	58818	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7c;7i;7k;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1					1				
H3907	803	0	1	1	1	H3907_803_0	5	1			05/31/2019	2020.01	05/31/2019 02:38:00 PM Eastern Daylight Time					06/02/2019 04:00:18 PM Eastern Daylight Time	"UPMC HEALTH PLAN, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare	UPMC Employer Group Rx (HMO)	1	1		1			H3907	803	0	2020	Western Pennsylvania		1	12	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	http://www.upmchealthplan.com/medicare	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7c;7i;7k;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1					1				
H3908	1	0	1	20	8	H3908_001_0	1	1			05/21/2019	2020.01	05/21/2019 02:27:21 PM Eastern Daylight Time		05/20/2019 03:54:02 PM Eastern Daylight Time			05/21/2019 02:31:04 PM Eastern Daylight Time	"TRINITY HEALTH LIFE PENNSYLVANIA, INC."	Mercy LIFE - West Philadelphia	http://www.mercylife-westphila.org	Trinity Health LIFE Pennsylvania (PACE)	8	20		1			H3908	1	0	2020	"Counties: PHL (partial), DelCo (partial)"		2		2			2						www.CareKinesis.com	http://www.mercyhealth.org/services/mercy-life/west-phila/												(267)787-8282				(267)787-8282												(800)654-5984				(800)654-5984																
H3908	2	0	1	20	8	H3908_002_0	1	1			05/21/2019	2020.01	05/21/2019 02:28:14 PM Eastern Daylight Time		05/20/2019 03:53:52 PM Eastern Daylight Time			05/21/2019 02:31:04 PM Eastern Daylight Time	"TRINITY HEALTH LIFE PENNSYLVANIA, INC."	Mercy LIFE - West Philadelphia	http://www.mercylife-westphila.org	Trinity Health LIFE Pennsylvania (PACE)	8	20		1			H3908	2	0	2020	"Counties: PHL (partial), DelCo (partial)"		2		2			2						www.CareKinesis.com	http://www.mercyhealth.org/services/mercy-life/west-phila/												(267)787-8282				(267)787-8282												(800)654-5984				(800)654-5984																
H3909	1	0	1	4	1	H3909_001_0	5	1			06/28/2019	2020.01	06/28/2019 01:28:33 PM Eastern Daylight Time	08/02/2019 12:46:37 PM Eastern Daylight Time	08/02/2019 12:46:38 PM Eastern Daylight Time			08/02/2019 12:56:31 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Rx (PPO)	1	4		1			H3909	1	0	2020	"Bucks, Philadelphia Counties"		2	23094	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						2			
H3909	7	0	1	4	1	H3909_007_0	4	1			06/28/2019	2020.01	06/28/2019 01:38:40 PM Eastern Daylight Time	07/26/2019 10:50:41 AM Eastern Daylight Time				07/26/2019 01:21:15 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Medical Only (PPO)	1	4		1			H3909	7	0	2020	"Bucks, Philadelphia Counties"		2	1913	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						2			
H3909	9	0	1	4	1	H3909_009_0	5	1			06/28/2019	2020.01	06/28/2019 01:44:00 PM Eastern Daylight Time	08/02/2019 12:40:49 PM Eastern Daylight Time	08/02/2019 12:40:49 PM Eastern Daylight Time			08/02/2019 01:01:29 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Rx (PPO)	1	4		1			H3909	9	0	2020	"Chester, Delaware, Montgomery Counties"		2	37741	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						2			
H3909	14	0	1	4	1	H3909_014_0	8	1			08/01/2019	2020.01	08/01/2019 02:18:01 PM Eastern Daylight Time	08/02/2019 12:40:50 PM Eastern Daylight Time	08/02/2019 12:40:50 PM Eastern Daylight Time			08/02/2019 01:06:26 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Prime Rx PPO (PPO)	1	4		1			H3909	14	0	2020	"Bucks, Philadelphia Counties"		2	19116	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						1	1	7a;7d;7g;9a1;9a2;16b;17a;18a;	
H3909	15	0	1	4	1	H3909_015_0	6	1			08/01/2019	2020.01	08/01/2019 02:22:39 PM Eastern Daylight Time	08/02/2019 12:40:51 PM Eastern Daylight Time	08/02/2019 12:40:51 PM Eastern Daylight Time			08/02/2019 01:06:26 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Prime Rx PPO (PPO)	1	4		1			H3909	15	0	2020	"Chester, Delaware, Montgomery Counties"		2	31241	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						1	1	7a;7d;7g;9a1;9a2;16b;17a;18a;	
H3909	801	0	1	4	1	H3909_801_0	2	1			06/18/2019	2020.01	06/18/2019 09:17:48 AM Eastern Daylight Time					06/18/2019 09:23:08 AM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Group Medical Only (PPO)	1	4		1			H3909	801	0	2020	National		1	7044	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	1a;1b;2;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;	2		1									
H3909	802	0	1	4	1	H3909_802_0	2	1			06/18/2019	2020.01	06/18/2019 09:18:08 AM Eastern Daylight Time					06/18/2019 09:23:08 AM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Group Rx (PPO)	1	4		1			H3909	802	0	2020	National		1	16032	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	1a;1b;2;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;	2		1									
H3916	1	0	1	4	1	H3916_001_0	4	1			08/02/2019	2020.01	08/02/2019 01:22:18 PM Eastern Daylight Time	08/01/2019 10:42:08 AM Eastern Daylight Time	07/31/2019 11:04:38 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Classic (PPO)	1	4		1			H3916	1	0	2020	Southwestern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	2	0	1	4	1	H3916_002_0	4	1			07/17/2019	2020.01	07/17/2019 01:07:06 PM Eastern Daylight Time	08/01/2019 10:42:43 AM Eastern Daylight Time	07/31/2019 11:08:02 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Classic (PPO)	1	4		1			H3916	2	0	2020	West Central PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	5	0	1	4	1	H3916_005_0	4	1			07/17/2019	2020.01	07/17/2019 01:08:53 PM Eastern Daylight Time	08/01/2019 10:43:15 AM Eastern Daylight Time	07/31/2019 11:12:05 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Deluxe (PPO)	1	4		1			H3916	5	0	2020	Central and Northeastern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	12	0	1	4	1	H3916_012_0	3	1			07/17/2019	2020.01	07/17/2019 01:10:45 PM Eastern Daylight Time	06/27/2019 01:40:26 PM Eastern Daylight Time				07/18/2019 10:37:07 AM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Basic (PPO)	1	4		1			H3916	12	0	2020	Central and Northeastern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478										(711)-		(711)-		(711)-		(711)-										2					2						2			
H3916	15	0	1	4	1	H3916_015_0	4	1			07/17/2019	2020.01	07/17/2019 01:11:52 PM Eastern Daylight Time	08/01/2019 10:44:20 AM Eastern Daylight Time	07/31/2019 11:15:25 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Standard (PPO)	1	4		1			H3916	15	0	2020	Central and Northeastern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	18	0	1	4	1	H3916_018_0	4	1			07/17/2019	2020.01	07/17/2019 01:12:53 PM Eastern Daylight Time	08/01/2019 10:44:52 AM Eastern Daylight Time	07/31/2019 11:18:37 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO ValueRx (PPO)	1	4		1			H3916	18	0	2020	Central and Northeastern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	22	0	1	4	1	H3916_022_0	4	1			07/17/2019	2020.01	07/17/2019 01:13:59 PM Eastern Daylight Time	08/01/2019 10:45:26 AM Eastern Daylight Time	07/31/2019 11:21:31 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Select (PPO)	1	4		1			H3916	22	0	2020	Southwestern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	24	0	1	4	1	H3916_024_0	4	1			07/17/2019	2020.01	07/17/2019 01:14:54 PM Eastern Daylight Time	08/01/2019 10:45:59 AM Eastern Daylight Time	07/31/2019 11:26:18 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Select (PPO)	1	4		1			H3916	24	0	2020	West Central PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	32	0	1	4	1	H3916_032_0	4	1			07/17/2019	2020.01	07/17/2019 01:16:10 PM Eastern Daylight Time	08/01/2019 11:16:32 AM Eastern Daylight Time	07/31/2019 11:29:17 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO ValueRx (PPO)	1	4		1			H3916	32	0	2020	Southwestern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	33	0	1	4	1	H3916_033_0	4	1			07/17/2019	2020.01	07/17/2019 01:21:27 PM Eastern Daylight Time	08/01/2019 10:47:05 AM Eastern Daylight Time	07/31/2019 11:32:31 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO ValueRx (PPO)	1	4		1			H3916	33	0	2020	West Central PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	34	1	1	4	1	H3916_034_1	4	1			07/17/2019	2020.01	07/17/2019 01:21:17 PM Eastern Daylight Time	08/01/2019 10:47:40 AM Eastern Daylight Time	07/31/2019 11:35:27 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	1	4		1			H3916	34	1	2020	North Central PA	Lehigh Valley	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	34	3	1	4	1	H3916_034_3	4	1			07/17/2019	2020.01	07/17/2019 01:21:08 PM Eastern Daylight Time	08/01/2019 10:48:14 AM Eastern Daylight Time	07/31/2019 11:41:10 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	1	4		1			H3916	34	3	2020	North Central PA	South Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	34	4	1	4	1	H3916_034_4	4	1			07/17/2019	2020.01	07/17/2019 01:20:58 PM Eastern Daylight Time	08/01/2019 10:48:47 AM Eastern Daylight Time	07/31/2019 11:37:59 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	1	4		1			H3916	34	4	2020	North Central PA	North Central	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	34	5	1	4	1	H3916_034_5	4	1			07/17/2019	2020.01	07/17/2019 01:22:27 PM Eastern Daylight Time	08/01/2019 10:49:19 AM Eastern Daylight Time	07/31/2019 11:44:12 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	1	4		1			H3916	34	5	2020	North Central PA	Lancaster	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	35	1	1	4	1	H3916_035_1	4	1			07/17/2019	2020.01	07/17/2019 01:23:56 PM Eastern Daylight Time	08/01/2019 10:49:50 AM Eastern Daylight Time	07/31/2019 11:51:38 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	1	4		1			H3916	35	1	2020	Western PA	Southwest PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	35	2	1	4	1	H3916_035_2	4	1			07/17/2019	2020.01	07/17/2019 01:24:43 PM Eastern Daylight Time	08/01/2019 10:50:21 AM Eastern Daylight Time	07/31/2019 11:54:43 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	1	4		1			H3916	35	2	2020	Western PA	West Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	35	3	1	4	1	H3916_035_3	4	1			07/17/2019	2020.01	07/17/2019 01:25:47 PM Eastern Daylight Time	08/01/2019 10:50:53 AM Eastern Daylight Time	07/31/2019 11:57:33 AM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Distinct (PPO)	1	4		1			H3916	35	3	2020	Western PA	Northwestern PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	36	0	1	4	1	H3916_036_0	4	1			07/17/2019	2020.01	07/17/2019 01:27:00 PM Eastern Daylight Time	08/01/2019 10:51:25 AM Eastern Daylight Time	07/31/2019 12:00:32 PM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare Plus PPO Distinct (PPO)	1	4		1			H3916	36	0	2020	"Counties: TA, LG, SN, CN"		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	37	1	1	4	1	H3916_037_1	4	1			07/17/2019	2020.01	07/17/2019 01:28:02 PM Eastern Daylight Time	08/01/2019 10:51:56 AM Eastern Daylight Time	07/31/2019 12:03:18 PM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Signature (PPO)	1	4		1			H3916	37	1	2020	Central PA	Lehigh Valley PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	37	2	1	4	1	H3916_037_2	6	1			07/17/2019	2020.01	07/17/2019 01:28:51 PM Eastern Daylight Time	08/01/2019 10:52:28 AM Eastern Daylight Time	07/31/2019 12:06:37 PM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Signature (PPO)	1	4		1			H3916	37	2	2020	Central PA	South Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	37	3	1	4	1	H3916_037_3	4	1			07/17/2019	2020.01	07/17/2019 01:29:49 PM Eastern Daylight Time	08/01/2019 10:52:59 AM Eastern Daylight Time	07/31/2019 12:09:23 PM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Signature (PPO)	1	4		1			H3916	37	3	2020	Central PA	NEPA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	37	4	1	4	1	H3916_037_4	4	1			07/17/2019	2020.01	07/17/2019 01:30:48 PM Eastern Daylight Time	08/01/2019 10:54:22 AM Eastern Daylight Time	07/31/2019 12:12:09 PM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Signature (PPO)	1	4		1			H3916	37	4	2020	Central PA	Lancaster PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	38	0	1	4	1	H3916_038_0	4	1			07/17/2019	2020.01	07/17/2019 01:32:39 PM Eastern Daylight Time	08/01/2019 10:55:03 AM Eastern Daylight Time	07/31/2019 12:15:55 PM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO Signature (PPO)	1	4		1			H3916	38	0	2020	Northwestern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3916	39	0	1	4	1	H3916_039_0	4	1			07/17/2019	2020.01	07/17/2019 02:40:08 PM Eastern Daylight Time	08/01/2019 10:55:41 AM Eastern Daylight Time	07/31/2019 12:18:46 PM Eastern Daylight Time			08/02/2019 01:32:23 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare Plus PPO Signature (PPO)	1	4		1			H3916	39	0	2020	"Counties: TA, CN. LG, SN"		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(888)757-2946		(888)757-2946		(844)785-1787		(844)785-1787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3916	801	0	1	4	1	H3916_801_0	2	1			05/17/2019	2020.01	05/17/2019 02:11:04 PM Eastern Daylight Time					05/31/2019 01:28:06 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MA PA CALENDAR (PPO)	1	4		1			H3916	801	0	2020	Pennsylvania		1	244524	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H3916	802	0	1	4	1	H3916_802_0	2	1			05/17/2019	2020.01	05/17/2019 02:11:17 PM Eastern Daylight Time					05/31/2019 01:28:06 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MAPD PA CALENDAR (PPO)	1	4		1			H3916	802	0	2020	Pennsylvania		1	507172	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H3916	804	0	1	4	1	H3916_804_0	2	1			05/17/2019	2020.01	05/17/2019 02:04:36 PM Eastern Daylight Time					05/31/2019 01:28:06 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MAPD PA Non-Calendar (PPO)	1	4		1			H3916	804	0	2020	Pennsylvania		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H3916	805	0	1	4	1	H3916_805_0	2	1			05/17/2019	2020.01	05/17/2019 02:12:52 PM Eastern Daylight Time					05/31/2019 01:28:06 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO MA PA Calendar (PPO)	1	4		1			H3916	805	0	2020	Pennsylvania		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H3916	806	0	1	4	1	H3916_806_0	2	1			05/17/2019	2020.01	05/17/2019 02:13:05 PM Eastern Daylight Time					05/31/2019 01:28:06 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare PPO PA MAPD Calendar (PPO)	1	4		1			H3916	806	0	2020	Pennsylvania		1	28884	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H3916	807	0	1	4	1	H3916_807_0	2	1			05/17/2019	2020.01	05/17/2019 02:13:24 PM Eastern Daylight Time					05/31/2019 01:28:06 PM Eastern Daylight Time	HIGHMARK SENIOR HEALTH COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare Plus PPO MAPD Calendar (PPO)	1	4		1			H3916	807	0	2020	Pennsylvania		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H3917	1	0	1	20	8	H3917_001_0	1	1			05/21/2019	2020.01	05/21/2019 05:09:32 PM Eastern Daylight Time		05/21/2019 01:33:51 PM Eastern Daylight Time			05/21/2019 05:11:20 PM Eastern Daylight Time	"PITTSBURGH CARE PARTNERSHIP, INC."	Community LIFE	http://www.commlife.org/	Community LIFE (PACE)	8	20		1			H3917	1	0	2020	"Allegheny Westmoreland Washington partial, Bedford"		2	9331	2			2						www.commlife.org	www.commlife.org										(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101										(711)-		(711)-		(711)-		(711)-																
H3917	2	0	1	20	8	H3917_002_0	1	1			05/21/2019	2020.01	05/21/2019 05:07:14 PM Eastern Daylight Time		05/21/2019 01:34:03 PM Eastern Daylight Time			05/21/2019 05:11:20 PM Eastern Daylight Time	"PITTSBURGH CARE PARTNERSHIP, INC."	Community LIFE	http://www.commlife.org/	Community LIFE (PACE)	8	20		1			H3917	2	0	2020	"Allegheny Westmoreland Washington partial, Bedford"		2	46	2			2						www.commlife.org	www.commlife.org										(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101										(711)-		(711)-		(711)-		(711)-																
H3918	1	0	1	20	8	H3918_001_0	1	1			05/24/2019	2020.01	05/24/2019 07:51:04 AM Eastern Daylight Time		05/24/2019 07:41:44 AM Eastern Daylight Time			05/24/2019 07:53:14 AM Eastern Daylight Time	LIVING INDEPENDENCE FOR THE ELDERLY	LIFE Pittsburgh	LIFEPittsburgh.org	LIFE Pittsburgh Dual Eligibles Pharmacy (PACE)	8	20		1			H3918	1	0	2020	Partial Allegheny*		2		2			2						none	not applicable -- no formulary										(412)388-8042		(412)388-8042		(412)388-8042		(412)388-8042										(412)388-8042		(412)388-8042		(412)388-8042		(412)388-8042																
H3918	2	0	1	20	8	H3918_002_0	1	1			05/24/2019	2020.01	05/24/2019 07:51:40 AM Eastern Daylight Time		05/24/2019 07:43:23 AM Eastern Daylight Time			05/24/2019 07:53:14 AM Eastern Daylight Time	LIVING INDEPENDENCE FOR THE ELDERLY	LIFE Pittsburgh	LIFEPittsburgh.org	LIFE Pittsburgh Medicare Only Pharmacy (PACE)	8	20		1			H3918	2	0	2020	Partial Allegheny *		2		2			2						none	not applicable -- no formulary										(412)388-8042		(412)388-8042		(412)388-8042		(412)388-8042										(412)388-8042		(412)388-8042		(412)388-8042		(412)388-8042																
H3919	1	0	1	20	8	H3919_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:39:49 PM Eastern Daylight Time		05/22/2019 11:54:54 AM Eastern Daylight Time			05/22/2019 01:42:03 PM Eastern Daylight Time	ST. AGNES CONTINUING CARE CENTER	Mercy LIFE	www.mercylife.org	Mercy LIFE (PACE)	8	20		1			H3919	1	0	2020	"Counties: PHL (partial), DelCo, Montco (partial)"		2		2			2						www.mercylife.org	www.mercylife.org												(215)339-4747				(215)339-4747												(800)654-5984				(800)654-5984																
H3919	2	0	1	20	8	H3919_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:40:14 PM Eastern Daylight Time		05/22/2019 11:55:35 AM Eastern Daylight Time			05/22/2019 01:42:03 PM Eastern Daylight Time	ST. AGNES CONTINUING CARE CENTER	Mercy LIFE	www.mercylife.org	Mercy LIFE (PACE)	8	20		1			H3919	2	0	2020	"PHL (partial), DelCo, Montco (partial) Counties"		2		2			2						www.mercylife.org	www.mercylife.org												(215)339-4747				(215)339-4747												(800)654-5984				(800)654-5984																
H3923	13	0	1	4	1	H3923_013_0	3	1			07/08/2019	2020.01	07/08/2019 01:14:05 PM Eastern Daylight Time	07/31/2019 02:49:06 PM Eastern Daylight Time	07/31/2019 02:49:42 PM Eastern Daylight Time			08/02/2019 04:13:30 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Classic (PPO)	1	4		1			H3923	13	0	2020	21 Counties in Central PA		2	100836	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3923	17	0	1	4	1	H3923_017_0	3	1			07/08/2019	2020.01	07/08/2019 01:19:23 PM Eastern Daylight Time	07/31/2019 02:50:40 PM Eastern Daylight Time	07/31/2019 02:51:18 PM Eastern Daylight Time			08/02/2019 04:13:30 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Prime (PPO)	1	4		1			H3923	17	0	2020	21 Counties in Central PA		2	47580	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3923	801	0	1	4	1	H3923_801_0	1	1			06/02/2019	2020.01	06/02/2019 03:39:36 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Silver Rx (PPO)	1	4		1			H3923	801	0	2020	National		1	5833	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1									
H3923	802	0	1	4	1	H3923_802_0	1	1			06/02/2019	2020.01	06/02/2019 03:44:47 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Without Rx (PPO)	1	4		1			H3923	802	0	2020	National		1	564	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1									
H3923	803	0	1	4	1	H3923_803_0	1	1			06/02/2019	2020.01	06/02/2019 03:45:00 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Bronze Rx FY (PPO)	1	4		1			H3923	803	0	2020	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1									
H3923	817	0	1	4	1	H3923_817_0	1	1			06/02/2019	2020.01	06/02/2019 03:45:26 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Gold Rx (PPO)	1	4		1			H3923	817	0	2020	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1									
H3923	818	0	1	4	1	H3923_818_0	1	1			06/02/2019	2020.01	06/02/2019 03:45:42 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Platinum Rx (PPO)	1	4		1			H3923	818	0	2020	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1									
H3923	819	0	1	4	1	H3923_819_0	1	1			06/02/2019	2020.01	06/02/2019 03:45:58 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Bronze Rx (PPO)	1	4		1			H3923	819	0	2020	National		1	59	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1									
H3923	820	0	1	4	1	H3923_820_0	1	1			06/02/2019	2020.01	06/02/2019 03:46:04 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Platinum Rx FY (PPO)	1	4		1			H3923	820	0	2020	National		1	5912	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1									
H3923	821	0	1	4	1	H3923_821_0	1	1			06/02/2019	2020.01	06/02/2019 03:46:23 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Gold Rx FY (PPO)	1	4		1			H3923	821	0	2020	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1									
H3923	822	0	1	4	1	H3923_822_0	1	1			06/02/2019	2020.01	06/02/2019 03:46:38 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	www.capitalbluemedicare.com	BlueJourney Group PPO Silver Rx FY (PPO)	1	4		1			H3923	822	0	2020	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;17a;17b;18a;	2		1									
H3924	59	13	1	4	1	H3924_059_13	5	1			08/02/2019	2020.01	08/02/2019 05:17:39 PM Eastern Daylight Time	08/02/2019 06:10:57 PM Eastern Daylight Time	08/02/2019 06:11:04 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	1	4		1			H3924	59	13	2020	Pennsylvania	Midstate	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	59	14	1	4	1	H3924_059_14	5	1			08/02/2019	2020.01	08/02/2019 06:47:06 PM Eastern Daylight Time	08/02/2019 06:10:57 PM Eastern Daylight Time	08/02/2019 06:11:04 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	1	4		1			H3924	59	14	2020	Pennsylvania	Central	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	59	15	1	4	1	H3924_059_15	5	1			08/02/2019	2020.01	08/02/2019 06:47:17 PM Eastern Daylight Time	08/02/2019 06:10:58 PM Eastern Daylight Time	08/02/2019 06:11:04 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	1	4		1			H3924	59	15	2020	Pennsylvania	"Bucks, Carbon, Lehigh, Monroe, Northampton"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	59	16	1	4	1	H3924_059_16	5	1			08/02/2019	2020.01	08/02/2019 06:47:31 PM Eastern Daylight Time	08/02/2019 06:10:58 PM Eastern Daylight Time	08/02/2019 06:11:04 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	1	4		1			H3924	59	16	2020	Pennsylvania	Midwest	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	59	17	1	4	1	H3924_059_17	5	1			08/02/2019	2020.01	08/02/2019 06:47:51 PM Eastern Daylight Time	08/02/2019 06:10:58 PM Eastern Daylight Time	08/02/2019 06:11:04 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	1	4		1			H3924	59	17	2020	Pennsylvania	"Berks,Chester,Cumberland,Dauphin,Lancaster,Perry"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	59	18	1	4	1	H3924_059_18	5	1			08/02/2019	2020.01	08/02/2019 06:48:07 PM Eastern Daylight Time	08/02/2019 06:10:58 PM Eastern Daylight Time	08/02/2019 06:11:04 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	1	4		1			H3924	59	18	2020	Pennsylvania	"Adams, Franklin, Lebanon, York"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	60	13	1	4	1	H3924_060_13	7	1			08/06/2019	2020.01	08/06/2019 05:36:13 PM Eastern Daylight Time	08/02/2019 06:10:58 PM Eastern Daylight Time	08/02/2019 06:11:04 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	1	4		1			H3924	60	13	2020	Pennsylvania	Midstate	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	60	14	1	4	1	H3924_060_14	7	1			08/06/2019	2020.01	08/06/2019 05:37:11 PM Eastern Daylight Time	08/02/2019 06:10:58 PM Eastern Daylight Time	08/02/2019 06:11:04 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	1	4		1			H3924	60	14	2020	Pennsylvania	Central	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	60	15	1	4	1	H3924_060_15	6	1			08/06/2019	2020.01	08/06/2019 05:37:44 PM Eastern Daylight Time	08/02/2019 06:10:58 PM Eastern Daylight Time	08/02/2019 06:11:05 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	1	4		1			H3924	60	15	2020	Pennsylvania	"Bucks, Carbon, Lehigh, Monroe, Northampton"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	60	16	1	4	1	H3924_060_16	7	1			08/06/2019	2020.01	08/06/2019 05:37:52 PM Eastern Daylight Time	08/02/2019 06:10:58 PM Eastern Daylight Time	08/02/2019 06:11:05 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	1	4		1			H3924	60	16	2020	Pennsylvania	Midwest	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	60	17	1	4	1	H3924_060_17	6	1			08/06/2019	2020.01	08/06/2019 05:38:09 PM Eastern Daylight Time	08/02/2019 06:10:59 PM Eastern Daylight Time	08/02/2019 06:11:05 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	1	4		1			H3924	60	17	2020	Pennsylvania	"Berks,Chester,Cumberland,Dauphin,Lancaster,Perry"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	60	18	1	4	1	H3924_060_18	6	1			08/06/2019	2020.01	08/06/2019 05:38:17 PM Eastern Daylight Time	08/02/2019 06:10:59 PM Eastern Daylight Time	08/02/2019 06:11:05 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	1	4		1			H3924	60	18	2020	Pennsylvania	"Adams, Franklin, Lebanon, York"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	62	13	1	4	1	H3924_062_13	5	1			08/02/2019	2020.01	08/02/2019 06:45:02 PM Eastern Daylight Time	08/02/2019 06:10:59 PM Eastern Daylight Time	08/02/2019 06:11:05 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	1	4		1			H3924	62	13	2020	Pennsylvania	Midstate	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	62	14	1	4	1	H3924_062_14	5	1			08/02/2019	2020.01	08/02/2019 06:49:33 PM Eastern Daylight Time	08/02/2019 06:10:59 PM Eastern Daylight Time	08/02/2019 06:11:05 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	1	4		1			H3924	62	14	2020	Pennsylvania	Central	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	62	15	1	4	1	H3924_062_15	4	1			08/02/2019	2020.01	08/02/2019 06:49:46 PM Eastern Daylight Time	08/02/2019 06:10:59 PM Eastern Daylight Time	08/02/2019 06:11:05 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	1	4		1			H3924	62	15	2020	Pennsylvania	"Bucks, Carbon, Lehigh, Monroe, Northampton"	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	62	16	1	4	1	H3924_062_16	5	1			08/02/2019	2020.01	08/02/2019 06:50:02 PM Eastern Daylight Time	08/02/2019 06:10:59 PM Eastern Daylight Time	08/02/2019 06:11:05 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	1	4		1			H3924	62	16	2020	Pennsylvania	Midwest	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	62	17	1	4	1	H3924_062_17	4	1			08/02/2019	2020.01	08/02/2019 06:50:19 PM Eastern Daylight Time	08/02/2019 06:10:59 PM Eastern Daylight Time	08/02/2019 06:11:05 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	1	4		1			H3924	62	17	2020	Pennsylvania	"Berks,Chester,Cumberland,Dauphin,Lancaster,Perry"	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	62	18	1	4	1	H3924_062_18	4	1			08/02/2019	2020.01	08/02/2019 06:50:32 PM Eastern Daylight Time	08/02/2019 06:11:00 PM Eastern Daylight Time	08/02/2019 06:11:06 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	GeisingerGold.com	Geisinger Gold Preferred Enhanced Rx (PPO)	1	4		1			H3924	62	18	2020	Pennsylvania	"Adams, Franklin, Lebanon, York"	2		2			2						GeisingerGold.com	GeisingerGold.com	GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3924	804	0	1	4	1	H3924_804_0	2	1			05/24/2019	2020.01	05/24/2019 04:01:00 PM Eastern Daylight Time					06/02/2019 04:14:25 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Rx Employer Group Plan (PPO)	1	4		1			H3924	804	0	2020	Pennsylvania		1	600	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H3925	1	0	1	20	8	H3925_001_0	1	1			05/20/2019	2020.01	05/20/2019 02:13:20 PM Eastern Daylight Time		05/20/2019 01:04:37 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"PENNSYLVANIA PACE, INC."	"Senior LIFE Johnstown, Inc."	www.seniorlifepa.com	Senior LIFE Johnstown Dual Eligible (PACE)	8	20		1			H3925	1	0	2020	Cambria and Somerset Counties		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H3925	2	0	1	20	8	H3925_002_0	1	1			05/20/2019	2020.01	05/20/2019 02:13:38 PM Eastern Daylight Time		05/20/2019 01:04:36 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"PENNSYLVANIA PACE, INC."	"Senior LIFE Johnstown, Inc."	www.seniorlifejohnstown.com	Senior LIFE Johnstown Medicare Only (PACE)	8	20		1			H3925	2	0	2020	Cambria and Somerset Counties		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H3928	1	0	1	1	1	H3928_001_0	4	1			08/01/2019	2020.01	08/01/2019 05:40:50 PM Eastern Daylight Time	08/01/2019 06:10:36 PM Eastern Daylight Time	07/30/2019 11:51:19 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	"AETNA HEALTH, INC. (LA)"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Plan (HMO)	1	1		1			H3928	1	0	2020	New Orleans - Baton Rouge Metro Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3928	2	0	1	1	1	H3928_002_0	4	1			07/03/2019	2020.01	07/03/2019 07:40:46 PM Eastern Daylight Time	08/01/2019 06:11:10 PM Eastern Daylight Time	07/30/2019 11:52:31 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	"AETNA HEALTH, INC. (LA)"	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Plan (HMO)	1	1		1			H3928	2	0	2020	"Bossier, Caddo and St. Tammany Parishes"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3928	801	0	1	1	1	H3928_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:45:42 AM Eastern Daylight Time					05/30/2019 06:39:48 PM Eastern Daylight Time	"AETNA HEALTH, INC. (LA)"	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H3928	801	0	2020	Louisiana		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3928	803	0	1	1	1	H3928_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:45:52 AM Eastern Daylight Time					05/30/2019 06:39:48 PM Eastern Daylight Time	"AETNA HEALTH, INC. (LA)"	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H3928	803	0	2020	Louisiana		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3928	804	0	1	1	1	H3928_804_0	1	1			05/24/2019	2020.01	05/24/2019 09:46:02 AM Eastern Daylight Time					05/30/2019 06:39:48 PM Eastern Daylight Time	"AETNA HEALTH, INC. (LA)"	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H3928	804	0	2020	Louisiana		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3930	1	0	1	1	1	H3930_001_0	8	1		1	07/24/2019	2020.01	07/24/2019 01:05:29 PM Central Daylight Time	08/01/2019 11:17:52 AM Central Daylight Time	07/31/2019 02:36:13 PM Central Daylight Time			08/05/2019 06:27:26 PM Central Daylight Time	"SPARTAN PLAN NY, INC."	Sunrise Advantage Plan	www.sunriseadvantageplan.com	Sunrise Advantage Plan (HMO I-SNP)	1	1		1			H3930	1	0	2020	New York (partial)		2	2232	2			1	1	3				www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3930	2	0	1	1	1	H3930_002_0	8	1		1	07/24/2019	2020.01	07/24/2019 01:05:46 PM Central Daylight Time	08/01/2019 11:19:04 AM Central Daylight Time	07/31/2019 02:52:32 PM Central Daylight Time			08/05/2019 06:27:26 PM Central Daylight Time	"SPARTAN PLAN NY, INC."	Sunrise Advantage Plan	www.sunriseadvantageplan.com	Reflections (HMO C-SNP)	1	1		1			H3930	2	0	2020	New York (partial)		2	528	2			1	4			1E+14		www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3930	3	0	1	1	1	H3930_003_0	9	1			07/24/2019	2020.01	07/24/2019 01:06:02 PM Central Daylight Time	08/01/2019 11:25:21 AM Central Daylight Time	07/31/2019 02:53:01 PM Central Daylight Time			08/05/2019 06:27:26 PM Central Daylight Time	"SPARTAN PLAN NY, INC."	Sunrise Advantage Plan	www.sunriseadvantageplan.com	Sunrise Advantage Community Plan (HMO)	1	1		1			H3930	3	0	2020	New York (partial)		2	508	2			2						www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	4	0	1	1	1	H3931_004_0	5	1			07/03/2019	2020.01	07/03/2019 07:15:37 PM Eastern Daylight Time	08/02/2019 01:28:22 PM Eastern Daylight Time	07/30/2019 11:53:40 PM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (HMO)	1	1		1			H3931	4	0	2020	Southeast Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	64	0	1	1	1	H3931_064_0	4	1			07/03/2019	2020.01	07/03/2019 06:44:41 PM Eastern Daylight Time	08/02/2019 01:29:03 PM Eastern Daylight Time	07/30/2019 11:54:49 PM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (HMO)	1	1		1			H3931	64	0	2020	Southeast Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	70	0	1	1	1	H3931_070_0	4	1			07/03/2019	2020.01	07/03/2019 06:45:03 PM Eastern Daylight Time	08/02/2019 01:29:47 PM Eastern Daylight Time	07/30/2019 11:55:59 PM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Silver (HMO)	1	1		1			H3931	70	0	2020	Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	81	0	1	1	1	H3931_081_0	3	1			08/01/2019	2020.01	08/01/2019 10:17:33 AM Eastern Daylight Time	08/01/2019 11:37:02 AM Eastern Daylight Time	07/30/2019 11:57:08 PM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3931	81	0	2020	Raleigh NC and Surrounding Area		2	31500	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	91	0	1	1	1	H3931_091_0	4	1			08/01/2019	2020.01	08/01/2019 04:24:05 PM Eastern Daylight Time	08/02/2019 01:30:26 PM Eastern Daylight Time	07/30/2019 11:58:17 PM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare PinnacleHealth Prime (HMO)	1	1		1			H3931	91	0	2020	Cumberland and Dauphin counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	92	0	1	1	1	H3931_092_0	3	1			07/31/2019	2020.01	07/31/2019 04:57:58 PM Eastern Daylight Time	08/02/2019 06:52:31 AM Pacific Daylight Time	07/30/2019 08:59:26 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	1	1		1			H3931	92	0	2020	Maricopa County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	93	0	1	1	1	H3931_093_0	5	1			08/01/2019	2020.01	08/01/2019 11:41:52 AM Central Daylight Time	08/01/2019 03:45:58 PM Central Daylight Time	07/30/2019 11:00:35 PM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (HMO)	1	1		1			H3931	93	0	2020	Denver Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	94	0	1	1	1	H3931_094_0	3	1			07/31/2019	2020.01	07/31/2019 07:42:17 PM Eastern Daylight Time	08/02/2019 10:10:25 AM Eastern Daylight Time	07/31/2019 12:01:45 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	1	1		1			H3931	94	0	2020	Clark County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	95	0	1	1	1	H3931_095_0	4	1			07/03/2019	2020.01	07/03/2019 06:04:12 PM Eastern Daylight Time	08/02/2019 09:56:31 AM Eastern Daylight Time	07/31/2019 12:02:55 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	1	1		1			H3931	95	0	2020	District of Columbia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	96	0	1	1	1	H3931_096_0	4	1			07/03/2019	2020.01	07/03/2019 06:04:29 PM Eastern Daylight Time	08/02/2019 09:59:26 AM Eastern Daylight Time	07/31/2019 12:04:04 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	1	1		1			H3931	96	0	2020	Fairfax County and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	97	0	1	1	1	H3931_097_0	4	1			07/03/2019	2020.01	07/03/2019 06:04:45 PM Eastern Daylight Time	08/02/2019 10:02:26 AM Eastern Daylight Time	07/31/2019 12:05:14 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Connect Plus (HMO)	1	1		1			H3931	97	0	2020	Southern Maryland		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	98	0	1	1	1	H3931_098_0	4	1			08/01/2019	2020.01	08/01/2019 02:30:06 PM Eastern Daylight Time	08/02/2019 10:04:24 AM Eastern Daylight Time	07/31/2019 12:06:24 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	1	1		1			H3931	98	0	2020	Richmond and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	99	0	1	1	1	H3931_099_0	4	1			08/01/2019	2020.01	08/01/2019 08:59:07 AM Eastern Daylight Time	08/02/2019 10:06:24 AM Eastern Daylight Time	07/31/2019 12:07:35 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	1	1		1			H3931	99	0	2020	Danville and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	100	0	1	1	1	H3931_100_0	4	1			08/01/2019	2020.01	08/01/2019 08:59:24 AM Eastern Daylight Time	08/02/2019 10:08:23 AM Eastern Daylight Time	07/31/2019 12:09:20 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	1	1		1			H3931	100	0	2020	Newport News and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	101	0	1	1	1	H3931_101_0	4	1			08/01/2019	2020.01	08/01/2019 08:59:46 AM Eastern Daylight Time	08/02/2019 10:10:24 AM Eastern Daylight Time	07/31/2019 12:10:32 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	1	1		1			H3931	101	0	2020	Roanoke and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	102	0	1	1	1	H3931_102_0	4	1			07/03/2019	2020.01	07/03/2019 06:45:38 PM Eastern Daylight Time	08/02/2019 01:31:04 PM Eastern Daylight Time	07/31/2019 12:11:43 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (HMO)	1	1		1			H3931	102	0	2020	"New Castle, Kent and Sussex Counties"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	104	0	1	1	1	H3931_104_0	4	1			08/01/2019	2020.01	08/01/2019 04:24:47 PM Eastern Daylight Time	08/02/2019 01:31:41 PM Eastern Daylight Time	07/31/2019 12:12:52 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (HMO)	1	1		1			H3931	104	0	2020	"New Castle, Kent and Sussex Counties"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	105	0	1	1	1	H3931_105_0	4	1			08/01/2019	2020.01	08/01/2019 04:25:35 PM Eastern Daylight Time	08/02/2019 01:32:21 PM Eastern Daylight Time	07/31/2019 12:14:12 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Main Line Health Prime (HMO)	1	1		1			H3931	105	0	2020	"Chester, Delaware and Montgomery counties"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	106	0	1	1	1	H3931_106_0	8	1			07/03/2019	2020.01	07/03/2019 05:28:56 PM Eastern Daylight Time	08/02/2019 11:25:03 AM Eastern Daylight Time	07/31/2019 12:15:26 AM Eastern Daylight Time			08/02/2019 07:36:58 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (HMO)	1	1		1			H3931	106	0	2020	Chicagoland		2	17448	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	107	0	1	1	1	H3931_107_0	4	1			07/31/2019	2020.01	07/31/2019 08:52:52 PM Eastern Daylight Time	08/02/2019 10:40:59 AM Eastern Daylight Time	07/31/2019 12:16:37 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3931	107	0	2020	Northeastern/Youngstown OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	108	0	1	1	1	H3931_108_0	4	1			08/01/2019	2020.01	08/01/2019 02:22:50 PM Eastern Daylight Time	08/02/2019 10:41:39 AM Eastern Daylight Time	07/31/2019 12:17:47 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3931	108	0	2020	Central OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	109	0	1	1	1	H3931_109_0	4	1			07/31/2019	2020.01	07/31/2019 08:54:07 PM Eastern Daylight Time	08/02/2019 10:42:17 AM Eastern Daylight Time	07/31/2019 12:18:57 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (HMO)	1	1		1			H3931	109	0	2020	Toledo and Cincinnati OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	110	0	1	1	1	H3931_110_0	4	1			08/01/2019	2020.01	08/01/2019 02:30:54 PM Eastern Daylight Time	08/02/2019 10:42:57 AM Eastern Daylight Time	07/31/2019 12:20:07 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (HMO)	1	1		1			H3931	110	0	2020	Dayton OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	112	0	1	1	1	H3931_112_0	4	1			08/01/2019	2020.01	08/01/2019 04:26:16 PM Eastern Daylight Time	08/02/2019 01:32:59 PM Eastern Daylight Time	07/31/2019 12:21:16 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite (HMO)	1	1		1			H3931	112	0	2020	Southeastern and Central PA		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	115	0	1	1	1	H3931_115_0	3	1			07/31/2019	2020.01	07/31/2019 07:42:40 PM Eastern Daylight Time	08/02/2019 10:12:08 AM Eastern Daylight Time	07/31/2019 12:22:28 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO)	1	1		1			H3931	115	0	2020	"Carson City, Douglas and Washoe Counties"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	118	0	1	1	1	H3931_118_0	4	1			08/01/2019	2020.01	08/01/2019 02:31:39 PM Eastern Daylight Time	08/02/2019 10:43:36 AM Eastern Daylight Time	07/31/2019 12:23:38 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3931	118	0	2020	Lexington KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	122	0	1	1	1	H3931_122_0	5	1			08/01/2019	2020.01	08/01/2019 03:11:14 PM Eastern Daylight Time	08/02/2019 09:43:35 AM Eastern Daylight Time	07/31/2019 12:24:47 AM Eastern Daylight Time			08/05/2019 12:49:49 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3931	122	0	2020	Massachusetts		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	124	0	1	1	1	H3931_124_0	4	1			08/01/2019	2020.01	08/01/2019 09:00:04 AM Eastern Daylight Time	08/02/2019 10:12:24 AM Eastern Daylight Time	07/31/2019 12:25:56 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare UVA Health System Prime (HMO)	1	1		1			H3931	124	0	2020	Charlottesville and Surrounding area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	126	0	1	1	1	H3931_126_0	3	1			07/31/2019	2020.01	07/31/2019 03:47:04 PM Eastern Daylight Time	08/01/2019 05:15:41 PM Eastern Daylight Time	07/31/2019 12:27:05 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3931	126	0	2020	Puget Sound		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	127	0	1	1	1	H3931_127_0	3	1			07/03/2019	2020.01	07/03/2019 02:37:49 PM Eastern Daylight Time	08/01/2019 05:26:58 PM Eastern Daylight Time	07/31/2019 12:28:15 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO)	1	1		1			H3931	127	0	2020	Puget Sound		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	129	0	1	1	1	H3931_129_0	3	1			07/31/2019	2020.01	07/31/2019 04:58:43 PM Eastern Daylight Time	08/02/2019 07:18:34 AM Pacific Daylight Time	07/30/2019 09:29:25 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO)	1	1		1			H3931	129	0	2020	Pima and Pinal Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	130	0	1	1	1	H3931_130_0	3	1			07/31/2019	2020.01	07/31/2019 05:00:02 PM Eastern Daylight Time	08/02/2019 07:19:36 AM Pacific Daylight Time	07/30/2019 09:30:34 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO)	1	1		1			H3931	130	0	2020	Maricopa county		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	131	0	1	1	1	H3931_131_0	3	1			07/03/2019	2020.01	07/03/2019 11:45:23 AM Pacific Daylight Time	08/02/2019 07:20:48 AM Pacific Daylight Time	07/30/2019 09:31:43 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (HMO)	1	1		1			H3931	131	0	2020	"Mohave, Yavapai and Gila counties"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	132	0	1	1	1	H3931_132_0	4	1			07/31/2019	2020.01	07/31/2019 08:54:43 PM Eastern Daylight Time	08/02/2019 10:44:15 AM Eastern Daylight Time	07/31/2019 12:32:52 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3931	132	0	2020	Toledo OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	133	0	1	1	1	H3931_133_0	4	1			08/01/2019	2020.01	08/01/2019 02:25:12 PM Eastern Daylight Time	08/02/2019 10:44:55 AM Eastern Daylight Time	07/31/2019 12:34:02 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3931	133	0	2020	Louisville KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	134	0	1	1	1	H3931_134_0	4	1			07/31/2019	2020.01	07/31/2019 08:55:56 PM Eastern Daylight Time	08/02/2019 10:45:34 AM Eastern Daylight Time	07/31/2019 12:35:11 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3931	134	0	2020	Bowling Green/Southwest KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	140	0	1	1	1	H3931_140_0	4	1			08/01/2019	2020.01	08/01/2019 02:26:07 PM Eastern Daylight Time	08/02/2019 10:46:13 AM Eastern Daylight Time	07/31/2019 12:36:20 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3931	140	0	2020	Ashland KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	141	0	1	1	1	H3931_141_0	4	1			07/31/2019	2020.01	07/31/2019 08:58:21 PM Eastern Daylight Time	08/02/2019 10:46:53 AM Eastern Daylight Time	07/31/2019 12:37:31 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3931	141	0	2020	Eastern KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	142	0	1	1	1	H3931_142_0	4	1			07/31/2019	2020.01	07/31/2019 08:59:13 PM Eastern Daylight Time	08/02/2019 10:47:34 AM Eastern Daylight Time	07/31/2019 12:38:41 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H3931	142	0	2020	Northern Kentucky		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3931	801	0	1	1	1	H3931_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:46:15 AM Eastern Daylight Time					05/30/2019 06:41:56 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H3931	801	0	2020	Pennsylvania		1	28980	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-1637		(888)267-1637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3931	804	0	1	1	1	H3931_804_0	1	1			05/24/2019	2020.01	05/24/2019 09:46:25 AM Eastern Daylight Time					05/30/2019 06:41:56 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H3931	804	0	2020	Pennsylvania		1	56110	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3931	807	0	1	1	1	H3931_807_0	1	1			05/24/2019	2020.01	05/24/2019 09:46:37 AM Eastern Daylight Time					05/30/2019 06:41:56 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H3931	807	0	2020	Multi-State		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3942	1	0	1	20	8	H3942_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:54:42 PM Eastern Daylight Time		05/23/2019 03:38:03 PM Eastern Daylight Time			05/23/2019 03:45:33 PM Eastern Daylight Time	ELDERHAUS INC.	Elderhaus PACE	www.elderhaus.com	Elderhaus PACE (PACE)	8	20		1			H3942	1	0	2020	Elderhaus PACE-New Hanover County		2	1500	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	2	0	1	20	8	H3942_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:12:08 PM Eastern Daylight Time		05/23/2019 03:38:45 PM Eastern Daylight Time			05/23/2019 03:45:33 PM Eastern Daylight Time	ELDERHAUS INC.	Elderhaus PACE	www.elderhaus.com	Elderhaus PACE (PACE)	8	20		1			H3942	2	0	2020	Elderhaus PACE-Brunswick County		2	1500	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																
H3949	9	0	1	1	1	H3949_009_0	4	1	2	1	07/08/2019	2020.01	07/08/2019 04:45:22 PM Central Daylight Time	07/31/2019 05:03:16 PM Central Daylight Time	07/30/2019 04:13:40 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH PENNSYLVANIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H3949	9	0	2020	Philadelphia Area		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H3949	13	0	1	1	1	H3949_013_0	4	1			07/08/2019	2020.01	07/08/2019 04:46:02 PM Central Daylight Time	07/31/2019 05:03:37 PM Central Daylight Time	07/30/2019 04:13:53 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH PENNSYLVANIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus (HMO)	1	1		1			H3949	13	0	2020	Philadelphia Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H3949	16	0	1	1	1	H3949_016_0	4	1		1	07/08/2019	2020.01	07/08/2019 04:46:47 PM Central Daylight Time	07/31/2019 05:03:59 PM Central Daylight Time	07/30/2019 04:14:07 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH PENNSYLVANIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Traditions (HMO I-SNP)	1	1		1			H3949	16	0	2020	Philadelphia Area		2		2			1	1	1				www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H3949	24	0	1	1	1	H3949_024_0	4	1		1	07/08/2019	2020.01	07/08/2019 04:47:26 PM Central Daylight Time	07/31/2019 05:04:21 PM Central Daylight Time	07/30/2019 04:14:21 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH PENNSYLVANIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Achieve (HMO C-SNP)	1	1		1			H3949	24	0	2020	Philadelphia Area		2		2			1	4			1E+13		www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H3949	26	0	1	1	1	H3949_026_0	3	1			07/08/2019	2020.01	07/08/2019 04:48:06 PM Central Daylight Time	05/29/2019 03:50:32 PM Central Daylight Time				07/11/2019 08:52:36 PM Central Daylight Time	"BRAVO HEALTH PENNSYLVANIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	1	1		1			H3949	26	0	2020	Philadelphia Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3949	30	0	1	1	1	H3949_030_0	4	1			07/08/2019	2020.01	07/08/2019 04:50:02 PM Central Daylight Time	07/31/2019 05:04:42 PM Central Daylight Time	07/30/2019 04:14:34 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH PENNSYLVANIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H3949	30	0	2020	Philadelphia Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H3949	31	0	1	1	1	H3949_031_0	4	1			07/08/2019	2020.01	07/08/2019 04:50:48 PM Central Daylight Time	07/31/2019 05:05:04 PM Central Daylight Time	07/30/2019 04:14:48 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH PENNSYLVANIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Alliance (HMO)	1	1		1			H3949	31	0	2020	Philadelphia Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H3949	32	0	1	1	1	H3949_032_0	4	1			07/08/2019	2020.01	07/08/2019 04:51:30 PM Central Daylight Time	07/31/2019 05:05:25 PM Central Daylight Time	07/30/2019 04:15:01 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH PENNSYLVANIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H3949	32	0	2020	Southern New Jersey		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H3949	33	0	1	1	1	H3949_033_0	4	1			07/08/2019	2020.01	07/08/2019 04:52:38 PM Central Daylight Time	07/31/2019 05:05:47 PM Central Daylight Time	07/30/2019 04:15:15 PM Central Daylight Time			08/02/2019 11:38:22 AM Central Daylight Time	"BRAVO HEALTH PENNSYLVANIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus (HMO)	1	1		1			H3949	33	0	2020	Southern New Jersey		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.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	2			
H3949	804	0	1	1	1	H3949_804_0	2	1			04/18/2019	2020.01	04/18/2019 12:14:16 PM Central Daylight Time					05/30/2019 05:00:36 PM Central Daylight Time	"BRAVO HEALTH PENNSYLVANIA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	1	1		1			H3949	804	0	2020	Statewide PA		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H3952	8	0	1	1	1	H3952_008_0	6	1			06/28/2019	2020.01	06/28/2019 02:03:51 PM Eastern Daylight Time	07/25/2019 01:07:16 PM Eastern Daylight Time				07/25/2019 01:39:39 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Medical Only (HMO)	1	1		1			H3952	8	0	2020	"Bucks, Philadelphia Counties"		2	11308	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	1	1	7a;	
H3952	20	0	1	1	1	H3952_020_0	7	1			06/28/2019	2020.01	06/28/2019 02:19:26 PM Eastern Daylight Time	08/02/2019 12:40:52 PM Eastern Daylight Time	08/02/2019 12:40:52 PM Eastern Daylight Time			08/02/2019 01:14:09 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Rx (HMO)	1	1		1			H3952	20	0	2020	"Bucks, Philadelphia Counties"		2	61634	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	1	1	7a;	
H3952	44	0	1	1	1	H3952_044_0	6	1			06/28/2019	2020.01	06/28/2019 02:15:47 PM Eastern Daylight Time	07/25/2019 01:07:15 PM Eastern Daylight Time				07/25/2019 01:39:39 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Medical Only (HMO)	1	1		1			H3952	44	0	2020	"Chester, Delaware, Montgomery Counties"		2	5556	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	1	1	7a;	
H3952	45	0	1	1	1	H3952_045_0	7	1			06/28/2019	2020.01	06/28/2019 02:21:50 PM Eastern Daylight Time	08/02/2019 12:40:53 PM Eastern Daylight Time	08/02/2019 12:40:53 PM Eastern Daylight Time			08/02/2019 01:17:46 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Rx (HMO)	1	1		1			H3952	45	0	2020	"Chester, Delaware, Montgomery Counties"		2	35482	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	1	1	7a;	
H3952	48	0	1	1	1	H3952_048_0	10	1			06/28/2019	2020.01	06/28/2019 02:22:43 PM Eastern Daylight Time	07/25/2019 12:03:19 PM Eastern Daylight Time				07/25/2019 01:48:06 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Medical Only (HMO)	1	1		1			H3952	48	0	2020	"Bucks, Philadelphia Counties"		2	17139	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	1	1	7a;	
H3952	49	0	1	1	1	H3952_049_0	8	1			06/28/2019	2020.01	06/28/2019 02:27:04 PM Eastern Daylight Time	08/02/2019 12:40:54 PM Eastern Daylight Time	08/02/2019 12:40:54 PM Eastern Daylight Time			08/02/2019 01:22:44 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Rx (HMO)	1	1		1			H3952	49	0	2020	"Bucks, Philadelphia Counties"		2	176584	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	1	1	7a;	
H3952	50	0	1	1	1	H3952_050_0	7	1			06/28/2019	2020.01	06/28/2019 02:23:00 PM Eastern Daylight Time	07/25/2019 12:03:20 PM Eastern Daylight Time				07/25/2019 01:48:06 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Medical Only (HMO)	1	1		1			H3952	50	0	2020	"Chester, Delaware, Montgomery Counties"		2	16516	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	1	1	7a;	
H3952	51	0	1	1	1	H3952_051_0	7	1			06/28/2019	2020.01	06/28/2019 02:26:51 PM Eastern Daylight Time	08/02/2019 12:40:55 PM Eastern Daylight Time	08/02/2019 12:40:55 PM Eastern Daylight Time			08/02/2019 01:26:51 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Rx (HMO)	1	1		1			H3952	51	0	2020	"Chester, Delaware, Montgomery Counties"		2	125198	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	1	1	7a;	
H3952	53	0	1	2	1	H3952_053_0	6	1			06/28/2019	2020.01	06/28/2019 03:48:55 PM Eastern Daylight Time	08/02/2019 12:40:56 PM Eastern Daylight Time	08/02/2019 12:40:56 PM Eastern Daylight Time			08/02/2019 02:03:18 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Focus Rx (HMO-POS)	1	2		1			H3952	53	0	2020	"Philadelphia, Bucks"		2	132224	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	1	1	7a;	
H3952	54	0	1	2	1	H3952_054_0	7	1			06/28/2019	2020.01	06/28/2019 03:51:31 PM Eastern Daylight Time	08/02/2019 12:40:57 PM Eastern Daylight Time	08/02/2019 12:40:57 PM Eastern Daylight Time			08/02/2019 02:03:18 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Focus Rx (HMO-POS)	1	2		1			H3952	54	0	2020	"Chester, Delaware, Montgomery"		2	61643	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	1	1	7a;	
H3952	55	0	1	1	1	H3952_055_0	7	1			08/01/2019	2020.01	08/01/2019 02:08:29 PM Eastern Daylight Time	08/02/2019 12:40:58 PM Eastern Daylight Time	08/02/2019 12:40:58 PM Eastern Daylight Time			08/02/2019 02:07:57 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Basic Rx (HMO)	1	1		1			H3952	55	0	2020	"Philadelphia, Bucks"		2	219728	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	1	1	7a;	
H3952	56	0	1	1	1	H3952_056_0	7	1			08/01/2019	2020.01	08/01/2019 02:13:46 PM Eastern Daylight Time	08/02/2019 12:40:59 PM Eastern Daylight Time	08/02/2019 12:40:59 PM Eastern Daylight Time			08/02/2019 02:07:57 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Basic Rx (HMO)	1	1		1			H3952	56	0	2020	"Chester, Delaware, Montgomery"		2	169122	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	1	1	7a;	
H3952	802	0	1	1	1	H3952_802_0	2	1			06/18/2019	2020.01	06/18/2019 09:19:10 AM Eastern Daylight Time					06/18/2019 09:27:04 AM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Group Medical Only (HMO)	1	1		1			H3952	802	0	2020	"Bucks,Chester,Delaware,Montgomery,Philadelphia Cty"		1	16596	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	1a;1b;2;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3952	804	0	1	1	1	H3952_804_0	2	1			06/18/2019	2020.01	06/18/2019 09:19:34 AM Eastern Daylight Time					06/18/2019 09:27:04 AM Eastern Daylight Time	"KEYSTONE HEALTH PLAN EAST, INC."	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Group Rx (HMO)	1	1		1			H3952	804	0	2020	"Bucks,Chester,Delaware,Montgomery,Philadelphia Cty"		1	31044	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	1a;1b;2;5;6;7c;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;	2		1					1				
H3954	97	0	1	1	1	H3954_097_0	5	1	2	1	08/02/2019	2020.01	08/02/2019 05:09:45 PM Eastern Daylight Time	08/02/2019 06:11:00 PM Eastern Daylight Time	08/02/2019 06:11:06 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Secure Rx (HMO D-SNP)	1	1		1			H3954	97	0	2020	Pennsylvania		2		2			1	3		2		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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	156	13	1	1	1	H3954_156_13	3	1			07/22/2019	2020.01	07/22/2019 06:21:47 PM Eastern Daylight Time	07/22/2019 11:47:54 AM Eastern Daylight Time				07/22/2019 08:31:44 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	1	1		1			H3954	156	13	2020	Pennsylvania	Midstate	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	14	1	1	1	H3954_156_14	4	1			07/22/2019	2020.01	07/22/2019 06:22:51 PM Eastern Daylight Time	07/22/2019 11:47:54 AM Eastern Daylight Time				07/22/2019 08:31:44 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	1	1		1			H3954	156	14	2020	Pennsylvania	Central	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	15	1	1	1	H3954_156_15	3	1			07/22/2019	2020.01	07/22/2019 06:22:51 PM Eastern Daylight Time	07/22/2019 11:47:54 AM Eastern Daylight Time				07/22/2019 08:31:44 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	1	1		1			H3954	156	15	2020	Pennsylvania	"Bucks, Carbon, Lehigh, Monroe, Northampton"	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	16	1	1	1	H3954_156_16	3	1			07/22/2019	2020.01	07/22/2019 06:22:51 PM Eastern Daylight Time	07/22/2019 11:47:54 AM Eastern Daylight Time				07/22/2019 08:31:44 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	1	1		1			H3954	156	16	2020	Pennsylvania	Midwest	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	17	1	1	1	H3954_156_17	3	1			07/22/2019	2020.01	07/22/2019 06:22:51 PM Eastern Daylight Time	07/22/2019 11:47:54 AM Eastern Daylight Time				07/22/2019 08:31:44 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	1	1		1			H3954	156	17	2020	Pennsylvania	"Berks,Chester,Cumberland,Dauphin,Lancaster,Perry"	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	156	18	1	1	1	H3954_156_18	3	1			07/22/2019	2020.01	07/22/2019 06:22:51 PM Eastern Daylight Time	07/22/2019 11:47:54 AM Eastern Daylight Time				07/22/2019 08:31:44 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	1	1		1			H3954	156	18	2020	Pennsylvania	"Adams, Franklin, Lebanon, York"	2		2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	157	13	1	1	1	H3954_157_13	5	1			07/22/2019	2020.01	07/22/2019 06:23:51 PM Eastern Daylight Time	08/02/2019 06:11:01 PM Eastern Daylight Time	08/02/2019 06:11:06 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	1	1		1			H3954	157	13	2020	Pennsylvania	Midstate	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	157	14	1	1	1	H3954_157_14	6	1			07/22/2019	2020.01	07/22/2019 06:23:58 PM Eastern Daylight Time	08/02/2019 06:11:01 PM Eastern Daylight Time	08/02/2019 06:11:06 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	1	1		1			H3954	157	14	2020	Pennsylvania	Central	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	157	15	1	1	1	H3954_157_15	5	1			07/22/2019	2020.01	07/22/2019 06:24:04 PM Eastern Daylight Time	08/02/2019 06:11:01 PM Eastern Daylight Time	08/02/2019 06:11:06 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	1	1		1			H3954	157	15	2020	Pennsylvania	"Bucks, Carbon, Lehigh, Monroe, Northampton"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	157	16	1	1	1	H3954_157_16	5	1			07/22/2019	2020.01	07/22/2019 06:24:10 PM Eastern Daylight Time	08/02/2019 06:11:01 PM Eastern Daylight Time	08/02/2019 06:11:06 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	1	1		1			H3954	157	16	2020	Pennsylvania	Midwest	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	157	17	1	1	1	H3954_157_17	5	1			07/22/2019	2020.01	07/22/2019 06:24:22 PM Eastern Daylight Time	08/02/2019 06:11:01 PM Eastern Daylight Time	08/02/2019 06:11:06 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	1	1		1			H3954	157	17	2020	Pennsylvania	"Berks,Chester,Cumberland,Dauphin,Lancaster,Perry"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	157	18	1	1	1	H3954_157_18	5	1			07/22/2019	2020.01	07/22/2019 06:24:32 PM Eastern Daylight Time	08/02/2019 06:11:02 PM Eastern Daylight Time	08/02/2019 06:11:06 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	1	1		1			H3954	157	18	2020	Pennsylvania	"Adams, Franklin, Lebanon, York"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	13	1	1	1	H3954_158_13	6	1			08/06/2019	2020.01	08/06/2019 05:14:49 PM Eastern Daylight Time	08/02/2019 06:11:02 PM Eastern Daylight Time	08/02/2019 06:11:06 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	1	1		1			H3954	158	13	2020	Pennsylvania	Midstate	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	14	1	1	1	H3954_158_14	6	1			08/06/2019	2020.01	08/06/2019 05:16:04 PM Eastern Daylight Time	08/02/2019 06:11:02 PM Eastern Daylight Time	08/02/2019 06:11:07 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	1	1		1			H3954	158	14	2020	Pennsylvania	Central	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	15	1	1	1	H3954_158_15	6	1			08/06/2019	2020.01	08/06/2019 05:16:12 PM Eastern Daylight Time	08/02/2019 06:11:02 PM Eastern Daylight Time	08/02/2019 06:11:07 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	1	1		1			H3954	158	15	2020	Pennsylvania	"Bucks, Carbon, Lehigh, Monroe, Northampton"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	16	1	1	1	H3954_158_16	6	1			08/06/2019	2020.01	08/06/2019 05:16:19 PM Eastern Daylight Time	08/02/2019 06:11:03 PM Eastern Daylight Time	08/02/2019 06:11:07 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	1	1		1			H3954	158	16	2020	Pennsylvania	Midwest	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	17	1	1	1	H3954_158_17	6	1			08/06/2019	2020.01	08/06/2019 05:16:33 PM Eastern Daylight Time	08/02/2019 06:11:03 PM Eastern Daylight Time	08/02/2019 06:11:07 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	1	1		1			H3954	158	17	2020	Pennsylvania	"Berks,Chester,Cumberland,Dauphin,Lancaster,Perry"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	158	18	1	1	1	H3954_158_18	6	1			08/06/2019	2020.01	08/06/2019 05:16:59 PM Eastern Daylight Time	08/02/2019 06:11:03 PM Eastern Daylight Time	08/02/2019 06:11:07 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	1	1		1			H3954	158	18	2020	Pennsylvania	"Adams, Franklin, Lebanon, York"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	13	1	1	1	H3954_159_13	6	1			08/06/2019	2020.01	08/06/2019 05:17:54 PM Eastern Daylight Time	08/02/2019 06:11:03 PM Eastern Daylight Time	08/02/2019 06:11:07 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	1	1		1			H3954	159	13	2020	Pennsylvania	Midstate	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	14	1	1	1	H3954_159_14	6	1			08/06/2019	2020.01	08/06/2019 05:18:54 PM Eastern Daylight Time	08/02/2019 06:11:03 PM Eastern Daylight Time	08/02/2019 06:11:07 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	1	1		1			H3954	159	14	2020	Pennsylvania	Central	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	15	1	1	1	H3954_159_15	6	1			08/06/2019	2020.01	08/06/2019 05:19:09 PM Eastern Daylight Time	08/02/2019 06:11:03 PM Eastern Daylight Time	08/02/2019 06:11:07 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	1	1		1			H3954	159	15	2020	Pennsylvania	"Bucks, Carbon, Lehigh, Monroe, Northampton"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	16	1	1	1	H3954_159_16	7	1			08/06/2019	2020.01	08/06/2019 05:19:26 PM Eastern Daylight Time	08/02/2019 06:11:03 PM Eastern Daylight Time	08/02/2019 06:11:07 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	1	1		1			H3954	159	16	2020	Pennsylvania	Midwest	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	17	1	1	1	H3954_159_17	6	1			08/06/2019	2020.01	08/06/2019 05:20:48 PM Eastern Daylight Time	08/02/2019 06:11:03 PM Eastern Daylight Time	08/02/2019 06:11:08 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	1	1		1			H3954	159	17	2020	Pennsylvania	"Berks,Chester,Cumberland,Dauphin,Lancaster,Perry"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	159	18	1	1	1	H3954_159_18	6	1			08/06/2019	2020.01	08/06/2019 05:20:57 PM Eastern Daylight Time	08/02/2019 06:11:04 PM Eastern Daylight Time	08/02/2019 06:11:08 PM Eastern Daylight Time			08/06/2019 06:24:04 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Essential Rx (HMO)	1	1		1			H3954	159	18	2020	Pennsylvania	"Adams, Franklin, Lebanon, York"	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	160	0	1	1	1	H3954_160_0	5	1			08/05/2019	2020.01	08/05/2019 02:17:49 PM Eastern Daylight Time	08/02/2019 06:11:04 PM Eastern Daylight Time	08/02/2019 06:11:08 PM Eastern Daylight Time			08/05/2019 07:52:18 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic 360 Rx (HMO)	1	1		1			H3954	160	0	2020	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	801	0	1	1	1	H3954_801_0	2	1			05/24/2019	2020.01	05/24/2019 09:04:08 PM Eastern Daylight Time					06/02/2019 04:14:25 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic (Employer Group) (HMO)	1	1		1			H3954	801	0	2020	Pennsylvania		1	67061	2			2						www.geisingergold.com	https://www.thehealthplan.com/pharmacy/pharmacy.aspx?strip=true&style=OneGeisinger	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3954	802	0	1	1	1	H3954_802_0	2	1			05/24/2019	2020.01	05/24/2019 09:07:26 PM Eastern Daylight Time					06/02/2019 04:14:25 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Rx (Employer Group) (HMO)	1	1		1			H3954	802	0	2020	Pennsylvania		1	9529	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3954	805	0	1	1	1	H3954_805_0	2	1			05/24/2019	2020.01	05/24/2019 09:11:32 PM Eastern Daylight Time					06/02/2019 04:14:25 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Rx EGWP New Jersey (HMO)	1	1		1			H3954	805	0	2020	"Monmouth & Ocean Counties, NJ"		1	600	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	31	0	1	2	1	H3957_031_0	5	1			07/17/2019	2020.01	07/17/2019 02:13:10 PM Eastern Daylight Time	08/01/2019 11:21:17 AM Eastern Daylight Time	07/31/2019 12:22:07 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS ValueRx (HMO-POS)	1	2		1			H3957	31	0	2020	Southwestern PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	39	0	1	1	1	H3957_039_0	4	1			07/17/2019	2020.01	07/17/2019 02:22:23 PM Eastern Daylight Time	08/01/2019 10:56:47 AM Eastern Daylight Time	07/31/2019 12:25:58 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Prestige (HMO)	1	1		1			H3957	39	0	2020	Western PA		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	42	1	1	1	1	H3957_042_1	4	1			07/17/2019	2020.01	07/17/2019 02:24:03 PM Eastern Daylight Time	08/01/2019 10:57:20 AM Eastern Daylight Time	07/31/2019 12:28:59 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	1	1		1			H3957	42	1	2020	North Central PA	Lehigh Valley	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	42	2	1	1	1	H3957_042_2	4	1			07/17/2019	2020.01	07/17/2019 02:25:29 PM Eastern Daylight Time	08/01/2019 10:57:53 AM Eastern Daylight Time	07/31/2019 12:31:38 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	1	1		1			H3957	42	2	2020	North Central PA	South Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	42	4	1	1	1	H3957_042_4	4	1			07/17/2019	2020.01	07/17/2019 02:25:57 PM Eastern Daylight Time	08/01/2019 10:58:27 AM Eastern Daylight Time	07/31/2019 12:34:23 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	1	1		1			H3957	42	4	2020	North Central PA	North Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	42	5	1	1	1	H3957_042_5	4	1			07/17/2019	2020.01	07/17/2019 02:26:02 PM Eastern Daylight Time	08/01/2019 10:59:01 AM Eastern Daylight Time	07/31/2019 12:37:12 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	1	1		1			H3957	42	5	2020	North Central PA	Lancaster PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	43	1	1	2	1	H3957_043_1	3	1			07/17/2019	2020.01	07/17/2019 02:13:25 PM Eastern Daylight Time	05/31/2019 10:43:56 AM Eastern Daylight Time				07/18/2019 12:25:54 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Basic (HMO-POS)	1	2		1			H3957	43	1	2020	Western PA	Southwest PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3957	43	2	1	2	1	H3957_043_2	3	1			07/17/2019	2020.01	07/17/2019 02:14:10 PM Eastern Daylight Time	05/31/2019 10:44:31 AM Eastern Daylight Time				07/18/2019 12:25:54 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Basic (HMO-POS)	1	2		1			H3957	43	2	2020	Western PA	West Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3957	43	3	1	2	1	H3957_043_3	3	1			07/17/2019	2020.01	07/17/2019 02:14:16 PM Eastern Daylight Time	05/31/2019 10:45:03 AM Eastern Daylight Time				07/18/2019 12:25:54 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Basic (HMO-POS)	1	2		1			H3957	43	3	2020	Western PA	"Blair, Potter PA"	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3957	44	1	1	2	1	H3957_044_1	4	1			07/17/2019	2020.01	07/17/2019 02:15:51 PM Eastern Daylight Time	08/01/2019 11:01:18 AM Eastern Daylight Time	07/31/2019 12:40:33 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS ValueRx (HMO-POS)	1	2		1			H3957	44	1	2020	Western PA	West Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	44	2	1	2	1	H3957_044_2	4	1			07/17/2019	2020.01	07/17/2019 02:16:37 PM Eastern Daylight Time	08/01/2019 11:18:33 AM Eastern Daylight Time	07/31/2019 12:43:17 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS ValueRx (HMO-POS)	1	2		1			H3957	44	2	2020	Western PA	"Blair, Potter PA"	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	45	1	1	2	1	H3957_045_1	4	1			07/17/2019	2020.01	07/17/2019 02:17:48 PM Eastern Daylight Time	08/01/2019 11:02:35 AM Eastern Daylight Time	07/31/2019 12:46:22 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Standard (HMO-POS)	1	2		1			H3957	45	1	2020	Western PA	Southwest PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	45	2	1	2	1	H3957_045_2	4	1			07/17/2019	2020.01	07/17/2019 02:18:20 PM Eastern Daylight Time	08/01/2019 11:03:07 AM Eastern Daylight Time	07/31/2019 12:49:07 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Standard (HMO-POS)	1	2		1			H3957	45	2	2020	Western PA	West Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	45	3	1	2	1	H3957_045_3	4	1			07/17/2019	2020.01	07/17/2019 02:18:26 PM Eastern Daylight Time	08/01/2019 11:03:46 AM Eastern Daylight Time	07/31/2019 12:51:47 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Standard (HMO-POS)	1	2		1			H3957	45	3	2020	Western PA	"Blair, Potter PA"	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	46	1	1	2	1	H3957_046_1	4	1			07/17/2019	2020.01	07/17/2019 02:19:56 PM Eastern Daylight Time	08/01/2019 11:04:23 AM Eastern Daylight Time	07/31/2019 12:54:56 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Deluxe (HMO-POS)	1	2		1			H3957	46	1	2020	Western PA	Southwest PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	46	2	1	2	1	H3957_046_2	4	1			07/17/2019	2020.01	07/17/2019 02:20:25 PM Eastern Daylight Time	08/01/2019 11:04:55 AM Eastern Daylight Time	07/31/2019 12:58:05 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Deluxe (HMO-POS)	1	2		1			H3957	46	2	2020	Western PA	West Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	46	3	1	2	1	H3957_046_3	4	1			07/17/2019	2020.01	07/17/2019 02:20:36 PM Eastern Daylight Time	08/01/2019 11:05:25 AM Eastern Daylight Time	07/31/2019 01:00:54 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS Deluxe (HMO-POS)	1	2		1			H3957	46	3	2020	Western PA	"Blair, Potter PA"	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	47	1	1	1	1	H3957_047_1	4	1			07/17/2019	2020.01	07/17/2019 02:27:20 PM Eastern Daylight Time	08/01/2019 11:13:10 AM Eastern Daylight Time	07/31/2019 01:04:03 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	1	1		1			H3957	47	1	2020	Western PA	Southwest PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	47	2	1	1	1	H3957_047_2	4	1			07/17/2019	2020.01	07/17/2019 02:27:48 PM Eastern Daylight Time	08/01/2019 11:14:24 AM Eastern Daylight Time	07/31/2019 01:06:53 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO Signature (HMO)	1	1		1			H3957	47	2	2020	Western PA	West Central PA	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3957	805	0	1	1	1	H3957_805_0	2	1			05/17/2019	2020.01	05/17/2019 10:58:46 AM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO MA Calendar (HMO)	1	1		1			H3957	805	0	2020	Western PA		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1				
H3957	806	0	1	1	1	H3957_806_0	2	1			05/17/2019	2020.01	05/17/2019 10:59:16 AM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO MA-PD Calendar (HMO)	1	1		1			H3957	806	0	2020	Western PA		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1				
H3957	808	0	1	1	1	H3957_808_0	2	1			05/17/2019	2020.01	05/17/2019 11:00:08 AM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO MA-PD Non-Calendar (HMO)	1	1		1			H3957	808	0	2020	Western PA		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1				
H3957	810	0	1	1	1	H3957_810_0	2	1			05/17/2019	2020.01	05/17/2019 10:56:27 AM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO MA Calendar (HMO)	1	1		1			H3957	810	0	2020	Pennsylvania (Western and North Central)		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1				
H3957	811	0	1	1	1	H3957_811_0	2	1			05/17/2019	2020.01	05/17/2019 10:57:17 AM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO MA-PD Calendar (HMO)	1	1		1			H3957	811	0	2020	Pennsylvania (Western and North Central)		1	6264	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1				
H3957	812	0	1	1	1	H3957_812_0	2	1			05/17/2019	2020.01	05/17/2019 10:57:57 AM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Community Blue Medicare HMO MA-PD Non-Calendar (HMO)	1	1		1			H3957	812	0	2020	Pennsylvania (Western and North Central)		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1					1				
H3957	813	0	1	2	1	H3957_813_0	2	1			05/17/2019	2020.01	05/17/2019 10:52:06 AM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS MA Calendar (HMO-POS)	1	2		1			H3957	813	0	2020	Western PA		1	13116	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;16b;	2		1	1	1a;1b;3-1;3-2;3-3;3-4;5;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;15;	2		1				
H3957	814	0	1	2	1	H3957_814_0	2	1			05/17/2019	2020.01	05/17/2019 10:54:08 AM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS MA-PD Calendar (HMO-POS)	1	2		1			H3957	814	0	2020	Western PA		1	58872	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	1	1a;1b;3-1;3-2;3-3;3-4;5;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;15;	2		1				
H3957	815	0	1	2	1	H3957_815_0	2	1			05/17/2019	2020.01	05/17/2019 10:55:36 AM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HIGHMARK CHOICE COMPANY	Highmark Inc.	medicare.highmark.com	Security Blue HMO-POS MA-PD Non-Calendar (HMO-POS)	1	2		1			H3957	815	0	2020	Western PA		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1	1	1a;1b;3-1;3-2;3-3;3-4;5;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;15;	2		1				
H3959	1	0	1	1	1	H3959_001_0	5	1			07/08/2019	2020.01	07/08/2019 01:43:16 PM Eastern Daylight Time	08/02/2019 01:33:35 PM Eastern Daylight Time	07/31/2019 12:39:51 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Gold (HMO)	1	1		1			H3959	1	0	2020	Allegheny County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	2	0	1	1	1	H3959_002_0	3	1			07/03/2019	2020.01	07/03/2019 06:39:05 PM Eastern Daylight Time	08/02/2019 01:34:14 PM Eastern Daylight Time	07/31/2019 12:41:01 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Gold (HMO)	1	1		1			H3959	2	0	2020	Western Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	10	0	1	1	1	H3959_010_0	3	1			08/01/2019	2020.01	08/01/2019 04:27:14 PM Eastern Daylight Time	08/02/2019 01:34:51 PM Eastern Daylight Time	07/31/2019 12:42:11 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (HMO)	1	1		1			H3959	10	0	2020	Allegheny County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	11	0	1	1	1	H3959_011_0	3	1			08/01/2019	2020.01	08/01/2019 04:27:53 PM Eastern Daylight Time	08/02/2019 01:35:30 PM Eastern Daylight Time	07/31/2019 12:43:23 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (HMO)	1	1		1			H3959	11	0	2020	Western Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	32	0	1	1	1	H3959_032_0	3	1			08/01/2019	2020.01	08/01/2019 04:28:33 PM Eastern Daylight Time	08/02/2019 01:36:08 PM Eastern Daylight Time	07/31/2019 12:44:34 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier (HMO)	1	1		1			H3959	32	0	2020	Northwestern Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	33	0	1	1	1	H3959_033_0	3	1			07/03/2019	2020.01	07/03/2019 06:39:57 PM Eastern Daylight Time	08/02/2019 01:36:46 PM Eastern Daylight Time	07/31/2019 12:45:52 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier (HMO)	1	1		1			H3959	33	0	2020	Southeastern Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	35	0	1	1	1	H3959_035_0	6	1	2	1	07/10/2019	2020.01	07/10/2019 04:37:33 PM Eastern Daylight Time	08/02/2019 01:37:24 PM Eastern Daylight Time	07/31/2019 12:47:01 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Cares (HMO D-SNP)	1	1		1			H3959	35	0	2020	Southeastern Pennsylvania		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	36	0	1	1	1	H3959_036_0	5	1	2	1	07/10/2019	2020.01	07/10/2019 04:38:16 PM Eastern Daylight Time	08/02/2019 01:38:03 PM Eastern Daylight Time	07/31/2019 12:48:11 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Cares (HMO D-SNP)	1	1		1			H3959	36	0	2020	Central and Western Pennsylvania		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	37	0	1	1	1	H3959_037_0	3	1			08/01/2019	2020.01	08/01/2019 04:29:41 PM Eastern Daylight Time	08/02/2019 01:38:41 PM Eastern Daylight Time	07/31/2019 12:49:21 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Gold (HMO)	1	1		1			H3959	37	0	2020	Northeastern Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	39	0	1	1	1	H3959_039_0	3	1			07/03/2019	2020.01	07/03/2019 06:42:37 PM Eastern Daylight Time	08/02/2019 01:39:22 PM Eastern Daylight Time	07/31/2019 12:50:30 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier (HMO)	1	1		1			H3959	39	0	2020	Central Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	41	0	1	1	1	H3959_041_0	2	1			07/03/2019	2020.01	07/03/2019 06:46:29 PM Eastern Daylight Time	05/29/2019 08:39:16 PM Eastern Daylight Time				07/03/2019 07:42:27 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Core (HMO)	1	1		1			H3959	41	0	2020	Central and Western Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H3959	45	0	1	1	1	H3959_045_0	3	1			08/01/2019	2020.01	08/01/2019 04:30:41 PM Eastern Daylight Time	08/02/2019 01:39:58 PM Eastern Daylight Time	07/31/2019 12:51:40 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare PennHighlands Prime (HMO)	1	1		1			H3959	45	0	2020	"Clearfield, Elk and Jefferson Counties"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	46	0	1	1	1	H3959_046_0	3	1			08/01/2019	2020.01	08/01/2019 04:31:57 PM Eastern Daylight Time	08/02/2019 01:40:36 PM Eastern Daylight Time	07/31/2019 12:52:51 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Washington Prime (HMO)	1	1		1			H3959	46	0	2020	Greene and Washington Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	47	0	1	1	1	H3959_047_0	3	1			08/01/2019	2020.01	08/01/2019 04:33:09 PM Eastern Daylight Time	08/02/2019 01:41:12 PM Eastern Daylight Time	07/31/2019 12:54:01 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Butler Prime (HMO)	1	1		1			H3959	47	0	2020	Butler County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	49	0	1	1	1	H3959_049_0	3	1			08/01/2019	2020.01	08/01/2019 04:34:01 PM Eastern Daylight Time	08/02/2019 01:41:49 PM Eastern Daylight Time	07/31/2019 12:55:10 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Excela Prime (HMO)	1	1		1			H3959	49	0	2020	Westmoreland County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	51	0	1	1	1	H3959_051_0	3	1			08/01/2019	2020.01	08/01/2019 04:35:07 PM Eastern Daylight Time	08/02/2019 01:42:25 PM Eastern Daylight Time	07/31/2019 12:56:19 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Beaver Valley Prime (HMO)	1	1		1			H3959	51	0	2020	Beaver County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	52	0	1	1	1	H3959_052_0	4	1			08/01/2019	2020.01	08/01/2019 04:35:43 PM Eastern Daylight Time	08/02/2019 01:43:03 PM Eastern Daylight Time	07/31/2019 12:57:28 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Value (HMO)	1	1		1			H3959	52	0	2020	Southeastern Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3959	803	0	1	1	1	H3959_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:46:49 AM Eastern Daylight Time					05/30/2019 06:43:57 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H3959	803	0	2020	Pennsylvania		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3959	804	0	1	1	1	H3959_804_0	1	1			05/24/2019	2020.01	05/24/2019 09:46:58 AM Eastern Daylight Time					05/30/2019 06:43:57 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H3959	804	0	2020	Pennsylvania		1	21310	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3959	808	0	1	1	1	H3959_808_0	1	1			05/24/2019	2020.01	05/24/2019 09:47:07 AM Eastern Daylight Time					05/30/2019 06:43:57 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H3959	808	0	2020	Pennsylvania		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H3962	1	0	1	1	1	H3962_001_0	3	1			07/08/2019	2020.01	07/08/2019 01:20:56 PM Eastern Daylight Time	07/31/2019 02:52:16 PM Eastern Daylight Time	07/31/2019 02:52:54 PM Eastern Daylight Time			08/02/2019 04:13:30 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Premier (HMO)	1	1		1			H3962	1	0	2020	21 Counties in Central PA		2	46679	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3962	4	0	1	1	1	H3962_004_0	3	1			07/08/2019	2020.01	07/08/2019 01:22:27 PM Eastern Daylight Time	07/31/2019 02:53:50 PM Eastern Daylight Time	07/31/2019 02:54:28 PM Eastern Daylight Time			08/02/2019 04:13:30 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Value (HMO)	1	1		1			H3962	4	0	2020	21 Counties in Central PA		2	31884	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3962	7	0	1	1	1	H3962_007_0	4	1			07/08/2019	2020.01	07/08/2019 01:23:40 PM Eastern Daylight Time	07/31/2019 02:55:26 PM Eastern Daylight Time	07/31/2019 02:56:02 PM Eastern Daylight Time			08/02/2019 04:13:30 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Essential (HMO)	1	1		1			H3962	7	0	2020	21 Counties in Central PA		2	111519	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3962	18	0	1	1	1	H3962_018_0	4	1		1	07/08/2019	2020.01	07/08/2019 01:26:23 PM Eastern Daylight Time	07/31/2019 02:57:00 PM Eastern Daylight Time	07/31/2019 02:57:38 PM Eastern Daylight Time			08/02/2019 04:13:30 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Alliance Lung Care (HMO C-SNP)	1	1		1			H3962	18	0	2020	6 Counties in Central PA		2	94	2			1	4			100000000		www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3962	19	0	1	1	1	H3962_019_0	4	1		1	07/08/2019	2020.01	07/08/2019 01:27:32 PM Eastern Daylight Time	07/31/2019 02:58:34 PM Eastern Daylight Time	07/31/2019 02:59:10 PM Eastern Daylight Time			08/02/2019 04:13:30 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Alliance Heart and Diabetes Care (HMO C-SNP)	1	1		1			H3962	19	0	2020	6 Counties in Central PA		2	206	2			1	4			10		www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3962	20	0	1	1	1	H3962_020_0	3	1		1	07/08/2019	2020.01	07/08/2019 01:28:56 PM Eastern Daylight Time	07/31/2019 03:00:06 PM Eastern Daylight Time	07/31/2019 03:00:42 PM Eastern Daylight Time			08/02/2019 04:13:30 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Alliance Assisted Care (HMO I-SNP)	1	1		1			H3962	20	0	2020	6 Counties in Central PA		2	651	2			1	1	3				www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H3962	801	0	1	1	1	H3962_801_0	2	1			06/03/2019	2020.01	06/03/2019 12:28:22 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Group HMO Silver Rx (HMO)	1	1		1			H3962	801	0	2020	National		1	12952	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					2				
H3962	802	0	1	1	1	H3962_802_0	2	1			06/03/2019	2020.01	06/03/2019 12:27:56 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Group HMO Without Rx (HMO)	1	1		1			H3962	802	0	2020	National		1	20180	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					2				
H3962	803	0	1	1	1	H3962_803_0	2	1			06/03/2019	2020.01	06/03/2019 12:30:04 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Group HMO Bronze Rx FY (HMO)	1	1		1			H3962	803	0	2020	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					2				
H3962	813	0	1	1	1	H3962_813_0	2	1			06/03/2019	2020.01	06/03/2019 12:37:56 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Group HMO Gold Rx (HMO)	1	1		1			H3962	813	0	2020	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					2				
H3962	814	0	1	1	1	H3962_814_0	2	1			06/03/2019	2020.01	06/03/2019 12:38:12 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Group HMO Platinum Rx (HMO)	1	1		1			H3962	814	0	2020	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					2				
H3962	815	0	1	1	1	H3962_815_0	2	1			06/03/2019	2020.01	06/03/2019 12:38:22 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Group HMO Bronze Rx (HMO)	1	1		1			H3962	815	0	2020	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					2				
H3962	816	0	1	1	1	H3962_816_0	2	1			06/03/2019	2020.01	06/03/2019 12:38:33 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Group HMO Platinum Rx FY (HMO)	1	1		1			H3962	816	0	2020	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					2				
H3962	817	0	1	1	1	H3962_817_0	2	1			06/03/2019	2020.01	06/03/2019 12:38:47 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Group HMO Silver Rx FY (HMO)	1	1		1			H3962	817	0	2020	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					2				
H3962	818	0	1	1	1	H3962_818_0	2	1			06/03/2019	2020.01	06/03/2019 12:39:03 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"KEYSTONE HEALTH PLAN CENTRAL, INC."	"Keystone Health Plan Central, Inc."	www.capitalbluemedicare.com	BlueJourney Group HMO Gold Rx FY (HMO)	1	1		1			H3962	818	0	2020	National		1	24	2			2						www.capitalbluemedicare.com	www.capitalbluemedicare.com	www.capitalbluemedicare.com	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1					2				
H3979	1	0	1	1	1	H3979_001_0	6	1			05/29/2019	2020.01	05/29/2019 03:58:04 PM Central Daylight Time	08/06/2019 02:24:30 PM Central Daylight Time	08/06/2019 02:24:34 PM Central Daylight Time			08/06/2019 04:56:13 PM Central Daylight Time	"GHS HEALTH MAINTENANCE ORGANIZATION, INC."	Blue Cross and Blue Shield of Oklahoma	www.getblueok.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	1	1		1			H3979	1	0	2020	Oklahoma City Metro Area		2	34044	2			2						www.getblueok.com/mapd/pharmacies	www.getblueok.com/mapd/druglist	www.getblueok.com/mapd/providers	(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	2			
H3979	801	0	1	1	1	H3979_801_0	2	1			05/30/2019	2020.01	05/30/2019 03:27:18 PM Central Daylight Time					06/03/2019 11:20:09 AM Central Daylight Time	"GHS HEALTH MAINTENANCE ORGANIZATION, INC."	Blue Cross and Blue Shield of Oklahoma	www.getblueok.com/mapd	BlueCross Medicare Advantage (HMO)	1	1		1			H3979	801	0	2020	State of Oklahoma		1	1	2			2						www.getblueok.com/mapd/pharmacies	www.getblueok.com/mapd/druglist	www.getblueok.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H3979	803	0	1	1	1	H3979_803_0	2	1			05/30/2019	2020.01	05/30/2019 03:27:50 PM Central Daylight Time					06/03/2019 11:20:09 AM Central Daylight Time	"GHS HEALTH MAINTENANCE ORGANIZATION, INC."	Blue Cross and Blue Shield of Oklahoma	www.getblueok.com/mapd	BlueCross Medicare Advantage (HMO)	1	1		1			H3979	803	0	2020	State of Oklahoma		1	1	2			2						www.getblueok.com/mapd/pharmacies	www.getblueok.com/mapd/druglist	www.getblueok.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H3979	805	0	1	1	1	H3979_805_0	2	1			05/30/2019	2020.01	05/30/2019 03:28:13 PM Central Daylight Time					06/03/2019 11:20:09 AM Central Daylight Time	"GHS HEALTH MAINTENANCE ORGANIZATION, INC."	Blue Cross and Blue Shield of Oklahoma	www.getblueok.com/mapd	BlueCross Medicare Advantage (HMO)	1	1		1			H3979	805	0	2020	State of Oklahoma		1	1	2			2						www.getblueok.com/mapd/pharmacies	www.getblueok.com/mapd/druglist	www.getblueok.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H4000	1	0	1	20	8	H4000_001_0	1	1			05/22/2019	2020.01	05/22/2019 11:07:10 AM Mountain Daylight Time		05/21/2019 05:21:06 PM Mountain Daylight Time			05/22/2019 11:13:32 AM Mountain Daylight Time	MEMORIAL HOSPITAL OF LARAMIE COUNTY	Wyoming PACE	www.crmcwy.org	001-Dual Eligible (PACE)	8	20		1			H4000	1	0	2020	001-Wyoming PACE		2		2			2						www.seniorscript.com	www.seniorscript.com										(307)773-8112		(307)773-8112		(307)773-8112		(307)773-8112										(800)877-9965		(800)877-9965		(800)877-9965		(800)877-9965																
H4000	2	0	1	20	8	H4000_002_0	1	1			05/22/2019	2020.01	05/22/2019 11:07:35 AM Mountain Daylight Time		05/21/2019 05:20:47 PM Mountain Daylight Time			05/22/2019 11:13:32 AM Mountain Daylight Time	MEMORIAL HOSPITAL OF LARAMIE COUNTY	Wyoming PACE	www.crmcwy.org	002-Medicare Only (PACE)	8	20		1			H4000	2	0	2020	002-Wyoming PACE		2		2			2						www.seniorscript.com	www.seniorscript.com										(307)773-8112		(307)773-8112		(307)773-8112		(307)773-8112										(800)877-9965		(800)877-9965		(800)877-9965		(800)877-9965																
H4003	9	0	1	1	1	H4003_009_0	10	1		1	07/01/2019	2020.01	07/01/2019 05:52:23 PM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time			08/05/2019 05:21:16 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Supremo (HMO C-SNP)	1	1		1			H4003	9	0	2020	Puerto Rico		2	110254	2			1	4			10		www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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	1	1	7d;9a2;12;	
H4003	17	0	1	1	1	H4003_017_0	12	1	1	1	07/23/2019	2020.01	07/23/2019 09:52:20 AM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time	08/05/2019 05:15:48 PM SA Western Standard Time			08/05/2019 05:21:16 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Diamante Platino (HMO D-SNP)	1	1		1			H4003	17	0	2020	Puerto Rico		2	882694	2		1	1	3		2		2	www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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	2			
H4003	19	0	1	2	1	H4003_019_0	8	1			07/16/2019	2020.01	07/16/2019 11:55:12 AM SA Western Standard Time	08/05/2019 05:15:48 PM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time			08/05/2019 05:21:16 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Unico (HMO-POS)	1	2		1			H4003	19	0	2020	Puerto Rico		2	31579	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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	1	1	7d;9a2;12;	
H4003	34	0	1	2	1	H4003_034_0	8	1			07/16/2019	2020.01	07/16/2019 11:55:33 AM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time			08/05/2019 05:21:16 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Elite (HMO-POS)	1	2		1			H4003	34	0	2020	Puerto Rico		2	1008405	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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	1	1	7d;9a2;12;	
H4003	41	0	1	1	1	H4003_041_0	10	1	1	1	07/16/2019	2020.01	07/16/2019 11:56:02 AM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time			08/05/2019 05:21:16 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Completo Platino (HMO D-SNP)	1	1		1			H4003	41	0	2020	Puerto Rico		2	122682	2		1	1	3		2		2	www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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	2			
H4003	44	0	1	2	1	H4003_044_0	8	1			07/16/2019	2020.01	07/16/2019 11:56:25 AM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time			08/05/2019 05:21:16 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Extra (HMO-POS)	1	2		1			H4003	44	0	2020	Puerto Rico		2	25977	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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	1	1	7d;9a2;12;	
H4003	45	0	1	2	1	H4003_045_0	9	1			07/17/2019	2020.01	07/17/2019 05:28:59 PM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time			08/05/2019 05:21:16 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Cero (HMO-POS)	1	2		1			H4003	45	0	2020	Puerto Rico		2	3858	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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	1	1	7d;9a2;12;	
H4003	47	0	1	1	1	H4003_047_0	7	1	1	1	07/23/2019	2020.01	07/23/2019 10:40:56 AM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time			08/05/2019 05:21:16 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Valor Platino (HMO D-SNP)	1	1		1			H4003	47	0	2020	Puerto Rico		2	33499	2		1	1	3		2		2	www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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	2			
H4003	49	0	1	1	1	H4003_049_0	8	1	1	1	07/16/2019	2020.01	07/16/2019 11:57:13 AM SA Western Standard Time	08/05/2019 05:15:49 PM SA Western Standard Time	08/05/2019 05:17:11 PM SA Western Standard Time			08/05/2019 05:21:16 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Bienestar Platino (HMO D-SNP)	1	1		1			H4003	49	0	2020	Puerto Rico		2	63590	2		1	1	3		2		2	www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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	2			
H4003	806	0	1	2	1	H4003_806_0	3	1			05/30/2019	2020.01	05/30/2019 12:25:40 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Group $0 Calendar (HMO-POS)	1	2		1			H4003	806	0	2020	Puerto Rico		1	306621	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4003	807	0	1	2	1	H4003_807_0	3	1			05/23/2019	2020.01	05/23/2019 03:43:14 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Group $25 Calendar (HMO-POS)	1	2		1			H4003	807	0	2020	Puerto Rico		1	1200	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4003	820	0	1	2	1	H4003_820_0	3	1			05/23/2019	2020.01	05/23/2019 03:43:22 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Group $50 Calendar (HMO-POS)	1	2		1			H4003	820	0	2020	Puerto Rico		1	1200	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4003	821	0	1	2	1	H4003_821_0	3	1			05/23/2019	2020.01	05/23/2019 03:43:29 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Group $100 Calendar (HMO-POS)	1	2		1			H4003	821	0	2020	Puerto Rico		1	1200	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4003	822	0	1	2	1	H4003_822_0	3	1			05/23/2019	2020.01	05/23/2019 03:43:37 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Group $0 Non-Calendar (HMO-POS)	1	2		1			H4003	822	0	2020	Puerto Rico		1	1200	2			2						www.mmm-pr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4003	823	0	1	2	1	H4003_823_0	3	1			05/28/2019	2020.01	05/28/2019 02:55:35 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Group $25 Non-Calendar (HMO-POS)	1	2		1			H4003	823	0	2020	Puerto Rico		1	1200	2			2						www.mmm-pr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4003	824	0	1	2	1	H4003_824_0	3	1			05/23/2019	2020.01	05/23/2019 03:43:52 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Group $50 Non-Calendar (HMO-POS)	1	2		1			H4003	824	0	2020	Puerto Rico		1	1200	2			2						www.mmm-pr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4003	825	0	1	2	1	H4003_825_0	3	1			05/23/2019	2020.01	05/23/2019 03:44:00 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Group $100 Non-Calendar (HMO-POS)	1	2		1			H4003	825	0	2020	Puerto Rico		1	1200	2			2						www.mmm-pr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4004	48	0	1	1	1	H4004_048_0	10	1	1	1	07/16/2019	2020.01	07/16/2019 11:57:47 AM SA Western Standard Time	08/05/2019 05:17:11 PM SA Western Standard Time	08/05/2019 05:17:11 PM SA Western Standard Time			08/05/2019 05:21:16 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	PMC Medicare Choice	www.mmmpr.com	PMC Premier Platino (HMO D-SNP)	1	1		1			H4004	48	0	2020	Puerto Rico		2	161931	2		1	1	3		2		2	www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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	2			
H4004	56	0	1	2	1	H4004_056_0	10	1			08/05/2019	2020.01	08/05/2019 05:38:34 PM SA Western Standard Time	08/05/2019 05:17:11 PM SA Western Standard Time	08/05/2019 05:17:11 PM SA Western Standard Time			08/05/2019 05:42:41 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	PMC Medicare Choice	www.mmmpr.com	PMC Max (HMO-POS)	1	2		1			H4004	56	0	2020	Puerto Rico		2	90814	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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	1	1	7d;9a2;12;	
H4004	61	0	1	1	1	H4004_061_0	10	1	1	1	07/16/2019	2020.01	07/16/2019 11:58:32 AM SA Western Standard Time	08/05/2019 05:17:11 PM SA Western Standard Time	08/05/2019 05:17:11 PM SA Western Standard Time			08/05/2019 05:21:16 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	PMC Medicare Choice	www.mmmpr.com	MMM Relax Platino (HMO D-SNP)	1	1		1			H4004	61	0	2020	Puerto Rico		2	315938	2		1	1	3		2		2	www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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	2			
H4004	817	0	1	2	1	H4004_817_0	3	1			05/23/2019	2020.01	05/23/2019 03:55:28 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	PMC Medicare Choice	www.mmmpr.com	PMC Group $0 Calendar (HMO-POS)	1	2		1			H4004	817	0	2020	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4004	818	0	1	2	1	H4004_818_0	3	1			05/23/2019	2020.01	05/23/2019 03:55:45 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	PMC Medicare Choice	www.mmmpr.com	PMC Group $25 Calendar (HMO-POS)	1	2		1			H4004	818	0	2020	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4004	819	0	1	2	1	H4004_819_0	3	1			05/23/2019	2020.01	05/23/2019 03:56:00 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	PMC Medicare Choice	www.mmmpr.com	PMC Group $50 Calendar (HMO-POS)	1	2		1			H4004	819	0	2020	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4004	820	0	1	2	1	H4004_820_0	3	1			05/23/2019	2020.01	05/23/2019 03:56:16 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	PMC Medicare Choice	www.mmmpr.com	PMC Group $100 Calendar (HMO-POS)	1	2		1			H4004	820	0	2020	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4004	822	0	1	2	1	H4004_822_0	3	1			05/23/2019	2020.01	05/23/2019 03:56:32 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	PMC Medicare Choice	www.mmmpr.com	PMC Group $0 Non-Calendar (HMO-POS)	1	2		1			H4004	822	0	2020	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4004	823	0	1	2	1	H4004_823_0	3	1			05/23/2019	2020.01	05/23/2019 03:56:43 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	PMC Medicare Choice	www.mmmpr.com	PMC Group $25 Non-Calendar (HMO-POS)	1	2		1			H4004	823	0	2020	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4004	824	0	1	2	1	H4004_824_0	3	1			05/23/2019	2020.01	05/23/2019 03:56:58 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	PMC Medicare Choice	www.mmmpr.com	PMC Group $50 Non-Calendar (HMO-POS)	1	2		1			H4004	824	0	2020	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4004	825	0	1	2	1	H4004_825_0	3	1			05/23/2019	2020.01	05/23/2019 07:19:37 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	PMC Medicare Choice	www.mmmpr.com	PMC Group $100 Non-Calendar (HMO-POS)	1	2		1			H4004	825	0	2020	Puerto Rico		1	0	2			2						www.mmmpr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	2				
H4005	1	0	1	4	1	H4005_001_0	3	1			06/03/2019	2020.01	06/03/2019 03:37:40 PM SA Western Standard Time	06/03/2019 08:08:59 PM SA Western Standard Time				06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple-S Advantage	www.sssadvantage.com	ptimo (PPO)	1	4		1			H4005	1	0	2020	Puerto Rico		2	10200	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										2					2						1	11	7d;7f;8a1;8a2;8b1;8b2;8b3;	7f;
H4005	4	0	1	4	1	H4005_004_0	5	1			06/03/2019	2020.01	06/03/2019 03:40:57 PM SA Western Standard Time	08/01/2019 06:23:11 PM SA Western Standard Time	08/05/2019 10:08:42 AM SA Western Standard Time			08/05/2019 06:25:09 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple-S Advantage	www.sssadvantage.com	ptimo Plus (PPO)	1	4		1			H4005	4	0	2020	Puerto Rico		2	57000	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(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						1	11	7d;7f;8b1;8b2;8b3;	7f;
H4005	801	0	1	4	1	H4005_801_0	3	1			06/03/2019	2020.01	06/03/2019 03:42:49 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple-S Advantage	www.sssadvantage.com	ptimo (PPO)	1	4		1			H4005	801	0	2020	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1									
H4005	802	0	1	4	1	H4005_802_0	3	1			06/03/2019	2020.01	06/03/2019 03:45:49 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple-S Advantage	www.sssadvantage.com	ptimo Plus A (PPO)	1	4		1			H4005	802	0	2020	Puerto Rico		1	88926	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1									
H4005	804	0	1	4	1	H4005_804_0	3	1			06/03/2019	2020.01	06/03/2019 03:48:56 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple-S Advantage	www.sssadvantage.com	ptimo Plus B (PPO)	1	4		1			H4005	804	0	2020	Puerto Rico		1	1452	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1									
H4005	807	0	1	4	1	H4005_807_0	3	1			06/03/2019	2020.01	06/03/2019 03:50:54 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple-S Advantage	www.sssadvantage.com	ptimo Plus C (PPO)	1	4		1			H4005	807	0	2020	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;15;16b;	2		1									
H4005	808	0	1	4	1	H4005_808_0	3	1			06/03/2019	2020.01	06/03/2019 03:53:44 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple-S Advantage	www.sssadvantage.com	ptimo Plus D (PPO)	1	4		1			H4005	808	0	2020	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1									
H4007	12	0	1	1	1	H4007_012_0	6	1			08/02/2019	2020.01	08/02/2019 04:38:47 PM Eastern Daylight Time	08/04/2019 12:15:38 PM Eastern Daylight Time	08/02/2019 01:18:14 PM Eastern Daylight Time			08/05/2019 11:00:06 AM Eastern Daylight Time	"HUMANA HEALTH PLANS OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H4007-012 (HMO)	1	1		1			H4007	12	0	2020	Puerto Rico Island Wide		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(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	2			
H4007	13	0	1	1	1	H4007_013_0	4	1			07/15/2019	2020.01	07/15/2019 10:46:05 AM Eastern Daylight Time	08/04/2019 12:05:38 PM Eastern Daylight Time	08/02/2019 01:18:14 PM Eastern Daylight Time			08/05/2019 11:29:55 AM Eastern Daylight Time	"HUMANA HEALTH PLANS OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H4007-013 (HMO)	1	1		1			H4007	13	0	2020	Puerto Rico Island Wide		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(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	2			
H4007	16	0	1	1	1	H4007_016_0	3	1	1	1	05/30/2019	2020.01	05/30/2019 05:43:56 PM Eastern Daylight Time	08/04/2019 12:08:56 PM Eastern Daylight Time	08/02/2019 01:18:14 PM Eastern Daylight Time			08/05/2019 11:29:55 AM Eastern Daylight Time	"HUMANA HEALTH PLANS OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4007-016 (HMO D-SNP)	1	1		1			H4007	16	0	2020	Puerto Rico Island Wide		2		2		1	1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(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	2			
H4007	18	0	1	1	1	H4007_018_0	2	1	1	1	08/02/2019	2020.01	08/02/2019 04:41:52 PM Eastern Daylight Time	08/04/2019 12:12:10 PM Eastern Daylight Time	08/02/2019 01:18:14 PM Eastern Daylight Time			08/05/2019 11:00:06 AM Eastern Daylight Time	"HUMANA HEALTH PLANS OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4007-018 (HMO D-SNP)	1	1		1			H4007	18	0	2020	Puerto Rico Island Wide		2		2		1	1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(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	2			
H4007	19	0	1	1	1	H4007_019_0	3	1	1	1	05/30/2019	2020.01	05/30/2019 05:51:41 PM Eastern Daylight Time	08/04/2019 12:18:50 PM Eastern Daylight Time	08/02/2019 01:18:14 PM Eastern Daylight Time			08/05/2019 11:29:55 AM Eastern Daylight Time	"HUMANA HEALTH PLANS OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4007-019 (HMO D-SNP)	1	1		1			H4007	19	0	2020	Puerto Rico Island Wide		2		2		1	1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(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	2			
H4007	20	0	1	1	1	H4007_020_0	3	1			08/01/2019	2020.01	08/01/2019 05:44:44 PM Eastern Daylight Time	08/04/2019 12:22:13 PM Eastern Daylight Time	08/02/2019 01:18:15 PM Eastern Daylight Time			08/05/2019 11:00:06 AM Eastern Daylight Time	"HUMANA HEALTH PLANS OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H4007-020 (HMO)	1	1		1			H4007	20	0	2020	Puerto Rico Island Wide		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(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	2			
H4007	801	0	1	1	1	H4007_801_0	1	1			05/29/2019	2020.01	05/29/2019 10:48:38 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH PLANS OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4007	801	0	2020	Puerto Rico - Island Wide		1	39079	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4007	802	0	1	1	1	H4007_802_0	1	1			05/29/2019	2020.01	05/29/2019 10:50:08 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH PLANS OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4007	802	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4007	811	0	1	1	1	H4007_811_0	1	1			05/29/2019	2020.01	05/29/2019 12:39:21 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH PLANS OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4007	811	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H4007	812	0	1	1	1	H4007_812_0	1	1			05/29/2019	2020.01	05/29/2019 12:40:53 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH PLANS OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4007	812	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H4007	813	0	1	1	1	H4007_813_0	1	1			05/29/2019	2020.01	05/29/2019 12:42:20 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH PLANS OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4007	813	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H4007	814	0	1	1	1	H4007_814_0	1	1			05/29/2019	2020.01	05/29/2019 12:44:29 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA HEALTH PLANS OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4007	814	0	2020	Puerto Rico - Island Wide		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H4036	8	0	1	4	1	H4036_008_0	6	1			07/31/2019	2020.01	07/31/2019 09:54:02 PM Eastern Daylight Time	08/05/2019 10:01:41 AM Eastern Daylight Time	07/30/2019 06:55:05 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	1	4		1			H4036	8	0	2020	Select Counties in Wisconsin		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7802		(855)690-7802		(800)797-5940		(800)797-5940		(855)690-7802		(855)690-7802		(844)364-2118		(844)364-2118		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	9	0	1	4	1	H4036_009_0	7	1			08/05/2019	2020.01	08/05/2019 04:28:52 PM Eastern Daylight Time	08/05/2019 10:01:41 AM Eastern Daylight Time	07/30/2019 06:55:43 PM Eastern Daylight Time			08/05/2019 04:31:19 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	1	4		1			H4036	9	0	2020	Select Counties in Wisconsin		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7802		(855)690-7802		(800)797-5940		(800)797-5940		(855)690-7802		(855)690-7802		(844)364-2118		(844)364-2118		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	10	1	1	4	1	H4036_010_1	6	1			07/31/2019	2020.01	07/31/2019 06:07:16 PM Eastern Daylight Time	08/05/2019 10:01:41 AM Eastern Daylight Time	07/30/2019 06:56:20 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	1	4		1			H4036	10	1	2020	Select Counties in Ohio	Select Counties in Ohio	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7801		(855)690-7801		(800)797-5940		(800)797-5940		(855)690-7801		(855)690-7801		(844)364-2118		(844)364-2118		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	10	2	1	4	1	H4036_010_2	6	1			07/31/2019	2020.01	07/31/2019 06:07:45 PM Eastern Daylight Time	08/05/2019 10:01:42 AM Eastern Daylight Time	07/30/2019 06:56:57 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	1	4		1			H4036	10	2	2020	Select Counties in Ohio	Select Counties in Ohio	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7801		(855)690-7801		(800)797-5940		(800)797-5940		(855)690-7801		(855)690-7801		(844)364-2118		(844)364-2118		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	16	0	1	4	1	H4036_016_0	3	1			05/31/2019	2020.01	05/31/2019 09:45:28 PM Eastern Daylight Time	06/01/2019 01:18:16 PM Eastern Daylight Time				06/01/2019 02:37:28 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Core (PPO)	1	4		1			H4036	16	0	2020	Select Counties in Wisconsin		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7802		(855)690-7802		(800)797-5940		(800)797-5940										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4036	17	0	1	4	1	H4036_017_0	6	1			07/31/2019	2020.01	07/31/2019 06:08:32 PM Eastern Daylight Time	08/05/2019 10:01:43 AM Eastern Daylight Time	07/30/2019 06:57:33 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Plus (PPO)	1	4		1			H4036	17	0	2020	Select Counties in Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7801		(855)690-7801		(800)797-5940		(800)797-5940		(855)690-7801		(855)690-7801		(844)364-2118		(844)364-2118		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4036	801	0	1	4	1	H4036_801_0	2	1			05/30/2019	2020.01	05/30/2019 04:47:46 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4036	801	0	2020	Wisconsin		1	32710	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	802	0	1	4	1	H4036_802_0	2	1			05/30/2019	2020.01	05/30/2019 04:47:56 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4036	802	0	2020	Wisconsin		1	3096	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	803	0	1	4	1	H4036_803_0	2	1			05/30/2019	2020.01	05/30/2019 04:48:03 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4036	803	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	805	0	1	4	1	H4036_805_0	2	1			05/30/2019	2020.01	05/30/2019 04:48:14 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4036	805	0	2020	National (ASO)		1	77429	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	806	0	2	4	1	H4036_806_0	2	1			05/30/2019	2020.01	05/30/2019 04:48:27 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H4036	806	0	2020	National (Part B Only)		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	807	0	1	4	1	H4036_807_0	2	1			05/30/2019	2020.01	05/30/2019 04:48:34 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4036	807	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	808	0	2	4	1	H4036_808_0	2	1			05/30/2019	2020.01	05/30/2019 04:48:41 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H4036	808	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	809	0	2	4	1	H4036_809_0	2	1			05/30/2019	2020.01	05/30/2019 04:48:48 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H4036	809	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	810	0	2	4	1	H4036_810_0	2	1			05/30/2019	2020.01	05/30/2019 04:48:56 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H4036	810	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	811	0	1	4	1	H4036_811_0	2	1			05/30/2019	2020.01	05/30/2019 04:49:04 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4036	811	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	812	0	1	4	1	H4036_812_0	2	1			05/30/2019	2020.01	05/30/2019 04:49:14 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4036	812	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4036	813	0	1	4	1	H4036_813_0	2	1			05/30/2019	2020.01	05/30/2019 04:49:22 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4036	813	0	2020	Wisconsin		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4053	1	0	1	20	8	H4053_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:47:54 PM Eastern Daylight Time		05/21/2019 11:01:54 AM Eastern Daylight Time			05/22/2019 01:49:40 PM Eastern Daylight Time	PRISMA HEALTH-UPSTATE	Prisma Health SeniorCare PACE-Upstate	https://www.ghs.org/healthcareservices/seniorcare/	Prisma Health PACE-Upstate - Dual Eligible (PACE)	8	20		1			H4053	1	0	2020	"Anderson, Greenville and Pickens counties"		2		2			2						https://www.ghs.org/healthcareservices/upstate-pharmacy/	N/A	https://www.ghs.org/providers/ohmar-win/											(864)522-1950				(864)522-1950												(711)-				(711)-																
H4053	2	0	1	20	8	H4053_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:48:21 PM Eastern Daylight Time		05/21/2019 11:01:40 AM Eastern Daylight Time			05/22/2019 01:49:40 PM Eastern Daylight Time	PRISMA HEALTH-UPSTATE	Prisma Health SeniorCare PACE-Upstate	https://www.ghs.org/healthcareservices/seniorcare/	Prisma Health PACE-Upstate - Medicare Only (PACE)	8	20		1			H4053	2	0	2020	"Anderson, Greenville and Pickens counties"		2		2			2						https://www.ghs.org/healthcareservices/upstate-pharmacy/	N/A	https://www.ghs.org/providers/ohmar-win/											(864)522-1950				(864)522-1950												(711)-				(711)-																
H4074	1	0	1	20	8	H4074_001_0	1	1			05/22/2019	2020.01	05/22/2019 12:08:00 PM Central Daylight Time		05/21/2019 10:30:52 AM Central Daylight Time			05/22/2019 12:14:01 PM Central Daylight Time	MERCY LIFE OF ALABAMA	Mercy LIFE of Alabama	mercylifeal.com	Mercy LIFE of Alabama (PACE)	8	20		1			H4074	1	0	2020	Mercy LIFE of Alabama Baldwin and Mobile counties		2		2			2						pharmastarpbm.com	www.mercylifeal.com	mercylifeal.com									(855)367-6562		(251)287-8420		(855)367-6562		(251)287-8420										(855)212-1552		(855)212-1552		(855)212-1552		(855)212-1552																
H4074	2	0	1	20	8	H4074_002_0	1	1			05/22/2019	2020.01	05/22/2019 12:08:16 PM Central Daylight Time		05/21/2019 10:30:40 AM Central Daylight Time			05/22/2019 12:14:01 PM Central Daylight Time	MERCY LIFE OF ALABAMA	Mercy LIFE of Alabama	mercylifeal.com	Mercy LIFE of Alabama (PACE)	8	20		1			H4074	2	0	2020	Mercy LIFE of Alabama Baldwin and Mobile counties		2		2			2						pharmastarpbm.com	www.mercylifeal.com	mercylifeal.com									(855)367-6562		(251)287-8420		(855)367-6562		(251)287-8420										(855)212-1552		(855)212-1552		(855)212-1552		(855)212-1552																
H4091	1	0	1	4	1	H4091_001_0	4	1		1	08/02/2019	2020.01	08/02/2019 12:31:48 PM Central Daylight Time	08/02/2019 03:54:28 PM Central Daylight Time	07/31/2019 02:18:40 PM Central Daylight Time			08/06/2019 09:40:20 AM Central Daylight Time	"SIMPRA ADVANTAGE, INC."	Simpra Advantage	www.simpra.com	Simpra Advantage (PPO I-SNP)	1	4		1			H4091	1	0	2020	Alabama statewide		2	34784	2			1	1	1				www.simpra.com	www.simpra.com	www.simpra.com	(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4091	2	0	1	4	1	H4091_002_0	4	1	2	1	08/02/2019	2020.01	08/02/2019 12:32:18 PM Central Daylight Time	08/02/2019 03:57:44 PM Central Daylight Time	07/31/2019 02:19:39 PM Central Daylight Time			08/06/2019 09:40:20 AM Central Daylight Time	"SIMPRA ADVANTAGE, INC."	Simpra Advantage	www.simpra.com	Simpra Advantage (PPO D-SNP)	1	4		1			H4091	2	0	2020	Alabama statewide		2	600	2			1	3		2		1	www.simpra.com	www.simpra.com	www.simpra.com	(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(844)637-4770		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4093	1	0	1	1	1	H4093_001_0	15	1		1	08/06/2019	2020.01	08/06/2019 10:47:06 AM Eastern Daylight Time	08/06/2019 12:47:41 AM Eastern Daylight Time	08/06/2019 12:47:41 AM Eastern Daylight Time			08/06/2019 11:04:13 AM Eastern Daylight Time	"PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC"	Provider Partners Pennsylvania Advantage Plan	www.pphealthplanpa.com	Provider Partners Pennsylvania Advantage Plan (HMO I-SNP)	1	1		1			H4093	1	0	2020	PA East & West Borders		2	20328	2			1	1	1				www.pphealthplanpa.com	www.pphealthplanpa.com	www.pphealthplanpa.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4094	1	0	1	1	1	H4094_001_0	3	1	2	1	07/11/2019	2020.01	07/11/2019 09:54:52 AM Central Daylight Time	08/02/2019 10:59:46 AM Central Daylight Time	07/30/2019 08:43:00 PM Central Daylight Time			08/06/2019 12:14:20 PM Central Daylight Time	"OPTIMUM CHOICE, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H4094	1	0	2020	Montgomery County		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)855-9776		(844)855-9776		(888)834-3721		(888)834-3721		(844)855-9776		(844)855-9776		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4105	1	0	1	20	8	H4105_001_0	1	1			05/22/2019	2020.01	05/22/2019 08:04:10 AM Eastern Daylight Time		05/22/2019 08:11:37 AM Eastern Daylight Time			05/22/2019 08:20:29 AM Eastern Daylight Time	PACE ORGANIZATION OF RHODE ISLAND	PACE Organization Of Rhode Island	www.pace-ri.org	PACE Organization of Rhode Island (PACE)	8	20		1			H4105	1	0	2020	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										(800)745-5555		(800)745-5555		(800)745-5555		(800)745-5555																
H4105	2	0	1	20	8	H4105_002_0	1	1			05/22/2019	2020.01	05/22/2019 08:04:44 AM Eastern Daylight Time		05/22/2019 08:11:18 AM Eastern Daylight Time			05/22/2019 08:20:29 AM Eastern Daylight Time	PACE ORGANIZATION OF RHODE ISLAND	PACE Organization Of Rhode Island	www.pace-ri.org	PACE Organization of Rhode Island (PACE)	8	20		1			H4105	2	0	2020	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										(800)745-5555		(800)745-5555		(800)745-5555		(800)745-5555																
H4118	1	0	1	20	8	H4118_001_0	1	1			05/21/2019	2020.01	05/21/2019 12:38:18 PM Eastern Daylight Time		05/21/2019 12:32:28 PM Eastern Daylight Time			05/21/2019 12:40:41 PM Eastern Daylight Time	THE WASHTENAW PACE	Huron Valley PACE	www.huronvalleypace.org	Huron Valley PACE - Dual Eligible (PACE)	8	20		1			H4118	1	0	2020	"Wash Co, Parts of Mon, Oak, Wayne & Livingston Co"		2		2			2						http://www.hometownpharmacy.com/	http://huronvalleypace.org/										(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	2	0	1	20	8	H4118_002_0	1	1			05/21/2019	2020.01	05/21/2019 12:38:36 PM Eastern Daylight Time		05/21/2019 12:32:28 PM Eastern Daylight Time			05/21/2019 12:40:41 PM Eastern Daylight Time	THE WASHTENAW PACE	Huron Valley PACE	www.huronvalleypace.org	Huron Valley PACE - Medicare Only (PACE)	8	20		1			H4118	2	0	2020	"Wash Co, Parts of Mon, Oak, Wayne & Livingston Co"		2		2			2						http://www.hometownpharmacy.com/	http://huronvalleypace.org/										(855)483-7223		(734)572-5777		(855)483-7223		(734)572-5777										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777																
H4140	1	0	1	2	1	H4140_001_0	8	1			07/09/2019	2020.01	07/09/2019 09:58:06 AM Mountain Daylight Time	08/01/2019 11:03:39 AM Mountain Daylight Time	08/01/2019 11:25:19 AM Mountain Daylight Time			08/05/2019 04:31:50 PM Mountain Daylight Time	"DOCTORS HEALTHCARE PLANS, INC."	"Doctors HealthCare Plans, Inc."	www.doctorshcp.com	DrMax (HMO-POS)	1	2		1			H4140	1	0	2020	Miami-Dade County		2	91094	2			2						www.doctorshcp.com	www.doctorshcp.com	www.doctorshcp.com	(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4140	2	0	1	2	1	H4140_002_0	8	1	2	1	07/09/2019	2020.01	07/09/2019 09:59:27 AM Mountain Daylight Time	08/01/2019 11:05:44 AM Mountain Daylight Time	08/01/2019 11:27:22 AM Mountain Daylight Time			08/05/2019 04:31:50 PM Mountain Daylight Time	"DOCTORS HEALTHCARE PLANS, INC."	"Doctors HealthCare Plans, Inc."	www.doctorshcp.com	DrPlus (HMO-POS D-SNP)	1	2		1			H4140	2	0	2020	Miami-Dade County		2		2			1	3		1		2	www.doctorshcp.com	www.doctorshcp.com	www.doctorshcp.com	(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4140	3	0	1	2	1	H4140_003_0	8	1		1	07/09/2019	2020.01	07/09/2019 10:00:35 AM Mountain Daylight Time	08/01/2019 11:08:21 AM Mountain Daylight Time	08/01/2019 11:29:32 AM Mountain Daylight Time			08/05/2019 04:31:50 PM Mountain Daylight Time	"DOCTORS HEALTHCARE PLANS, INC."	"Doctors HealthCare Plans, Inc."	www.doctorshcp.com	DrCare (HMO-POS C-SNP)	1	2		1			H4140	3	0	2020	Miami-Dade County		2		2			1	4			1E+15		www.doctorshcp.com	www.doctorshcp.com	www.doctorshcp.com	(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4140	4	0	1	2	1	H4140_004_0	8	1		1	07/09/2019	2020.01	07/09/2019 10:01:20 AM Mountain Daylight Time	08/01/2019 11:10:46 AM Mountain Daylight Time	08/01/2019 11:32:50 AM Mountain Daylight Time			08/05/2019 04:31:50 PM Mountain Daylight Time	"DOCTORS HEALTHCARE PLANS, INC."	"Doctors HealthCare Plans, Inc."	www.doctorshcp.com	DrExtra (HMO-POS C-SNP)	1	2		1			H4140	4	0	2020	Miami-Dade County		2		2			1	4			1E+13		www.doctorshcp.com	www.doctorshcp.com	www.doctorshcp.com	(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4140	5	0	1	2	1	H4140_005_0	8	1			07/09/2019	2020.01	07/09/2019 10:01:46 AM Mountain Daylight Time	08/01/2019 11:13:30 AM Mountain Daylight Time	08/01/2019 11:35:07 AM Mountain Daylight Time			08/05/2019 04:31:50 PM Mountain Daylight Time	"DOCTORS HEALTHCARE PLANS, INC."	"Doctors HealthCare Plans, Inc."	www.doctorshcp.com	DrValue (HMO-POS)	1	2		1			H4140	5	0	2020	Miami-Dade County		2		2			2						www.doctorshcp.com	www.doctorshcp.com	www.doctorshcp.com	(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(833)342-7463		(786)460-3427		(833)639-3427		(786)420-3427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	3	0	1	1	1	H4141_003_0	2	1	2	1	05/30/2019	2020.01	05/30/2019 10:39:20 AM Eastern Daylight Time	08/04/2019 11:56:44 AM Eastern Daylight Time	08/02/2019 01:18:15 PM Eastern Daylight Time			08/05/2019 10:51:08 AM Eastern Daylight Time	"HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4141-003 (HMO D-SNP)	1	1		1			H4141	3	0	2020	Greater Georgia Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	15	0	1	1	1	H4141_015_0	4	1			08/01/2019	2020.01	08/01/2019 05:35:19 PM Eastern Daylight Time	08/04/2019 11:37:48 AM Eastern Daylight Time	08/02/2019 01:18:15 PM Eastern Daylight Time			08/05/2019 10:51:08 AM Eastern Daylight Time	"HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H4141-015 (HMO)	1	1		1			H4141	15	0	2020	Atlanta Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	17	3	1	1	1	H4141_017_3	3	1			08/01/2019	2020.01	08/01/2019 05:36:06 PM Eastern Daylight Time	08/04/2019 11:55:38 AM Eastern Daylight Time	08/02/2019 01:18:15 PM Eastern Daylight Time			08/05/2019 10:51:08 AM Eastern Daylight Time	"HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H4141-017 (HMO)	1	1		1			H4141	17	3	2020	Atlanta	Atlanta Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	17	4	1	1	1	H4141_017_4	3	1			08/01/2019	2020.01	08/01/2019 05:37:11 PM Eastern Daylight Time	08/04/2019 11:48:31 AM Eastern Daylight Time	08/02/2019 01:18:15 PM Eastern Daylight Time			08/05/2019 10:51:08 AM Eastern Daylight Time	"HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H4141-017 (HMO)	1	1		1			H4141	17	4	2020	Atlanta	Atlanta	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	19	1	1	1	1	H4141_019_1	3	1			08/01/2019	2020.01	08/01/2019 05:37:53 PM Eastern Daylight Time	08/04/2019 12:00:01 PM Eastern Daylight Time	08/02/2019 01:18:15 PM Eastern Daylight Time			08/05/2019 10:51:08 AM Eastern Daylight Time	"HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H4141-019 (HMO)	1	1		1			H4141	19	1	2020	Select Counties in Georgia	Macon Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	19	2	1	1	1	H4141_019_2	3	1			08/01/2019	2020.01	08/01/2019 05:38:33 PM Eastern Daylight Time	08/04/2019 12:01:13 PM Eastern Daylight Time	08/02/2019 01:18:15 PM Eastern Daylight Time			08/05/2019 10:51:08 AM Eastern Daylight Time	"HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H4141-019 (HMO)	1	1		1			H4141	19	2	2020	Select Counties in Georgia	Coastal area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	20	0	1	1	1	H4141_020_0	3	1			08/01/2019	2020.01	08/01/2019 05:43:04 PM Eastern Daylight Time	08/04/2019 12:21:42 PM Eastern Daylight Time	08/02/2019 01:18:15 PM Eastern Daylight Time			08/05/2019 10:50:19 AM Eastern Daylight Time	"HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H4141-020 (HMO)	1	1		1			H4141	20	0	2020	Gwinnett County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4141	801	0	1	1	1	H4141_801_0	1	1			05/29/2019	2020.01	05/29/2019 10:51:55 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4141	801	0	2020	Select counties in Georgia		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4141	802	0	1	1	1	H4141_802_0	1	1			05/29/2019	2020.01	05/29/2019 10:53:17 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4141	802	0	2020	Select counties in Georgia		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4141	805	0	1	1	1	H4141_805_0	1	1			05/29/2019	2020.01	05/29/2019 12:46:03 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4141	805	0	2020	Select counties in Georgia		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H4141	806	0	1	1	1	H4141_806_0	1	1			05/29/2019	2020.01	05/29/2019 12:46:59 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4141	806	0	2020	Select counties in Georgia		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H4142	1	0	1	20	8	H4142_001_0	1	1			05/20/2019	2020.01	05/20/2019 08:47:16 AM Central Daylight Time		05/20/2019 08:39:24 AM Central Daylight Time			05/20/2019 08:50:59 AM Central Daylight Time	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	Cherokee Elder Care	http://eldercare.cherokee.org	Cherokee Elder Care (PACE)	8	20		1			H4142	1	0	2020	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	2	0	1	20	8	H4142_002_0	1	1			05/20/2019	2020.01	05/20/2019 08:47:30 AM Central Daylight Time		05/20/2019 08:39:09 AM Central Daylight Time			05/20/2019 08:50:59 AM Central Daylight Time	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	Cherokee Elder Care	http://eldercare.cherokee.org	Cherokee Elder Care (PACE)	8	20		1			H4142	2	0	2020	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																
H4152	4	0	1	1	1	H4152_004_0	6	1			07/22/2019	2020.01	07/22/2019 02:16:33 PM Eastern Daylight Time	07/22/2019 04:35:08 PM Eastern Daylight Time				07/22/2019 04:39:12 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 Core (HMO)	1	1		1			H4152	4	0	2020	State of Rhode Island		2	10607	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.bcbsri.com/	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583										(711)-		(711)-		(711)-		(711)-										2					2					2	1	1	7a;	
H4152	5	0	1	1	1	H4152_005_0	7	1			07/22/2019	2020.01	07/22/2019 11:23:26 AM Eastern Daylight Time	08/06/2019 12:51:40 PM Eastern Daylight Time	08/06/2019 12:51:41 PM Eastern Daylight Time			08/06/2019 12:59:48 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)	1	1		1			H4152	5	0	2020	State of Rhode Island		2	30387	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.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)-		2					2					2	1	1	7a;	
H4152	7	0	1	2	1	H4152_007_0	7	1			07/22/2019	2020.01	07/22/2019 01:49:07 PM Eastern Daylight Time	08/06/2019 12:51:41 PM Eastern Daylight Time	08/06/2019 12:51:33 PM Eastern Daylight Time			08/06/2019 12:59:48 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)	1	2		1			H4152	7	0	2020	State of Rhode Island		2	10731	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.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)-		2					2					2	1	1	7a;	
H4152	13	0	1	1	1	H4152_013_0	7	1			07/22/2019	2020.01	07/22/2019 01:50:52 PM Eastern Daylight Time	08/06/2019 12:51:34 PM Eastern Daylight Time	08/06/2019 12:51:35 PM Eastern Daylight Time			08/06/2019 12:59:48 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)	1	1		1			H4152	13	0	2020	State of Rhode Island		2	45144	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.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)-		2					2					2	1	1	7a;	
H4152	17	0	1	1	1	H4152_017_0	7	1			07/22/2019	2020.01	07/22/2019 02:23:47 PM Eastern Daylight Time	08/06/2019 12:51:35 PM Eastern Daylight Time	08/06/2019 12:51:36 PM Eastern Daylight Time			08/06/2019 12:59:48 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 Advance (HMO)	1	1		1			H4152	17	0	2020	State of Rhode Island		2	26685	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.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)-		2					2					2	2			
H4152	18	0	1	2	1	H4152_018_0	8	1			07/22/2019	2020.01	07/22/2019 01:54:47 PM Eastern Daylight Time	08/06/2019 12:51:36 PM Eastern Daylight Time	08/06/2019 12:51:37 PM Eastern Daylight Time			08/06/2019 12:59:48 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)	1	2		1			H4152	18	0	2020	State of Rhode Island		2	69955	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.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)-		2					2					2	1	1	7a;	
H4152	20	0	1	2	1	H4152_020_0	6	1			07/22/2019	2020.01	07/22/2019 01:57:09 PM Eastern Daylight Time	08/06/2019 12:51:37 PM Eastern Daylight Time	08/06/2019 12:51:38 PM Eastern Daylight Time			08/06/2019 12:59:48 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)	1	2		1			H4152	20	0	2020	State of Rhode Island		2	399852	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.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)-		2					2					2	1	1	7a;	
H4152	815	0	1	2	1	H4152_815_0	4	1			05/30/2019	2020.01	05/30/2019 04:25:23 PM Eastern Daylight Time					07/22/2019 04:39:12 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 Group Preferred (HMO-POS)	1	2		1			H4152	815	0	2020	"RI, Bristol Cty MA, Partial New London Cty CT"		1	40129	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.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	1a;1b;2;5;6;7e;7g;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;15;	2		1	1	1a;1b;2;5;6;7e;7g;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;15;	2		1				
H4152	817	0	1	1	1	H4152_817_0	4	1			05/30/2019	2020.01	05/30/2019 04:22:18 PM Eastern Daylight Time					07/22/2019 04:39:12 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 Group Plus (HMO)	1	1		1			H4152	817	0	2020	"RI, Bristol Cty MA, Partial New London Cty CT"		1	6204	2			2						www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	http://findadoctor.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	1a;1b;2;5;6;7e;7g;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;15;	2		1					1				
H4172	1	0	1	1	1	H4172_001_0	5	1		1	08/06/2019	2020.01	08/06/2019 12:38:30 PM Central Daylight Time	08/06/2019 12:08:19 PM Central Daylight Time	07/31/2019 04:26:47 PM Central Daylight Time			08/06/2019 01:19:38 PM Central Daylight Time	"NHC ADVANTAGE, LLC"	NHC Advantage	www.nhcadvantageplan.com	NHC Advantage (HMO I-SNP)	1	1		1			H4172	1	0	2020	Missouri (partial) Tennessee (partial)		2	18144	2			1	1	3				www.nhcadvantageplan.com	www.nhcadvantageplan.com	www.nhcadvantageplan.com	(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4172	2	0	1	1	1	H4172_002_0	5	1		1	07/09/2019	2020.01	07/09/2019 07:35:32 PM Central Daylight Time	08/02/2019 12:14:12 PM Central Daylight Time	07/31/2019 04:27:27 PM Central Daylight Time			08/05/2019 04:58:20 PM Central Daylight Time	"NHC ADVANTAGE, LLC"	NHC Advantage	www.nhcadvantageplan.com	NHC Advantage Gold (HMO I-SNP)	1	1		1			H4172	2	0	2020	Missouri (partial) Tennessee (partial)		2	1872	2			1	1	3				www.nhcadvantageplan.com	www.nhcadvantageplan.com	www.nhcadvantageplan.com	(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(844)854-6886		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4198	1	0	1	1	1	H4198_001_0	4	1			07/04/2019	2020.01	07/04/2019 09:46:21 PM Eastern Daylight Time	05/31/2019 01:38:28 PM Eastern Daylight Time				07/04/2019 09:52:07 PM Eastern Daylight Time	"COMMUNITYCARE GOVERNMENT PROGRAMS, INC."	"CommunityCare Choice, Inc."	www.ccokadvantage.com	Advantage Choice (HMO)	1	1		1			H4198	1	0	2020	"Counties CG, CK, MC, MU, NO, OS, TU, WG, WS"		2		2			2								www.ccokadvantage.com	(800)333-3275		(918)594-5202		(800)333-3275		(918)594-5202										(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353										2					2					2	2			
H4198	3	0	1	1	1	H4198_003_0	6	1			08/06/2019	2020.01	08/06/2019 01:37:37 PM Eastern Daylight Time	08/01/2019 03:14:12 PM Eastern Daylight Time	08/01/2019 10:45:14 AM Eastern Daylight Time			08/06/2019 01:45:01 PM Eastern Daylight Time	"COMMUNITYCARE GOVERNMENT PROGRAMS, INC."	"CommunityCare Choice, Inc."	www.ccokadvantage.com	Advantage Premier (HMO)	1	1		1			H4198	3	0	2020	"Counties CG, CK, MC, MU, NO, OS, TU, WG, WS"		2		2			2						www.ccokadvantage.com	www.ccokadvantage.com	www.ccokadvantage.com	(800)333-3275		(918)594-5202		(800)333-3275		(918)594-5202		(877)293-8628		(918)594-5211		(800)333-3275		(918)594-5202		(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	2			
H4198	5	0	1	1	1	H4198_005_0	5	1			08/06/2019	2020.01	08/06/2019 01:38:16 PM Eastern Daylight Time	08/01/2019 03:18:42 PM Eastern Daylight Time	08/01/2019 10:48:40 AM Eastern Daylight Time			08/06/2019 01:45:01 PM Eastern Daylight Time	"COMMUNITYCARE GOVERNMENT PROGRAMS, INC."	"CommunityCare Choice, Inc."	www.ccokadvantage.com	Advantage Choice Plus (HMO)	1	1		1			H4198	5	0	2020	"Counties CG, CK, MC, MU, NO, OS, TU, WG, WS"		2		2			2						www.ccokadvantage.com	www.ccokadvantage.com	www.ccokadvantage.com	(800)333-3275		(918)594-5202		(800)333-3275		(918)594-5202		(877)293-8628		(918)594-5211		(800)333-3275		(918)594-5202		(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	2			
H4198	802	0	1	1	1	H4198_802_0	4	1			06/18/2019	2020.01	06/18/2019 07:20:41 AM Eastern Daylight Time					06/18/2019 07:25:51 AM Eastern Daylight Time	"COMMUNITYCARE GOVERNMENT PROGRAMS, INC."	"CommunityCare Choice, Inc."	www.ccokadvantage.com	Advantage Medicare EGHP+D (HMO)	1	1		1			H4198	802	0	2020	"Counties CG, CK, MC, MU, NO, OS, TU, WG, WS"		1	0	2			2						www.ccokadvantage.com	www.ccokadvantage.com	www.ccokadvantage.com	(800)333-3275		(918)594-5202		(800)333-3275		(918)594-5202		(877)293-8628		(918)594-5211		(800)333-3275		(918)594-5202		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9d;10a;11a;11b;12;14a;14d;14e2;14e6;15;16b;	1	5;6;7b;7c;7d;7e;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9d;12;14a;14d;14e2;16b;	1					1				
H4203	1	0	1	20	8	H4203_001_0	2	1			05/23/2019	2020.01	05/23/2019 11:01:31 AM Eastern Daylight Time		05/23/2019 10:59:03 AM Eastern Daylight Time			05/23/2019 11:04:38 AM Eastern Daylight Time	PRISMA HEALTH-MIDLANDS	Palmetto SeniorCare PACE	Palmettohealth.org	Palmetto Health - Palmetto SeniorCare (PACE)	8	20		1			H4203	1	0	2020	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	2	0	1	20	8	H4203_002_0	2	1			05/23/2019	2020.01	05/23/2019 11:01:52 AM Eastern Daylight Time		05/23/2019 10:58:49 AM Eastern Daylight Time			05/23/2019 11:04:38 AM Eastern Daylight Time	PRISMA HEALTH-MIDLANDS	Palmetto SeniorCare PACE	Palmettohealth.org	Palmetto Health - Palmetto SeniorCare (PACE)	8	20		1			H4203	2	0	2020	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																
H4213	16	1	1	9	4	H4213_016_1	6	1			07/02/2019	2020.01	07/02/2019 12:12:27 PM Central Daylight Time	06/02/2019 02:38:18 PM Central Daylight Time				07/03/2019 07:17:22 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Advantage MA (PFFS)	4	9	1	1			H4213	16	1	2020	State of Arkansas	"Northern, Western and South Central AR counties"	2	20790	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4213	16	3	1	9	4	H4213_016_3	6	1			07/02/2019	2020.01	07/02/2019 12:13:12 PM Central Daylight Time	06/02/2019 02:39:05 PM Central Daylight Time				07/03/2019 07:17:22 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Advantage MA (PFFS)	4	9	1	1			H4213	16	3	2020	State of Arkansas	"Northwest, Western and Central AR counties"	2	12829	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4213	16	4	1	9	4	H4213_016_4	6	1			07/02/2019	2020.01	07/02/2019 12:13:43 PM Central Daylight Time	06/02/2019 02:39:52 PM Central Daylight Time				07/03/2019 07:17:22 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Advantage MA (PFFS)	4	9	1	1			H4213	16	4	2020	State of Arkansas	East Central AR counties	2	11659	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4213	17	1	1	9	4	H4213_017_1	7	1			07/02/2019	2020.01	07/02/2019 12:37:18 PM Central Daylight Time	08/01/2019 03:42:03 PM Central Daylight Time	08/01/2019 08:49:41 AM Central Daylight Time			08/05/2019 09:30:47 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS)	4	9	1	1			H4213	17	1	2020	State of Arkansas	"Northern, Western and South Central AR counties"	2	34239	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444		(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4213	17	5	1	9	4	H4213_017_5	7	1			07/02/2019	2020.01	07/02/2019 12:37:01 PM Central Daylight Time	08/01/2019 03:43:02 PM Central Daylight Time	08/01/2019 08:50:20 AM Central Daylight Time			08/05/2019 09:30:47 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS)	4	9	1	1			H4213	17	5	2020	State of Arkansas	"Northwest, Western and Central AR counties"	2	25065	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444		(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4213	17	6	1	9	4	H4213_017_6	7	1			07/02/2019	2020.01	07/02/2019 12:20:44 PM Central Daylight Time	08/01/2019 03:44:07 PM Central Daylight Time	08/01/2019 08:50:57 AM Central Daylight Time			08/05/2019 09:30:47 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS)	4	9	1	1			H4213	17	6	2020	State of Arkansas	East Central AR counties	2	7558	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444		(877)233-7022		(877)233-7022		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4227	1	0	1	1	1	H4227_001_0	5	1	2	1	08/05/2019	2020.01	08/05/2019 08:29:26 AM Central Daylight Time	08/02/2019 12:26:09 PM Central Daylight Time	07/31/2019 10:48:28 AM Central Daylight Time			08/05/2019 08:30:13 AM Central Daylight Time	"VISTA HEALTH PLAN, INC."	VISTA Health Plan Inc.	www.keystonefirstvipchoice.com	Keystone First VIP Choice (HMO D-SNP)	1	1		1			H4227	1	0	2020	Eastern Pennsylvania		2		2			1	3		1		1	www.keystonefirstvipchoice.com	www.keystonefirstvipchoice.com	www.keystonefirstvipchoice.com	(800)450-1166		(800)450-1166		(855)241-3648		(855)241-3648		(800)450-1166		(800)450-1166		(855)241-3648		(855)241-3648		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4227	2	0	1	1	1	H4227_002_0	5	1	2	1	08/05/2019	2020.01	08/05/2019 08:29:36 AM Central Daylight Time	08/02/2019 12:27:40 PM Central Daylight Time	07/31/2019 10:49:16 AM Central Daylight Time			08/05/2019 08:30:13 AM Central Daylight Time	"VISTA HEALTH PLAN, INC."	VISTA Health Plan Inc.	www.amerihealthcaritasvipcare.com	AmeriHealth Caritas VIP Care (HMO D-SNP)	1	1		1			H4227	2	0	2020	Lehigh Capital and Southwestern Pennsylvania		2		2			1	3		1		1	www.amerihealthcaritasvipcare.com	www.amerihealthcaritasvipcare.com	www.amerihealthcaritasvipcare.com	(866)533-5490		(866)533-5490		(855)241-3648		(855)241-3648		(866)533-5490		(866)533-5490		(855)241-3648		(855)241-3648		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4235	1	0	1	20	8	H4235_001_0	1	1			05/30/2019	2020.01	05/30/2019 11:47:43 AM Eastern Daylight Time		05/30/2019 11:36:42 AM Eastern Daylight Time			05/30/2019 11:53:51 AM Eastern Daylight Time	"SENIOR TOTAL LIFE CARE, INC."	Senior Total Life Care	www.seniorTLC.org	Senior Total Life Care Dual (PACE)	8	20		1			H4235	1	0	2020	Gaston County and Parts of Cleveland and Lincoln		2		2			2						www.seniortlc.org	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	2	0	1	20	8	H4235_002_0	1	1			05/30/2019	2020.01	05/30/2019 11:48:25 AM Eastern Daylight Time		05/30/2019 11:36:35 AM Eastern Daylight Time			05/30/2019 11:53:51 AM Eastern Daylight Time	"SENIOR TOTAL LIFE CARE, INC."	Senior Total Life Care	www.seniorTLC.org	Senior Total Life Care Medicare (PACE)	8	20		1			H4235	2	0	2020	"Gaston, Lincoln and Cleveland Counties in NC"		2		2			2						www.seniortlc.org	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																
H4236	1	0	1	1	1	H4236_001_0	8	1		1	07/24/2019	2020.01	07/24/2019 01:06:23 PM Central Daylight Time	08/01/2019 11:27:01 AM Central Daylight Time	07/31/2019 02:53:40 PM Central Daylight Time			08/05/2019 06:27:26 PM Central Daylight Time	"SPARTAN PLAN PA, INC."	Sunrise Advantage Plan	www.sunriseadvantageplan.com	Sunrise Advantage Plan (HMO I-SNP)	1	1		1			H4236	1	0	2020	Pennsylvania (partial)		2	1008	2			1	1	3				www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4236	2	0	1	1	1	H4236_002_0	8	1		1	07/24/2019	2020.01	07/24/2019 01:06:39 PM Central Daylight Time	08/01/2019 11:30:04 AM Central Daylight Time	07/31/2019 02:53:49 PM Central Daylight Time			08/05/2019 06:27:26 PM Central Daylight Time	"SPARTAN PLAN PA, INC."	Sunrise Advantage Plan	www.sunriseadvantageplan.com	Reflections (HMO C-SNP)	1	1		1			H4236	2	0	2020	Pennsylvania (partial)		2	432	2			1	4			1E+14		www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4236	3	0	1	1	1	H4236_003_0	9	1			07/24/2019	2020.01	07/24/2019 01:06:56 PM Central Daylight Time	08/01/2019 11:33:02 AM Central Daylight Time	07/31/2019 02:54:50 PM Central Daylight Time			08/05/2019 06:27:26 PM Central Daylight Time	"SPARTAN PLAN PA, INC."	Sunrise Advantage Plan	www.sunriseadvantageplan.com	Sunrise Advantage Community Plan (HMO)	1	1		1			H4236	3	0	2020	Pennsylvania (partial)		2	713	2			2						www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4256	1	0	1	20	8	H4256_001_0	1	1			07/22/2019	2020.01	07/22/2019 01:26:07 PM Eastern Daylight Time		07/22/2019 01:21:50 PM Eastern Daylight Time			07/22/2019 01:33:52 PM Eastern Daylight Time	"PACE NORTH, INC."	PACE North	www.pacenorth.org	"PACE North, Inc (PACE)"	8	20		1			H4256	1	0	2020	"Grand Traverse, Benz, Leel,Wexf, Kalk, Antr, Mani"		2		2			2						KalamazooLTCPharmacy.com	N/A												(231)252-2767				(231)252-2767										(833)410-2082		(833)410-2082				(833)410-2082																
H4256	2	0	1	20	8	H4256_002_0	1	1			07/22/2019	2020.01	07/22/2019 01:26:23 PM Eastern Daylight Time		07/22/2019 01:22:27 PM Eastern Daylight Time			07/22/2019 01:33:52 PM Eastern Daylight Time	"PACE NORTH, INC."	PACE North	www.pacenorth.org	"PACE North, Inc (PACE)"	8	20		1			H4256	2	0	2020	"Grand Traverse, Benz, Leel,Wexf, Kalk, Antr, Mani"		2		2			2						KalamazooLTCPharmacy.com	N/A												(231)252-2767				(231)252-2767												(833)410-2082				(833)410-2082																
H4279	1	0	1	1	1	H4279_001_0	11	1	2	1	08/02/2019	2020.01	08/02/2019 05:15:29 PM Eastern Daylight Time	08/02/2019 01:56:38 PM Eastern Daylight Time	07/31/2019 03:35:10 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC FOR YOU, INC"	UPMC for Life Dual	www.upmchealthplan.com/snp	UPMC for Life Dual (HMO D-SNP)	1	1		1			H4279	1	0	2020	Pennsylvania		2	380071	2			1	3		1		1	www.upmchealthplan.com/medicare/documents-and-forms	www.upmchealthplan.com/medicare/documents-and-forms	http://www.upmchealthplan.com/snp	(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4305	1	0	1	20	8	H4305_001_0	1	1			05/22/2019	2020.01	05/22/2019 12:55:42 PM Central Daylight Time		05/20/2019 03:44:16 PM Central Daylight Time			05/22/2019 12:57:19 PM Central Daylight Time	TOTAL LIFE HEALTHCARE	Total Life Healthcare	www.stbernards.info/	Total Life Healthcare Dual (PACE)	8	20		1			H4305	1	0	2020	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										(000)000-0000		(870)207-0527		(000)000-0000		(870)207-0527																
H4305	2	0	1	20	8	H4305_002_0	1	1			05/22/2019	2020.01	05/22/2019 12:56:06 PM Central Daylight Time		05/20/2019 03:45:57 PM Central Daylight Time			05/22/2019 12:57:19 PM Central Daylight Time	TOTAL LIFE HEALTHCARE	Total Life Healthcare	www.stbernards.info/	Total Life Healthcare Medicare only (PACE)	8	20		1			H4305	2	0	2020	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										(000)000-0000		(870)207-0527		(000)000-0000		(870)207-0527																
H4326	1	0	1	20	8	H4326_001_0	1	1			05/30/2019	2020.01	05/30/2019 09:31:45 AM Eastern Daylight Time		05/29/2019 12:55:09 PM Eastern Daylight Time			05/30/2019 09:33:54 AM Eastern Daylight Time	"PACE @ HOME, INC."	PACE@Home	www.pace-at-home.org	PACE at Home - dual (PACE)	8	20		1			H4326	1	0	2020	Catawba Co. and Surrounding Select Zip Codes		2		2			2						www.carekinesis.com	www.pace-at-home.org										(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	2	0	1	20	8	H4326_002_0	1	1			05/30/2019	2020.01	05/30/2019 09:32:08 AM Eastern Daylight Time		05/29/2019 12:55:09 PM Eastern Daylight Time			05/30/2019 09:33:54 AM Eastern Daylight Time	"PACE @ HOME, INC."	PACE@Home	www.pace-at-home.org	PACE at Home - medicare only (PACE)	8	20		1			H4326	2	0	2020	Catawba Co. and Surrounding Select Zip Codes		2		2			2						www.carekinesis.com	www.pace-at-home.org										(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	1	0	1	1	1	H4346_001_0	9	1			08/01/2019	2020.01	08/01/2019 03:46:47 PM Pacific Daylight Time	08/05/2019 07:01:43 AM Pacific Daylight Time	07/30/2019 03:58:11 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Value Plus (HMO)	1	1		1			H4346	1	0	2020	Clark County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	5	0	1	1	1	H4346_005_0	9	1		1	08/01/2019	2020.01	08/01/2019 03:46:25 PM Pacific Daylight Time	08/05/2019 07:01:43 AM Pacific Daylight Time	07/30/2019 03:58:53 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Breathe (HMO C-SNP)	1	1		1			H4346	5	0	2020	Clark County		2		2			1	4			100000000		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	6	0	1	1	1	H4346_006_0	11	1		1	08/06/2019	2020.01	08/06/2019 05:21:05 PM Pacific Daylight Time	08/05/2019 07:01:44 AM Pacific Daylight Time	07/30/2019 03:59:30 PM Pacific Daylight Time			08/06/2019 05:24:01 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes (HMO C-SNP)	1	1		1			H4346	6	0	2020	Clark County		2		2			1	4			1E+13		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	8	0	1	1	1	H4346_008_0	9	1		1	08/01/2019	2020.01	08/01/2019 03:47:50 PM Pacific Daylight Time	08/05/2019 07:01:44 AM Pacific Daylight Time	07/30/2019 04:00:07 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Heart (HMO C-SNP)	1	1		1			H4346	8	0	2020	Clark County		2		2			1	4			10		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	9	0	1	1	1	H4346_009_0	8	1			07/17/2019	2020.01	07/17/2019 01:15:27 AM Pacific Daylight Time	08/05/2019 07:01:44 AM Pacific Daylight Time	07/30/2019 04:00:43 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue StartSmart Plus (HMO)	1	1		1			H4346	9	0	2020	Clark County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	10	0	1	1	1	H4346_010_0	10	1		1	08/06/2019	2020.01	08/06/2019 05:21:24 PM Pacific Daylight Time	08/05/2019 07:01:45 AM Pacific Daylight Time	07/30/2019 04:01:20 PM Pacific Daylight Time			08/06/2019 05:24:01 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Care On Site (HMO I-SNP)	1	1		1			H4346	10	0	2020	Clark County		2		2			1	1	3				https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	11	0	1	1	1	H4346_011_0	8	1			07/17/2019	2020.01	07/17/2019 01:15:37 AM Pacific Daylight Time	08/05/2019 07:01:45 AM Pacific Daylight Time	07/30/2019 04:01:58 PM Pacific Daylight Time			08/05/2019 02:59:26 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Connect Plus (HMO)	1	1		1			H4346	11	0	2020	Clark County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	12	0	1	1	1	H4346_012_0	9	1			07/31/2019	2020.01	07/31/2019 11:46:12 PM Pacific Daylight Time	08/05/2019 07:01:46 AM Pacific Daylight Time	07/30/2019 04:02:35 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H4346	12	0	2020	Denver Metro Area		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(888)346-0095		(888)346-0095		(800)797-1746		(800)797-1746		(888)346-0095		(888)346-0095		(800)261-8667		(800)261-8667		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	13	0	1	1	1	H4346_013_0	9	1			07/31/2019	2020.01	07/31/2019 11:48:44 PM Pacific Daylight Time	08/05/2019 07:01:46 AM Pacific Daylight Time	07/30/2019 04:03:12 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H4346	13	0	2020	"El Paso, Larimer, Pueblo and Weld Counties"		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(888)346-0095		(888)346-0095		(800)797-1746		(800)797-1746		(888)346-0095		(888)346-0095		(800)261-8667		(800)261-8667		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	14	0	1	1	1	H4346_014_0	9	1	2	1	07/31/2019	2020.01	07/31/2019 11:54:44 PM Pacific Daylight Time	08/05/2019 07:01:47 AM Pacific Daylight Time	07/30/2019 04:03:49 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H4346	14	0	2020	Greater Denver Area		2		2			1	3		2		2	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)664-7175		(844)664-7175		(800)797-1746		(800)797-1746		(844)664-7175		(844)664-7175		(800)261-8667		(800)261-8667		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	17	0	1	1	1	H4346_017_0	9	1			08/01/2019	2020.01	08/01/2019 12:37:13 AM Pacific Daylight Time	08/05/2019 07:01:47 AM Pacific Daylight Time	07/30/2019 04:04:27 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H4346	17	0	2020	Clark County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)469-1759		(844)469-1759		(800)797-1746		(800)797-1746		(844)469-1759		(844)469-1759		(800)261-8667		(800)261-8667		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	18	0	1	1	1	H4346_018_0	9	1			06/25/2019	2020.01	06/25/2019 09:17:22 PM Eastern Daylight Time	08/05/2019 07:01:47 AM Pacific Daylight Time	07/30/2019 04:05:07 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Coordination Plus (HMO)	1	1		1			H4346	18	0	2020	Clark and Washoe Counties		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)469-1761		(844)469-1761		(800)797-1746		(800)797-1746		(844)469-1761		(844)469-1761		(800)261-8667		(800)261-8667		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	19	0	1	1	1	H4346_019_0	7	1			08/01/2019	2020.01	08/01/2019 12:39:21 AM Pacific Daylight Time	08/05/2019 07:01:36 AM Pacific Daylight Time	07/30/2019 04:05:44 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H4346	19	0	2020	Washoe County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(888)346-0095		(888)346-0095		(800)797-1746		(800)797-1746		(888)346-0095		(888)346-0095		(800)261-8667		(800)261-8667		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	22	0	1	1	1	H4346_022_0	10	1		1	08/02/2019	2020.01	08/02/2019 04:07:24 PM Pacific Daylight Time	08/05/2019 07:01:36 AM Pacific Daylight Time	07/30/2019 04:06:23 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Diabetes (HMO C-SNP)	1	1		1			H4346	22	0	2020	Denver Metro Area		2		2			1	4			1E+13		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(888)346-0095		(888)346-0095		(800)797-1746		(800)797-1746		(888)346-0095		(888)346-0095		(800)261-8667		(800)261-8667		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	23	0	1	1	1	H4346_023_0	10	1		1	08/02/2019	2020.01	08/02/2019 04:07:58 PM Pacific Daylight Time	08/05/2019 07:01:37 AM Pacific Daylight Time	07/30/2019 04:07:01 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Care On Site (HMO I-SNP)	1	1		1			H4346	23	0	2020	Denver Metro Area		2		2			1	1	3				https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(888)346-0095		(888)346-0095		(800)797-1746		(800)797-1746		(888)346-0095		(888)346-0095		(800)261-8667		(800)261-8667		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4346	802	0	1	1	1	H4346_802_0	2	1			05/29/2019	2020.01	05/29/2019 08:39:55 PM Pacific Daylight Time					05/29/2019 08:53:45 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	caremore.com	Anthem EGWP MAPD (HMO)	1	1		1			H4346	802	0	2020	Nevada		1	65	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(800)499-2793		(800)499-2793		(844)309-6995		(844)309-6995		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;	1					1				
H4346	805	0	1	1	1	H4346_805_0	3	1			05/22/2019	2020.01	05/22/2019 12:34:03 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	1	1		1			H4346	805	0	2020	Colorado - Select Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	806	0	2	1	1	H4346_806_0	3	1			05/30/2019	2020.01	05/30/2019 07:34:08 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	1	1		2	1		H4346	806	0	2020	Colorado - Select Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	809	0	1	1	1	H4346_809_0	3	1			05/22/2019	2020.01	05/22/2019 12:37:20 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	1	1		1			H4346	809	0	2020	Select Colorado Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	810	0	2	1	1	H4346_810_0	3	1			05/30/2019	2020.01	05/30/2019 07:34:20 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	1	1		2	1		H4346	810	0	2020	Select Coloardo Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	811	0	1	1	1	H4346_811_0	3	1			05/22/2019	2020.01	05/22/2019 12:43:59 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	1	1		1			H4346	811	0	2020	Select Colorado Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	812	0	1	1	1	H4346_812_0	3	1			05/22/2019	2020.01	05/22/2019 12:46:24 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	1	1		1			H4346	812	0	2020	Select Colorado Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	813	0	2	1	1	H4346_813_0	3	1			05/30/2019	2020.01	05/30/2019 07:34:33 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	1	1		2	1		H4346	813	0	2020	Select Colorado Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	821	0	2	1	1	H4346_821_0	3	1			05/30/2019	2020.01	05/30/2019 07:34:39 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/co/medicare	Anthem MediBlue (HMO)	1	1		2	1		H4346	821	0	2020	Select Colorado Counties		1	600	2			2						www.anthem.com/co/medicare	www.anthem.com/co/medicare	www.anthem.com/co/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	823	0	1	1	1	H4346_823_0	3	1			05/22/2019	2020.01	05/22/2019 12:58:28 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	1	1		1			H4346	823	0	2020	Nevada Select Counties		1	600	2			2						www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	824	0	1	1	1	H4346_824_0	3	1			05/22/2019	2020.01	05/22/2019 12:59:02 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	1	1		1			H4346	824	0	2020	Nevada select counties		1	600	2			2						www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	825	0	1	1	1	H4346_825_0	3	1			05/22/2019	2020.01	05/22/2019 12:59:31 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	1	1		1			H4346	825	0	2020	Nevada select counties		1	600	2			2						www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	826	0	1	1	1	H4346_826_0	3	1			05/22/2019	2020.01	05/22/2019 12:59:54 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/Medicare	Anthem MediBlue (HMO)	1	1		1			H4346	826	0	2020	Nevada select counties		1	600	2			2						www.anthem.com/Medicare	www.anthem.com/Medicare	www.anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	827	0	2	1	1	H4346_827_0	3	1			05/30/2019	2020.01	05/30/2019 07:34:56 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	1	1		2	1		H4346	827	0	2020	Nevada select counties		1	600	2			2						www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	828	0	2	1	1	H4346_828_0	3	1			05/30/2019	2020.01	05/30/2019 07:35:03 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	1	1		2	1		H4346	828	0	2020	Nevada select counties		1	600	2			2						www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	829	0	2	1	1	H4346_829_0	3	1			05/30/2019	2020.01	05/30/2019 07:35:11 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	1	1		2	1		H4346	829	0	2020	Nevada select counties		1	600	2			2						www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4346	830	0	2	1	1	H4346_830_0	3	1			05/30/2019	2020.01	05/30/2019 07:35:17 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"HMO COLORADO, INC."	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	1	1		2	1		H4346	830	0	2020	Nevada select counties		1	600	2			2						www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H4388	1	0		7	2	H4388_001_0	4	2			06/01/2019	2020.01	06/01/2019 09:48:21 PM Central Daylight Time			05/31/2019 03:32:48 PM Central Daylight Time		06/01/2019 09:59:33 PM Central Daylight Time	"SECURITY HEALTH PLAN OF WISCONSIN, INC."	"Security Health Plan of Wisconsin, Inc."	www.securityhealth.org/medicareadvantage	Secure Saver (MSA)	2	7	2				H4388	1	0	2020	Wisconsin statewide		2		2			2						www.securityhealth.org/msapharmacies	www.securityhealth.org/securesaver	www.securityhealth.org/securesaver	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897										(711)-		(711)-		(711)-		(711)-																								
H4393	1	0	1	20	8	H4393_001_0	1	1			06/02/2019	2020.01	06/02/2019 05:10:28 PM Eastern Daylight Time		06/02/2019 05:01:04 PM Eastern Daylight Time			06/02/2019 05:13:21 PM Eastern Daylight Time	"CATHOLIC MANAGED LONG TERM CARE, INC."	ArchCare Senior Life	www.ArchCareSeniorLife.org	ArchCare Senior Life - Dual (PACE)	8	20		1			H4393	1	0	2020	"New York, Bronx, Richmond and Westchester counties"		2		2			2						www.archcare.org	www.ArchCareSeniorLife.org										(866)263-9083		(866)263-9083		(866)263-9083		(866)263-9083										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																
H4393	2	0	1	20	8	H4393_002_0	1	1			06/02/2019	2020.01	06/02/2019 05:10:44 PM Eastern Daylight Time		06/02/2019 05:00:54 PM Eastern Daylight Time			06/02/2019 05:13:21 PM Eastern Daylight Time	"CATHOLIC MANAGED LONG TERM CARE, INC."	ArchCare Senior Life	www.ArchCareSeniorLife.org	ArchCare Senior Life - Medicare only (PACE)	8	20		1			H4393	2	0	2020	"New York, Bronx, Richmond and Westchester counties"		2		2			2						www.archcare.org	www.ArchCareSeniorLife.org										(866)263-9083		(866)263-9083		(866)263-9083		(866)263-9083										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																
H4402	1	0	1	20	8	H4402_001_0	3	1			06/03/2019	2020.01	06/03/2019 08:13:57 AM Central Daylight Time		06/03/2019 08:16:40 AM Central Daylight Time			06/03/2019 08:18:32 AM Central Daylight Time	ALEXIAN BROTHERS COMMUNITY SERVICES	Alexian Brothers Community Services	www.alexianpacetn.net	Alexian Brothers Community Services (PACE)	8	20		1			H4402	1	0	2020	Hamilton County Area		2		2			2						None	None										(800)441-8883		(423)698-0802		(800)441-8883		(423)698-0802										(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298																
H4402	2	0	1	20	8	H4402_002_0	3	1			06/03/2019	2020.01	06/03/2019 08:14:09 AM Central Daylight Time		06/03/2019 08:17:15 AM Central Daylight Time			06/03/2019 08:18:32 AM Central Daylight Time	ALEXIAN BROTHERS COMMUNITY SERVICES	Alexian Brothers Community Services	www.alexianpacetn.net	Alexian Brothers Community Services (PACE)	8	20		1			H4402	2	0	2020	Hamilton County Area		2		2			2						None	None										(800)441-8883		(423)698-0802		(800)441-8883		(423)698-0802										(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298																
H4407	4	0	1	1	1	H4407_004_0	4	1	2	1	07/08/2019	2020.01	07/08/2019 03:41:08 PM Central Daylight Time	07/31/2019 05:52:04 PM Central Daylight Time	07/30/2019 04:15:29 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H4407	4	0	2020	Southern Mississippi		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4407	11	0	1	1	1	H4407_011_0	3	1			07/08/2019	2020.01	07/08/2019 03:41:51 PM Central Daylight Time	05/29/2019 12:15:50 PM Central Daylight Time				07/11/2019 09:16:13 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	1	1		1			H4407	11	0	2020	Southern Mississippi		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4407	26	0	1	1	1	H4407_026_0	4	1			07/08/2019	2020.01	07/08/2019 03:42:34 PM Central Daylight Time	07/31/2019 05:52:25 PM Central Daylight Time	07/30/2019 04:15:43 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4407	26	0	2020	Southern Mississippi		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4407	27	0	1	1	1	H4407_027_0	4	1			07/08/2019	2020.01	07/08/2019 03:43:26 PM Central Daylight Time	07/31/2019 05:52:45 PM Central Daylight Time	07/30/2019 04:15:56 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus (HMO)	1	1		1			H4407	27	0	2020	Southern Mississippi		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	4	0	1	1	1	H4461_004_0	1	1			05/31/2019	2020.01	05/31/2019 12:30:59 PM Eastern Daylight Time	05/30/2019 08:58:56 PM Eastern Daylight Time				05/31/2019 12:53:44 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-004 (HMO)	1	1		1			H4461	4	0	2020	Greater Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4461	22	0	1	1	1	H4461_022_0	3	1	2	1	07/15/2019	2020.01	07/15/2019 10:40:11 AM Eastern Daylight Time	08/02/2019 05:25:22 PM Eastern Daylight Time	08/02/2019 01:18:15 PM Eastern Daylight Time			08/05/2019 10:36:43 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP)	1	1		1			H4461	22	0	2020	Greater Tennessee		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	25	0	1	1	1	H4461_025_0	3	1			07/31/2019	2020.01	07/31/2019 05:00:02 PM Eastern Daylight Time	08/02/2019 05:24:33 PM Eastern Daylight Time	08/02/2019 01:18:16 PM Eastern Daylight Time			08/05/2019 10:36:43 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-025 (HMO)	1	1		1			H4461	25	0	2020	Memphis Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	29	0	1	1	1	H4461_029_0	3	1			07/31/2019	2020.01	07/31/2019 05:02:30 PM Eastern Daylight Time	08/02/2019 05:26:11 PM Eastern Daylight Time	08/02/2019 01:18:16 PM Eastern Daylight Time			08/05/2019 10:36:43 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-029 (HMO)	1	1		1			H4461	29	0	2020	Nashville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	30	1	1	1	1	H4461_030_1	3	1			07/12/2019	2020.01	07/12/2019 12:30:30 PM Eastern Daylight Time	08/02/2019 05:27:01 PM Eastern Daylight Time	08/02/2019 01:18:16 PM Eastern Daylight Time			08/05/2019 10:36:43 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-030 (HMO)	1	1		1			H4461	30	1	2020	East Tennessee	East Tennessee	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	30	2	1	1	1	H4461_030_2	3	1			07/12/2019	2020.01	07/12/2019 12:33:44 PM Eastern Daylight Time	08/02/2019 05:27:51 PM Eastern Daylight Time	08/02/2019 01:18:16 PM Eastern Daylight Time			08/05/2019 10:36:43 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-030 (HMO)	1	1		1			H4461	30	2	2020	East Tennessee	East Tennessee	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	30	3	1	1	1	H4461_030_3	2	1			05/31/2019	2020.01	05/31/2019 12:33:25 PM Eastern Daylight Time	08/02/2019 05:28:39 PM Eastern Daylight Time	08/02/2019 01:18:16 PM Eastern Daylight Time			08/05/2019 10:36:43 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-030 (HMO)	1	1		1			H4461	30	3	2020	East Tennessee	East Tennessee	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	31	1	1	1	1	H4461_031_1	2	1			05/31/2019	2020.01	05/31/2019 12:34:08 PM Eastern Daylight Time	08/02/2019 05:29:31 PM Eastern Daylight Time	08/02/2019 01:18:16 PM Eastern Daylight Time			08/05/2019 10:49:51 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-031 (HMO)	1	1		1			H4461	31	1	2020	East Tennessee	East Tennessee	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	31	2	1	1	1	H4461_031_2	2	1			05/31/2019	2020.01	05/31/2019 12:34:39 PM Eastern Daylight Time	08/02/2019 05:30:20 PM Eastern Daylight Time	08/02/2019 01:18:16 PM Eastern Daylight Time			08/05/2019 10:49:51 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-031 (HMO)	1	1		1			H4461	31	2	2020	East Tennessee	East Tennessee	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	31	3	1	1	1	H4461_031_3	2	1			05/31/2019	2020.01	05/31/2019 12:35:01 PM Eastern Daylight Time	08/02/2019 05:31:10 PM Eastern Daylight Time	08/02/2019 01:18:16 PM Eastern Daylight Time			08/05/2019 10:49:51 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-031 (HMO)	1	1		1			H4461	31	3	2020	East Tennessee	East Tennessee	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	34	0	1	1	1	H4461_034_0	3	1			07/31/2019	2020.01	07/31/2019 05:04:21 PM Eastern Daylight Time	08/02/2019 05:33:05 PM Eastern Daylight Time	08/02/2019 01:18:17 PM Eastern Daylight Time			08/05/2019 10:49:51 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-034 (HMO)	1	1		1			H4461	34	0	2020	East Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	35	0	1	1	1	H4461_035_0	3	1			07/31/2019	2020.01	07/31/2019 05:06:12 PM Eastern Daylight Time	08/02/2019 05:46:32 PM Eastern Daylight Time	08/02/2019 01:18:17 PM Eastern Daylight Time			08/05/2019 10:49:51 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-035 (HMO)	1	1		1			H4461	35	0	2020	East Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	36	0	1	1	1	H4461_036_0	3	1			07/31/2019	2020.01	07/31/2019 05:07:53 PM Eastern Daylight Time	08/02/2019 05:47:35 PM Eastern Daylight Time	08/02/2019 01:18:17 PM Eastern Daylight Time			08/05/2019 10:49:51 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Gold Plus H4461-036 (HMO)	1	1		1			H4461	36	0	2020	East Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4461	806	0	1	1	1	H4461_806_0	1	1			05/29/2019	2020.01	05/29/2019 10:55:00 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4461	806	0	2020	Select counties in East Tennessee area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4461	807	0	1	1	1	H4461_807_0	1	1			05/29/2019	2020.01	05/29/2019 10:55:28 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4461	807	0	2020	Select counties in East Tennessee area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4461	810	0	1	1	1	H4461_810_0	1	1			05/29/2019	2020.01	05/29/2019 12:48:13 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4461	810	0	2020	Select counties in East Tennessee area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H4461	811	0	1	1	1	H4461_811_0	1	1			05/29/2019	2020.01	05/29/2019 12:49:27 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H4461	811	0	2020	Select counties in East Tennessee area		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H4490	1	0	1	1	1	H4490_001_0	3	1		1	08/01/2019	2020.01	08/01/2019 05:56:48 PM Central Daylight Time	08/01/2019 02:19:16 PM Central Daylight Time	07/30/2019 05:11:59 PM Central Daylight Time			08/05/2019 04:55:08 PM Central Daylight Time	"MISSOURI MEDICARE SELECT, LLC"	Missouri Medicare Select (HMO SNP)	mo.amhealtplans.com	American Health Advantage of Missouri (HMO I-SNP)	1	1		1			H4490	1	0	2020	"MO Counties: CAS, JAK, LAF, SCH & STL"		2	5439	2			1	1	1				mo.amhealtplans.com	mo.amhealtplans.com	mo.amhealtplans.com	(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(844)228-7934		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4497	1	1	1	4	1	H4497_001_1	13	1			08/06/2019	2020.01	08/06/2019 11:19:42 AM Eastern Daylight Time	07/31/2019 06:39:42 PM Eastern Daylight Time	07/31/2019 06:16:40 PM Eastern Daylight Time			08/06/2019 02:05:01 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/maplaninfo	MedMutual Advantage Select (PPO)	1	4		1			H4497	1	1	2020	Ohio Regions	Region 1	2	27226	2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	Provider.medmutual.com	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	1	2	1	4	1	H4497_001_2	11	1			07/17/2019	2020.01	07/17/2019 09:01:31 AM Eastern Daylight Time	07/31/2019 06:40:28 PM Eastern Daylight Time	07/31/2019 06:17:10 PM Eastern Daylight Time			08/06/2019 02:05:01 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/maplaninfo	MedMutual Advantage Select (PPO)	1	4		1			H4497	1	2	2020	Ohio Regions	Region 2	2	3838	2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	Provider.medmutual.com	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	2	1	1	4	1	H4497_002_1	11	1			07/17/2019	2020.01	07/17/2019 09:04:39 AM Eastern Daylight Time	07/31/2019 06:41:20 PM Eastern Daylight Time	07/31/2019 06:17:40 PM Eastern Daylight Time			08/06/2019 02:05:01 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/maplaninfo	MedMutual Advantage Preferred (PPO)	1	4		1			H4497	2	1	2020	Ohio Regions	Region 1	2	22356	2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	Provider.medmutual.com	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	2	2	1	4	1	H4497_002_2	11	1			07/17/2019	2020.01	07/17/2019 09:05:48 AM Eastern Daylight Time	07/31/2019 06:42:12 PM Eastern Daylight Time	07/31/2019 06:18:10 PM Eastern Daylight Time			08/06/2019 02:05:01 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/maplaninfo	MedMutual Advantage Preferred (PPO)	1	4		1			H4497	2	2	2020	Ohio Regions	Region 2	2	3999	2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	Provider.medmutual.com	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	3	1	1	4	1	H4497_003_1	11	1			07/17/2019	2020.01	07/17/2019 09:06:59 AM Eastern Daylight Time	07/31/2019 06:43:00 PM Eastern Daylight Time	07/31/2019 06:18:38 PM Eastern Daylight Time			08/06/2019 02:05:01 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/maplaninfo	MedMutual Advantage Premium (PPO)	1	4		1			H4497	3	1	2020	Ohio Regions	Region 1	2	28478	2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	Provider.medmutual.com	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	3	2	1	4	1	H4497_003_2	11	1			07/17/2019	2020.01	07/17/2019 09:07:54 AM Eastern Daylight Time	07/31/2019 06:43:54 PM Eastern Daylight Time	07/31/2019 06:19:08 PM Eastern Daylight Time			08/06/2019 02:05:01 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/maplaninfo	MedMutual Advantage Premium (PPO)	1	4		1			H4497	3	2	2020	Ohio Regions	Region 2	2	3469	2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	Provider.medmutual.com	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4497	801	0	1	4	1	H4497_801_0	7	1			05/17/2019	2020.01	05/17/2019 11:29:48 AM Eastern Daylight Time					06/03/2019 01:58:35 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/magroup	MedMutual Advantage EGWP (Calendar Year) (PPO)	1	4		1			H4497	801	0	2020	Ohio Regions		1	24000	2			2						medmutual.com/magroup	medmutual.com/magroup	Provider.medmutual.com	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;	2		1									
H4497	802	0	1	4	1	H4497_802_0	7	1			05/17/2019	2020.01	05/17/2019 11:30:05 AM Eastern Daylight Time					06/03/2019 01:58:35 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/magroup	MedMutual Advantage EGWP (Non-Calendar Year) (PPO)	1	4		1			H4497	802	0	2020	Ohio Regions		1	125	2			2						medmutual.com/magroup	medmutual.com/magroup	Provider.medmutual.com	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;	2		1									
H4497	803	0	1	4	1	H4497_803_0	7	1			05/17/2019	2020.01	05/17/2019 11:30:18 AM Eastern Daylight Time					06/03/2019 01:58:35 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/magroup	MedMutual Advantage EGWP (MA-Only) (PPO)	1	4		1			H4497	803	0	2020	Ohio Regions		1	125	2			2						medmutual.com/magroup	medmutual.com/magroup	Provider.medmutual.com	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;	2		1									
H4506	3	0	1	1	1	H4506_003_0	5	1			07/16/2019	2020.01	07/16/2019 01:31:54 PM Eastern Daylight Time	08/02/2019 06:32:34 AM Eastern Daylight Time	07/30/2019 10:29:12 PM Eastern Daylight Time			08/05/2019 04:03:16 PM Eastern Daylight Time	"SELECTCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	WellCare TexanPlus Classic (HMO)	1	1		1			H4506	3	0	2020	Select counties in TX		2	728140	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4506	10	0	1	1	1	H4506_010_0	3	1			07/11/2019	2020.01	07/11/2019 01:17:40 PM Eastern Daylight Time	06/02/2019 07:07:10 AM Eastern Daylight Time				07/12/2019 08:00:24 PM Eastern Daylight Time	"SELECTCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	WellCare TexanPlus Value (HMO)	1	1		1			H4506	10	0	2020	Select counties in TX		2	18134	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4506	29	0	1	2	1	H4506_029_0	5	1			07/11/2019	2020.01	07/11/2019 01:18:29 PM Eastern Daylight Time	08/02/2019 06:35:52 AM Eastern Daylight Time	07/30/2019 10:29:48 PM Eastern Daylight Time			08/05/2019 04:03:16 PM Eastern Daylight Time	"SELECTCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	WellCare TexanPlus Choice (HMO-POS)	1	2		1			H4506	29	0	2020	Select counties in TX		2	12841	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4506	801	0	1	1	1	H4506_801_0	4	1			05/24/2019	2020.01	05/24/2019 10:59:38 AM Eastern Daylight Time					05/31/2019 09:08:01 PM Eastern Daylight Time	"SELECTCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	H4506 - Retiree - MA-PD non-CY (HMO)	1	1		1			H4506	801	0	2020	TexanPlus-Employer Group (MAPD nonCY)		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4506	806	0	1	1	1	H4506_806_0	4	1			05/24/2019	2020.01	05/24/2019 11:01:44 AM Eastern Daylight Time					05/31/2019 09:08:01 PM Eastern Daylight Time	"SELECTCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	H4506 - Retiree - MA-PD CY (HMO)	1	1		1			H4506	806	0	2020	TexanPlus-Employer Group (MAPD CY)		1	8474	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4506	808	0	1	1	1	H4506_808_0	4	1			05/24/2019	2020.01	05/24/2019 11:03:19 AM Eastern Daylight Time					05/31/2019 09:08:01 PM Eastern Daylight Time	"SELECTCARE OF TEXAS, INC."	WellCare	www.wellcare.com/medicare	H4506 - Retiree MA (HMO)	1	1		1			H4506	808	0	2020	TexanValue-Employer Group (MA Only)		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4513	9	0	1	1	1	H4513_009_0	3	1			07/08/2019	2020.01	07/08/2019 04:53:31 PM Central Daylight Time	05/29/2019 03:03:34 PM Central Daylight Time				07/11/2019 09:16:13 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	1	1		1			H4513	9	0	2020	Houston & Valley		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	10	0	1	1	1	H4513_010_0	4	1	2	1	07/08/2019	2020.01	07/08/2019 04:54:17 PM Central Daylight Time	07/31/2019 05:09:31 PM Central Daylight Time	07/30/2019 04:16:11 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H4513	10	0	2020	"Houston, Valley, El Paso & San Antonio"		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	25	0	1	1	1	H4513_025_0	5	1			07/17/2019	2020.01	07/17/2019 10:10:44 AM Central Daylight Time	07/31/2019 05:09:50 PM Central Daylight Time	07/30/2019 04:16:24 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4513	25	0	2020	"Houston, Valley, El Paso & San Antonio"		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	26	0	1	1	1	H4513_026_0	4	1			07/08/2019	2020.01	07/08/2019 04:55:37 PM Central Daylight Time	07/31/2019 05:53:19 PM Central Daylight Time	07/30/2019 04:16:38 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4513	26	0	2020	East Texas		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	27	0	1	1	1	H4513_027_0	4	1	2	1	07/31/2019	2020.01	07/31/2019 03:22:44 PM Central Daylight Time	07/31/2019 05:23:02 PM Central Daylight Time	07/30/2019 04:16:52 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H4513	27	0	2020	East Texas		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	28	0	1	1	1	H4513_028_0	5	1			07/08/2019	2020.01	07/08/2019 04:57:13 PM Central Daylight Time	07/31/2019 05:23:23 PM Central Daylight Time	07/30/2019 04:17:05 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4513	28	0	2020	North Texas & San Antonio		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	29	0	1	1	1	H4513_029_0	5	1	2	1	07/08/2019	2020.01	07/08/2019 04:58:16 PM Central Daylight Time	07/31/2019 05:23:44 PM Central Daylight Time	07/30/2019 04:17:20 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H4513	29	0	2020	North Texas & San Antonio		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	30	0	1	1	1	H4513_030_0	4	1			07/08/2019	2020.01	07/08/2019 04:59:00 PM Central Daylight Time	07/31/2019 05:24:07 PM Central Daylight Time	07/30/2019 04:17:33 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4513	30	0	2020	Northwest Georgia		2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	33	0	1	1	1	H4513_033_0	3	1			07/08/2019	2020.01	07/08/2019 04:59:46 PM Central Daylight Time	05/29/2019 03:54:26 PM Central Daylight Time				07/11/2019 09:16:13 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	1	1		1			H4513	33	0	2020	Tennessee		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	34	0	1	1	1	H4513_034_0	4	1	2	1	07/08/2019	2020.01	07/08/2019 05:04:30 PM Central Daylight Time	07/31/2019 05:24:30 PM Central Daylight Time	07/30/2019 04:17:48 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H4513	34	0	2020	Middle and West Tennessee		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	35	0	1	1	1	H4513_035_0	5	1			07/08/2019	2020.01	07/08/2019 05:08:11 PM Central Daylight Time	07/31/2019 05:24:52 PM Central Daylight Time	07/30/2019 04:18:03 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Primary (HMO)	1	1		1			H4513	35	0	2020	East Tennessee		2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	36	0	1	2	1	H4513_036_0	4	1			07/08/2019	2020.01	07/08/2019 05:08:40 PM Central Daylight Time	07/31/2019 05:25:13 PM Central Daylight Time	07/30/2019 04:18:16 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	1	2		1			H4513	36	0	2020	Tennessee		2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	37	0	1	1	1	H4513_037_0	4	1			07/08/2019	2020.01	07/08/2019 05:09:28 PM Central Daylight Time	07/31/2019 05:25:34 PM Central Daylight Time	07/30/2019 04:18:30 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4513	37	0	2020	East Tennessee		2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	38	0	1	1	1	H4513_038_0	4	1			07/08/2019	2020.01	07/08/2019 05:10:12 PM Central Daylight Time	07/31/2019 05:25:55 PM Central Daylight Time	07/30/2019 04:18:43 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4513	38	0	2020	East Arkansas		2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	39	0	1	1	1	H4513_039_0	6	1	2	1	07/31/2019	2020.01	07/31/2019 12:47:39 PM Central Daylight Time	07/31/2019 05:26:16 PM Central Daylight Time	07/30/2019 04:18:58 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H4513	39	0	2020	East Arkansas		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	40	0	1	1	1	H4513_040_0	4	1	2	1	07/31/2019	2020.01	07/31/2019 12:48:21 PM Central Daylight Time	07/31/2019 05:26:36 PM Central Daylight Time	07/30/2019 04:19:12 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H4513	40	0	2020	East Tennessee		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	42	0	1	1	1	H4513_042_0	4	1			07/08/2019	2020.01	07/08/2019 05:12:34 PM Central Daylight Time	07/31/2019 06:06:44 PM Central Daylight Time	07/30/2019 04:19:25 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Alliance (HMO)	1	1		1			H4513	42	0	2020	Middle Tennessee		2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	43	0	1	1	1	H4513_043_0	4	1			07/08/2019	2020.01	07/08/2019 05:13:45 PM Central Daylight Time	07/31/2019 06:07:05 PM Central Daylight Time	07/30/2019 04:19:39 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus (HMO)	1	1		1			H4513	43	0	2020	Middle Tennessee		2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	45	0	1	1	1	H4513_045_0	3	1			07/08/2019	2020.01	07/08/2019 03:44:06 PM Central Daylight Time	05/29/2019 12:17:46 PM Central Daylight Time				07/11/2019 09:16:13 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	1	1		1			H4513	45	0	2020	Alabama		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4513	46	1	1	1	1	H4513_046_1	4	1			07/08/2019	2020.01	07/08/2019 03:44:51 PM Central Daylight Time	07/31/2019 06:07:25 PM Central Daylight Time	07/30/2019 04:19:52 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred AL (HMO)	1	1		1			H4513	46	1	2020	Alabama	South Alabama	2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	46	2	1	1	1	H4513_046_2	4	1			07/08/2019	2020.01	07/08/2019 03:45:44 PM Central Daylight Time	07/31/2019 06:07:45 PM Central Daylight Time	07/30/2019 04:20:06 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred AL (HMO)	1	1		1			H4513	46	2	2020	Alabama	North Alabama	2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	47	0	1	1	1	H4513_047_0	5	1			07/08/2019	2020.01	07/08/2019 03:46:35 PM Central Daylight Time	07/31/2019 06:08:06 PM Central Daylight Time	07/30/2019 04:20:19 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus (HMO)	1	1		1			H4513	47	0	2020	Alabama		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	48	0	1	1	1	H4513_048_0	4	1			07/08/2019	2020.01	07/08/2019 03:47:38 PM Central Daylight Time	07/31/2019 06:08:27 PM Central Daylight Time	07/30/2019 04:20:33 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus (HMO)	1	1		1			H4513	48	0	2020	Alabama		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4513	49	1	1	1	1	H4513_049_1	4	1			07/08/2019	2020.01	07/08/2019 05:19:22 PM Central Daylight Time	07/31/2019 05:27:38 PM Central Daylight Time	07/30/2019 04:20:46 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4513	49	1	2020	Tennessee	Tennessee Preferred	2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	49	2	1	1	1	H4513_049_2	4	1			07/08/2019	2020.01	07/12/2019 07:46:14 AM Central Daylight Time	07/31/2019 05:27:59 PM Central Daylight Time	07/30/2019 04:21:00 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4513	49	2	2020	Tennessee	Tennessee Preferred Select Counties	2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	50	0	1	1	1	H4513_050_0	4	1			07/08/2019	2020.01	07/08/2019 05:21:08 PM Central Daylight Time	07/31/2019 05:28:19 PM Central Daylight Time	07/30/2019 04:21:13 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4513	50	0	2020	Central Arkansas		2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	51	0	1	1	1	H4513_051_0	4	1			07/08/2019	2020.01	07/08/2019 05:21:54 PM Central Daylight Time	07/31/2019 05:28:40 PM Central Daylight Time	07/30/2019 04:21:27 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4513	51	0	2020	West Arkansas		2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	52	0	1	1	1	H4513_052_0	4	1			07/08/2019	2020.01	07/08/2019 05:22:40 PM Central Daylight Time	07/31/2019 05:29:01 PM Central Daylight Time	07/30/2019 04:21:40 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4513	52	0	2020	Northwest Arkansas		2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	53	0	1	1	1	H4513_053_0	4	1			07/08/2019	2020.01	07/08/2019 05:23:23 PM Central Daylight Time	07/31/2019 05:29:21 PM Central Daylight Time	07/30/2019 04:21:55 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Primary (HMO)	1	1		1			H4513	53	0	2020	West Tennessee		2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	54	0	1	1	1	H4513_054_0	4	1			07/08/2019	2020.01	07/08/2019 03:49:27 PM Central Daylight Time	07/31/2019 06:08:48 PM Central Daylight Time	07/30/2019 04:22:08 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4513	54	0	2020	Alabama		2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	55	0	1	1	1	H4513_055_0	5	1	2	1	07/08/2019	2020.01	07/08/2019 04:01:06 PM Central Daylight Time	07/31/2019 06:09:10 PM Central Daylight Time	07/30/2019 04:22:23 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H4513	55	0	2020	Alabama		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	56	1	1	1	1	H4513_056_1	5	1	2	1	07/08/2019	2020.01	07/08/2019 04:01:56 PM Central Daylight Time	07/31/2019 06:09:32 PM Central Daylight Time	07/30/2019 04:22:37 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare AL (HMO D-SNP)	1	1		1			H4513	56	1	2020	Alabama	South Alabama	2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	56	2	1	1	1	H4513_056_2	5	1	2	1	07/08/2019	2020.01	07/08/2019 04:02:43 PM Central Daylight Time	07/31/2019 06:09:53 PM Central Daylight Time	07/30/2019 04:22:51 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare AL (HMO D-SNP)	1	1		1			H4513	56	2	2020	Alabama	North Alabama	2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	57	0	1	1	1	H4513_057_0	4	1			07/08/2019	2020.01	07/08/2019 04:03:28 PM Central Daylight Time	07/31/2019 06:10:14 PM Central Daylight Time	07/30/2019 04:23:05 PM Central Daylight Time			08/02/2019 12:09:10 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H4513	57	0	2020	Alabama		2		2			2						www.cignahealthspring.com	www.cignahealthspring.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	2			
H4513	804	0	1	1	1	H4513_804_0	2	1			04/18/2019	2020.01	04/18/2019 12:25:57 PM Central Daylight Time					05/30/2019 05:19:32 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	1	1		1			H4513	804	0	2020	Statewide TX		1	7740	2			2						www.cignahealthspring.com	www.cignahealthspring.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4513	815	0	1	1	1	H4513_815_0	2	1			04/18/2019	2020.01	04/18/2019 12:15:05 PM Central Daylight Time					05/30/2019 05:19:32 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	1	1		1			H4513	815	0	2020	"Tennessee, Mississippi,  & Illinois"		1	17460	2			2						www.cignahealthspring.com	www.cignahealthspring.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4513	817	0	1	1	1	H4513_817_0	2	1			04/18/2019	2020.01	04/18/2019 12:16:40 PM Central Daylight Time					05/30/2019 05:19:32 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	1	1		1			H4513	817	0	2020	Alabama		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4513	819	0	1	1	1	H4513_819_0	2	1			04/18/2019	2020.01	04/18/2019 12:18:44 PM Central Daylight Time					05/30/2019 05:19:32 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	1	1		1			H4513	819	0	2020	Arkansas		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4513	820	0	1	1	1	H4513_820_0	2	1			04/18/2019	2020.01	04/18/2019 12:19:28 PM Central Daylight Time					05/30/2019 05:19:32 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	1	1		1			H4513	820	0	2020	Virginia		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4513	821	0	1	1	1	H4513_821_0	2	1			04/18/2019	2020.01	04/18/2019 12:26:07 PM Central Daylight Time					05/30/2019 05:19:32 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	1	1		1			H4513	821	0	2020	Nationwide		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.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)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4514	1	0	1	1	1	H4514_001_0	3	1	2	1	07/11/2019	2020.01	07/11/2019 01:54:44 PM Central Daylight Time	08/02/2019 11:32:40 AM Central Daylight Time	07/30/2019 08:43:37 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	"UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H4514	1	0	2020	Houston and Austin Metro areas		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-4983		(866)944-4983		(888)834-3721		(888)834-3721		(866)944-4983		(866)944-4983		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4514	7	0	1	1	1	H4514_007_0	4	1			08/06/2019	2020.01	08/06/2019 04:00:34 PM Central Daylight Time	08/02/2019 11:30:54 AM Central Daylight Time	07/30/2019 08:44:09 PM Central Daylight Time			08/06/2019 04:01:31 PM Central Daylight Time	"UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H4514	7	0	2020	Houston Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4514	801	0	1	1	1	H4514_801_0	1	1			05/12/2019	2020.01	05/12/2019 07:15:30 PM Central Daylight Time					06/02/2019 05:21:47 PM Central Daylight Time	"UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H4514	801	0	2020	TX Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H4514	803	0	1	1	1	H4514_803_0	1	1			05/12/2019	2020.01	05/12/2019 07:15:52 PM Central Daylight Time					06/02/2019 05:21:47 PM Central Daylight Time	"UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H4514	803	0	2020	TX Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H4514	806	0	1	1	1	H4514_806_0	1	1			05/12/2019	2020.01	05/12/2019 07:16:19 PM Central Daylight Time					06/02/2019 05:21:47 PM Central Daylight Time	"UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H4514	806	0	2020	TX Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H4517	1	0	1	20	8	H4517_001_0	1	1			05/20/2019	2020.01	05/20/2019 07:54:20 AM Central Daylight Time		05/20/2019 07:33:35 AM Central Daylight Time			05/20/2019 07:57:47 AM Central Daylight Time	AMARILLO MULTISVC CTR FR THE AGING INC	The Basics at Jan Werner	www.janwerneradultdaycare.org	DUAL ELIGIBLE (PACE)	8	20		1			H4517	1	0	2020	"Potter, TX and Randall, TX Counties"		2		2			2						N/A	N/A										(888)299-6401		(806)374-8400		(888)299-6401		(806)374-5516										(800)735-2989		(806)374-8400		(800)735-2989		(806)374-5516																
H4517	2	0	1	20	8	H4517_002_0	1	1			05/20/2019	2020.01	05/20/2019 07:55:01 AM Central Daylight Time		05/20/2019 07:33:36 AM Central Daylight Time			05/20/2019 07:57:47 AM Central Daylight Time	AMARILLO MULTISVC CTR FR THE AGING INC	The Basics at Jan Werner	www.janwerneradultdaycare.org	MEDICARE ONLY (PACE)	8	20		1			H4517	2	0	2020	"Potter, TX and Randall, TX Counties"		2		2			2						N/A	N/A										(888)299-6401		(806)374-8400		(888)299-6401		(806)374-5516										(800)735-2989		(806)374-8400		(800)735-2989		(806)374-5516																
H4518	1	0	1	20	8	H4518_001_0	1	1			05/31/2019	2020.01	05/31/2019 12:11:57 PM Mountain Daylight Time		05/31/2019 11:44:00 AM Mountain Daylight Time			05/31/2019 12:18:18 PM Mountain Daylight Time	BIENVIVIR SENIOR HEALTH SERVICES	Bienvivir Senior Health Services	www.Bienvivir.org	"BSHS Part D, Dual Eligibles (PACE)"	8	20		1			H4518	1	0	2020	"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	2	0	1	20	8	H4518_002_0	1	1			05/31/2019	2020.01	05/31/2019 12:12:48 PM Mountain Daylight Time		05/31/2019 11:45:32 AM Mountain Daylight Time			05/31/2019 12:18:18 PM Mountain Daylight Time	BIENVIVIR SENIOR HEALTH SERVICES	Bienvivir Senior Health Services	www.Bienvivir.org	"BSHS Part D, Medicare Only (PACE)"	8	20		1			H4518	2	0	2020	"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															
H4523	1	0	1	1	1	H4523_001_0	4	1			07/31/2019	2020.01	07/31/2019 11:45:02 AM Eastern Daylight Time	08/01/2019 12:25:48 PM Pacific Daylight Time	07/30/2019 09:58:37 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	1	1		1			H4523	1	0	2020	San Antonio and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	15	0	1	1	1	H4523_015_0	3	1			07/31/2019	2020.01	07/31/2019 11:45:26 AM Eastern Daylight Time	08/01/2019 12:26:30 PM Pacific Daylight Time	07/30/2019 09:59:53 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	1	1		1			H4523	15	0	2020	Houston and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	20	0	1	1	1	H4523_020_0	3	1			07/31/2019	2020.01	07/31/2019 11:45:50 AM Eastern Daylight Time	08/01/2019 12:27:12 PM Pacific Daylight Time	07/30/2019 10:01:14 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	1	1		1			H4523	20	0	2020	Bexar and Comal counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	21	0	1	1	1	H4523_021_0	3	1			07/31/2019	2020.01	07/31/2019 11:46:36 AM Eastern Daylight Time	08/01/2019 12:27:56 PM Pacific Daylight Time	07/30/2019 10:02:57 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	1	1		1			H4523	21	0	2020	Dallas and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	24	0	1	1	1	H4523_024_0	3	1			07/31/2019	2020.01	07/31/2019 11:50:27 AM Eastern Daylight Time	08/01/2019 12:28:36 PM Pacific Daylight Time	07/30/2019 10:04:12 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	1	1		1			H4523	24	0	2020	Harris County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4523	801	0	1	1	1	H4523_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:47:21 AM Eastern Daylight Time					05/30/2019 06:46:03 PM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H4523	801	0	2020	Texas		1	760	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4523	802	0	1	1	1	H4523_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:47:30 AM Eastern Daylight Time					05/30/2019 06:46:03 PM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H4523	802	0	2020	Texas		1	5390	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4523	804	0	1	1	1	H4523_804_0	1	1			05/24/2019	2020.01	05/24/2019 09:47:39 AM Eastern Daylight Time					05/30/2019 06:46:03 PM Eastern Daylight Time	AETNA HEALTH INC. (TX)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H4523	804	0	2020	Texas		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4527	1	0	1	1	1	H4527_001_0	4	1			08/02/2019	2020.01	08/02/2019 10:11:54 AM Central Daylight Time	08/02/2019 11:35:37 AM Central Daylight Time	07/30/2019 08:44:42 PM Central Daylight Time			08/06/2019 08:08:55 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO)	1	1		1			H4527	1	0	2020	Select Counties in Texas		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	2	0	1	1	1	H4527_002_0	4	1			08/02/2019	2020.01	08/02/2019 10:12:27 AM Central Daylight Time	08/02/2019 11:36:02 AM Central Daylight Time	07/30/2019 08:45:15 PM Central Daylight Time			08/06/2019 08:08:55 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO)	1	1		1			H4527	2	0	2020	"Bastrop, Hays, Travis, and Williamson counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	3	0	1	1	1	H4527_003_0	3	1	2	1	08/06/2019	2020.01	08/06/2019 09:09:38 AM Central Daylight Time	08/02/2019 11:36:26 AM Central Daylight Time	07/30/2019 08:45:48 PM Central Daylight Time			08/06/2019 09:21:24 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Focus (HMO D-SNP)	1	1		1			H4527	3	0	2020	"Hays, Travis, and Williamson counties"		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	4	0	1	1	1	H4527_004_0	3	1	2	1	08/06/2019	2020.01	08/06/2019 09:10:16 AM Central Daylight Time	08/02/2019 11:36:51 AM Central Daylight Time	07/30/2019 08:46:24 PM Central Daylight Time			08/06/2019 09:21:24 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Focus (HMO D-SNP)	1	1		1			H4527	4	0	2020	"Aransas, Kleberg, Nueces, San Patricio counties"		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	5	0	1	1	1	H4527_005_0	3	1			08/02/2019	2020.01	08/02/2019 10:13:05 AM Central Daylight Time	08/02/2019 11:37:15 AM Central Daylight Time	07/30/2019 08:46:57 PM Central Daylight Time			08/06/2019 08:08:55 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO)	1	1		1			H4527	5	0	2020	El Paso County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	6	0	1	1	1	H4527_006_0	3	1	2	1	08/06/2019	2020.01	08/06/2019 09:10:50 AM Central Daylight Time	08/02/2019 11:37:40 AM Central Daylight Time	07/30/2019 08:47:32 PM Central Daylight Time			08/06/2019 09:21:24 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Focus (HMO D-SNP)	1	1		1			H4527	6	0	2020	El Paso County		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	13	0	1	1	1	H4527_013_0	4	1			08/02/2019	2020.01	08/02/2019 10:13:37 AM Central Daylight Time	08/02/2019 11:38:06 AM Central Daylight Time	07/30/2019 08:48:07 PM Central Daylight Time			08/06/2019 08:08:55 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO)	1	1		1			H4527	13	0	2020	Brownsville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	15	0	1	1	1	H4527_015_0	3	1	2	1	08/06/2019	2020.01	08/06/2019 09:12:00 AM Central Daylight Time	08/02/2019 11:38:31 AM Central Daylight Time	07/31/2019 09:34:10 AM Central Daylight Time			08/06/2019 09:21:24 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete Focus (HMO D-SNP)	1	1		1			H4527	15	0	2020	"Cameron, Hidalgo, and Willacy counties"		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	24	0	1	2	1	H4527_024_0	2	1			07/11/2019	2020.01	07/11/2019 04:20:44 PM Central Daylight Time	05/31/2019 03:49:24 PM Central Daylight Time				07/12/2019 02:01:01 PM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus Essential (HMO-POS)	1	2		1			H4527	24	0	2020	Select counties in Texas		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4527	37	0	1	2	1	H4527_037_0	4	1			08/02/2019	2020.01	08/02/2019 10:18:56 AM Central Daylight Time	08/02/2019 11:38:56 AM Central Daylight Time	07/30/2019 08:49:13 PM Central Daylight Time			08/06/2019 08:08:55 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H4527	37	0	2020	Houston Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	38	0	1	2	1	H4527_038_0	4	1			08/02/2019	2020.01	08/02/2019 10:19:33 AM Central Daylight Time	08/02/2019 11:39:21 AM Central Daylight Time	07/30/2019 08:49:48 PM Central Daylight Time			08/06/2019 08:08:55 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H4527	38	0	2020	"Bell, Falls, Hill, and McLennan counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	39	0	1	1	1	H4527_039_0	4	1		1	08/02/2019	2020.01	08/02/2019 10:20:00 AM Central Daylight Time	08/02/2019 11:39:46 AM Central Daylight Time	07/30/2019 08:50:20 PM Central Daylight Time			08/06/2019 08:08:55 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	1	1		1			H4527	39	0	2020	"Bastrop, Hays, Travis, and Williamson counties"		2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	40	0	1	1	1	H4527_040_0	4	1		1	08/02/2019	2020.01	08/02/2019 10:20:29 AM Central Daylight Time	08/02/2019 11:40:11 AM Central Daylight Time	07/30/2019 08:50:54 PM Central Daylight Time			08/06/2019 08:08:55 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	1	1		1			H4527	40	0	2020	El Paso County		2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	41	0	1	1	1	H4527_041_0	4	1		1	08/02/2019	2020.01	08/02/2019 10:20:50 AM Central Daylight Time	08/02/2019 11:40:36 AM Central Daylight Time	07/30/2019 08:51:30 PM Central Daylight Time			08/06/2019 08:08:55 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	1	1		1			H4527	41	0	2020	Corpus Christi Metro Area		2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	42	0	1	1	1	H4527_042_0	4	1		1	08/02/2019	2020.01	08/02/2019 02:59:50 PM Central Daylight Time	08/02/2019 11:41:01 AM Central Daylight Time	07/30/2019 08:52:03 PM Central Daylight Time			08/06/2019 08:08:55 AM Central Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	1	1		1			H4527	42	0	2020	"Cameron, Hidalgo, Starr, and Willacy Counties"		2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(866)550-4736		(866)550-4736		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4527	801	0	1	1	1	H4527_801_0	1	1			05/11/2019	2020.01	05/11/2019 09:13:45 AM Eastern Daylight Time					06/03/2019 07:37:45 AM Eastern Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H4527	801	0	2020	TX Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4527	802	0	1	1	1	H4527_802_0	1	1			05/11/2019	2020.01	05/11/2019 09:14:27 AM Eastern Daylight Time					06/03/2019 07:37:45 AM Eastern Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H4527	802	0	2020	TX Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4527	803	0	1	1	1	H4527_803_0	1	1			05/11/2019	2020.01	05/11/2019 09:15:03 AM Eastern Daylight Time					06/03/2019 07:37:45 AM Eastern Daylight Time	"PHYSICIANS HEALTH CHOICE OF TEXAS, LLC"	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H4527	803	0	2020	TX Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4590	10	0	1	1	1	H4590_010_0	4	1			08/02/2019	2020.01	08/02/2019 10:21:48 AM Central Daylight Time	08/02/2019 11:07:29 AM Central Daylight Time	07/30/2019 08:52:38 PM Central Daylight Time			08/06/2019 02:49:47 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H4590	10	0	2020	San Antonio Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H4590	12	0	1	2	1	H4590_012_0	5	1			08/02/2019	2020.01	08/02/2019 10:22:16 AM Central Daylight Time	08/02/2019 11:07:56 AM Central Daylight Time	07/30/2019 08:53:13 PM Central Daylight Time			08/06/2019 02:49:47 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 1 (HMO-POS)	1	2		1			H4590	12	0	2020	Dallas/Fort Worth Metroplex		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H4590	20	0	1	1	1	H4590_020_0	4	1	2	1	07/11/2019	2020.01	07/11/2019 01:31:34 PM Central Daylight Time	08/02/2019 11:08:22 AM Central Daylight Time	07/30/2019 08:53:50 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H4590	20	0	2020	Dallas/Ft Worth Metroplex		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-2064		(866)480-2064		(888)834-3721		(888)834-3721		(866)480-2064		(866)480-2064		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	22	0	1	1	1	H4590_022_0	3	1	2	1	07/11/2019	2020.01	07/11/2019 01:32:44 PM Central Daylight Time	08/02/2019 11:08:48 AM Central Daylight Time	07/30/2019 08:54:27 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H4590	22	0	2020	San Antonio Metro area		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-2064		(866)480-2064		(888)834-3721		(888)834-3721		(866)480-2064		(866)480-2064		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	25	0	1	1	1	H4590_025_0	4	1			08/02/2019	2020.01	08/02/2019 10:22:40 AM Central Daylight Time	08/02/2019 11:09:14 AM Central Daylight Time	07/30/2019 08:55:02 PM Central Daylight Time			08/06/2019 02:49:47 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons (HMO)	1	1		1			H4590	25	0	2020	Corpus Christi Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H4590	27	0	1	2	1	H4590_027_0	3	1			07/11/2019	2020.01	07/11/2019 04:39:54 PM Central Daylight Time	07/08/2019 10:46:02 AM Central Daylight Time				07/16/2019 09:36:00 AM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Essential (HMO-POS)	1	2		1			H4590	27	0	2020	Dallas/Ft Worth Metroplex		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4590	29	0	1	1	1	H4590_029_0	2	1			07/11/2019	2020.01	07/11/2019 04:40:14 PM Central Daylight Time	05/31/2019 11:42:50 AM Central Daylight Time				07/12/2019 02:24:54 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Essential (HMO)	1	1		1			H4590	29	0	2020	San Antonio Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4590	33	0	1	1	1	H4590_033_0	3	1	2	1	07/11/2019	2020.01	07/11/2019 01:54:53 PM Central Daylight Time	08/02/2019 11:10:36 AM Central Daylight Time	07/30/2019 08:55:37 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H4590	33	0	2020	Corpus Christi metro area		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-2064		(866)480-2064		(888)834-3721		(888)834-3721		(866)480-2064		(866)480-2064		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	37	0	1	1	1	H4590_037_0	4	1		1	08/02/2019	2020.01	08/02/2019 10:23:13 AM Central Daylight Time	08/02/2019 11:11:03 AM Central Daylight Time	07/30/2019 08:56:11 PM Central Daylight Time			08/06/2019 02:49:47 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO C-SNP)	1	1		1			H4590	37	0	2020	San Antonio Metro Area		2		2			1	4			1.101E+16		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)846-2762		(866)846-2762		(800)555-5757		(800)555-5757		(866)846-2762		(866)846-2762		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4590	41	0	1	2	1	H4590_041_0	5	1			08/02/2019	2020.01	08/02/2019 10:23:35 AM Central Daylight Time	08/02/2019 11:11:30 AM Central Daylight Time	07/30/2019 08:56:42 PM Central Daylight Time			08/06/2019 02:49:47 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage SecureHorizons Plan 2 (HMO-POS)	1	2		1			H4590	41	0	2020	Dallas/Ft Worth Metroplex		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H4590	42	0	1	2	1	H4590_042_0	5	1			08/02/2019	2020.01	08/02/2019 10:24:05 AM Central Daylight Time	08/02/2019 11:11:57 AM Central Daylight Time	07/30/2019 08:57:16 PM Central Daylight Time			08/06/2019 02:49:47 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H4590	42	0	2020	Select Counties in Texas		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H4590	43	0	1	2	1	H4590_043_0	5	1			08/02/2019	2020.01	08/02/2019 10:24:41 AM Central Daylight Time	08/02/2019 11:12:24 AM Central Daylight Time	07/30/2019 08:57:48 PM Central Daylight Time			08/06/2019 02:49:47 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H4590	43	0	2020	Dallas Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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	2			
H4590	801	0	1	1	1	H4590_801_0	1	1			05/11/2019	2020.01	05/11/2019 07:41:02 AM Central Daylight Time					06/02/2019 05:53:30 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H4590	801	0	2020	TX Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4590	803	0	1	1	1	H4590_803_0	1	1			05/11/2019	2020.01	05/11/2019 07:41:29 AM Central Daylight Time					06/02/2019 05:53:30 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H4590	803	0	2020	TX Employer Sponsored Plan Service Area		1	19908	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4590	804	0	1	1	1	H4590_804_0	1	1			05/11/2019	2020.01	05/11/2019 07:41:56 AM Central Daylight Time					06/02/2019 05:53:30 PM Central Daylight Time	"UNITEDHEALTHCARE BENEFITS OF TEXAS, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H4590	804	0	2020	TX Employer Sponsored Plan Service Area		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H4604	3	0	1	1	1	H4604_003_0	3	1			08/02/2019	2020.01	08/02/2019 11:25:48 AM Central Daylight Time	08/02/2019 10:30:48 AM Central Daylight Time	07/30/2019 08:58:21 PM Central Daylight Time			08/06/2019 09:33:36 AM Central Daylight Time	"UNITEDHEALTHCARE OF UTAH, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H4604	3	0	2020	Select Counties in Utah		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	5	0	1	1	1	H4604_005_0	2	1			07/12/2019	2020.01	07/12/2019 08:46:52 AM Central Daylight Time	05/31/2019 11:47:48 AM Central Daylight Time				07/12/2019 01:02:03 PM Central Daylight Time	"UNITEDHEALTHCARE OF UTAH, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Essential (HMO)	1	1		1			H4604	5	0	2020	Select Counties in Utah		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4604	11	0	1	1	1	H4604_011_0	3	1			08/02/2019	2020.01	08/02/2019 11:26:19 AM Central Daylight Time	08/02/2019 10:32:12 AM Central Daylight Time	07/30/2019 08:58:56 PM Central Daylight Time			08/06/2019 09:33:36 AM Central Daylight Time	"UNITEDHEALTHCARE OF UTAH, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H4604	11	0	2020	Select Counties in Utah		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	12	0	1	1	1	H4604_012_0	3	1			08/02/2019	2020.01	08/02/2019 11:18:32 AM Central Daylight Time	08/02/2019 10:32:53 AM Central Daylight Time	07/30/2019 08:59:31 PM Central Daylight Time			08/06/2019 09:33:36 AM Central Daylight Time	"UNITEDHEALTHCARE OF UTAH, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H4604	12	0	2020	"Ada, Canyon, Gem, and Payette Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	13	0	1	1	1	H4604_013_0	3	1			08/02/2019	2020.01	08/02/2019 11:19:14 AM Central Daylight Time	08/02/2019 10:33:36 AM Central Daylight Time	07/30/2019 09:00:06 PM Central Daylight Time			08/06/2019 09:33:36 AM Central Daylight Time	"UNITEDHEALTHCARE OF UTAH, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H4604	13	0	2020	Bonner and Kootenai Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	14	0	1	1	1	H4604_014_0	3	1			08/02/2019	2020.01	08/02/2019 11:20:13 AM Central Daylight Time	08/02/2019 10:34:17 AM Central Daylight Time	07/30/2019 09:00:42 PM Central Daylight Time			08/06/2019 09:33:36 AM Central Daylight Time	"UNITEDHEALTHCARE OF UTAH, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H4604	14	0	2020	Select Counties in Idaho		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	15	0	1	1	1	H4604_015_0	3	1			08/05/2019	2020.01	08/05/2019 09:09:28 AM Central Daylight Time	08/02/2019 10:34:59 AM Central Daylight Time	07/30/2019 09:01:18 PM Central Daylight Time			08/06/2019 09:33:36 AM Central Daylight Time	"UNITEDHEALTHCARE OF UTAH, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Focus (HMO)	1	1		1			H4604	15	0	2020	"Ada, Canyon, and Gem Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	16	0	1	1	1	H4604_016_0	3	1			08/02/2019	2020.01	08/02/2019 11:23:07 AM Central Daylight Time	08/02/2019 10:35:41 AM Central Daylight Time	07/30/2019 09:01:53 PM Central Daylight Time			08/06/2019 09:33:36 AM Central Daylight Time	"UNITEDHEALTHCARE OF UTAH, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H4604	16	0	2020	Iron and Washington County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	17	0	1	1	1	H4604_017_0	3	1		1	08/05/2019	2020.01	08/05/2019 11:06:43 AM Central Daylight Time	08/02/2019 10:36:23 AM Central Daylight Time	07/30/2019 09:02:26 PM Central Daylight Time			08/06/2019 09:33:36 AM Central Daylight Time	"UNITEDHEALTHCARE OF UTAH, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Assist (HMO C-SNP)	1	1		1			H4604	17	0	2020	Select Counties in Utah		2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	18	0	1	1	1	H4604_018_0	4	1			08/02/2019	2020.01	08/02/2019 11:25:23 AM Central Daylight Time	08/02/2019 10:37:05 AM Central Daylight Time	07/30/2019 09:03:00 PM Central Daylight Time			08/06/2019 09:33:36 AM Central Daylight Time	"UNITEDHEALTHCARE OF UTAH, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO)	1	1		1			H4604	18	0	2020	Select Counties in Utah		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4604	801	0	1	1	1	H4604_801_0	1	1			05/11/2019	2020.01	05/11/2019 07:42:33 AM Central Daylight Time					06/02/2019 05:54:51 PM Central Daylight Time	"UNITEDHEALTHCARE OF UTAH, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H4604	801	0	2020	Salt Lake and Surrounding Counties		1	2772	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H4604	803	0	1	1	1	H4604_803_0	1	1			05/11/2019	2020.01	05/11/2019 07:43:03 AM Central Daylight Time					06/02/2019 05:54:51 PM Central Daylight Time	"UNITEDHEALTHCARE OF UTAH, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H4604	803	0	2020	Select Counties In UT		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H4604	805	0	1	1	1	H4604_805_0	1	1			05/11/2019	2020.01	05/11/2019 07:43:32 AM Central Daylight Time					06/02/2019 05:54:51 PM Central Daylight Time	"UNITEDHEALTHCARE OF UTAH, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H4604	805	0	2020	Select counties in UT		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1					1				
H4605	1	0	1	4	1	H4605_001_0	9	1			07/18/2019	2020.01	07/18/2019 09:40:54 PM Mountain Daylight Time	07/05/2019 02:37:29 PM Mountain Daylight Time				07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	1	4		1			H4605	1	0	2020	"Davis, Salt Lake, Utah, and Weber counties"		2	4768	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						2			
H4605	2	0	1	4	1	H4605_002_0	11	1			07/18/2019	2020.01	07/18/2019 10:25:28 PM Mountain Daylight Time	08/05/2019 10:38:12 AM Mountain Daylight Time	07/31/2019 12:22:03 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	1	4		1			H4605	2	0	2020	"Davis, Salt Lake, Utah, and Weber counties"		2	57792	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						2			
H4605	4	0	1	4	1	H4605_004_0	11	1			07/18/2019	2020.01	07/18/2019 09:41:39 PM Mountain Daylight Time	08/05/2019 10:39:34 AM Mountain Daylight Time	07/31/2019 12:23:47 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	1	4		1			H4605	4	0	2020	"Davis, Salt Lake, Utah, and Weber counties"		2	21379	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						2			
H4605	7	0	1	4	1	H4605_007_0	11	1			07/18/2019	2020.01	07/18/2019 09:42:09 PM Mountain Daylight Time	08/05/2019 10:40:52 AM Mountain Daylight Time	07/31/2019 12:25:50 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	1	4		1			H4605	7	0	2020	"Davis, Salt Lake, Utah, and Weber counties"		2	9984	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						2			
H4605	801	0	1	4	1	H4605_801_0	3	1			07/18/2019	2020.01	07/18/2019 09:42:43 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage (PPO)	1	4		1			H4605	801	0	2020	Nationwide except territories		1	12	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)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H4605	802	0	1	4	1	H4605_802_0	3	1			07/18/2019	2020.01	07/18/2019 09:43:01 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	1	4		1			H4605	802	0	2020	Nationwide except territories		1	2600	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)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H4605	803	0	1	4	1	H4605_803_0	3	1			07/18/2019	2020.01	07/18/2019 09:43:29 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx 02 (PPO)	1	4		1			H4605	803	0	2020	Nationwide except Territories		1	12	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)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H4605	804	0	1	4	1	H4605_804_0	3	1			07/18/2019	2020.01	07/18/2019 09:43:45 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx 03 (PPO)	1	4		1			H4605	804	0	2020	Nationwide except Territories		1	12	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)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H4623	1	0	1	1	1	H4623_001_0	3	1			08/02/2019	2020.01	08/02/2019 04:17:52 PM Eastern Daylight Time	08/02/2019 09:50:18 AM Eastern Daylight Time	08/02/2019 01:18:17 PM Eastern Daylight Time			08/05/2019 10:50:23 AM Eastern Daylight Time	"HUMANA REGIONAL HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H4623-001 (HMO)	1	1		1			H4623	1	0	2020	Southwest Missouri		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4623	2	0	1	1	1	H4623_002_0	3	1			08/01/2019	2020.01	08/01/2019 02:30:33 PM Eastern Daylight Time	08/02/2019 10:28:29 AM Eastern Daylight Time	08/02/2019 01:18:17 PM Eastern Daylight Time			08/05/2019 11:12:30 AM Eastern Daylight Time	"HUMANA REGIONAL HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Community HMO H4623-002 (HMO)	1	1		1			H4623	2	0	2020	"Greene, Christian, Webster counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4672	1	0	1	1	1	H4672_001_0	6	1			08/02/2019	2020.01	08/02/2019 09:44:59 AM Central Daylight Time	08/01/2019 10:56:35 AM Central Daylight Time	08/01/2019 10:58:45 AM Central Daylight Time			08/03/2019 06:06:56 AM Central Daylight Time	MEDICARE ADVANTAGE INSURANCE COMPANY OF OMAHA	Mutual of Omaha Medicare Advantage	https://www.mutualofomahacareadvantage.com	Mutual of Omaha CareAdvantage Complete (HMO)	1	1		1			H4672	1	0	2020	Dallas Fort Worth Metropolitan Area		2		2			2						www.mutualofomahacareadvantage.com	www.mutualofomahacareadvantage.com	https://www.mutualofomahacareadvantage.com	(844)335-3776		(844)335-3776		(844)335-2843		(844)335-2843		(844)335-3776		(844)335-3776		(844)335-2843		(844)335-2843		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4672	2	0	1	1	1	H4672_002_0	6	1			08/02/2019	2020.01	08/02/2019 09:40:34 AM Central Daylight Time	08/01/2019 11:04:24 AM Central Daylight Time	08/01/2019 11:06:44 AM Central Daylight Time			08/03/2019 06:06:56 AM Central Daylight Time	MEDICARE ADVANTAGE INSURANCE COMPANY OF OMAHA	Mutual of Omaha Medicare Advantage	https://www.mutualofomahacareadvantage.com	Mutual of Omaha CareAdvantage Rewards (HMO)	1	1		1			H4672	2	0	2020	Dallas Fort Worth Metropolitan Area		2		2			2						www.mutualofomahacareadvantage.com	www.mutualofomahacareadvantage.com	https://www.mutualofomahacareadvantage.com	(844)335-3776		(844)335-3776		(844)335-2843		(844)335-2843		(844)335-3776		(844)335-3776		(844)335-2843		(844)335-2843		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4672	3	0	1	1	1	H4672_003_0	6	1			08/02/2019	2020.01	08/02/2019 12:04:07 PM Central Daylight Time	08/01/2019 11:13:33 AM Central Daylight Time	08/01/2019 11:18:25 AM Central Daylight Time			08/03/2019 06:06:56 AM Central Daylight Time	MEDICARE ADVANTAGE INSURANCE COMPANY OF OMAHA	Mutual of Omaha Medicare Advantage	https://www.mutualofomahacareadvantage.com	Mutual of Omaha CareAdvantage Complete (HMO)	1	1		1			H4672	3	0	2020	Denver Metropolitan Area		2		2			2						www.mutualofomahacareadvantage.com	www.mutualofomahacareadvantage.com	https://www.mutualofomahacareadvantage.com	(844)335-4178		(844)335-4178		(844)335-3553		(844)335-3553		(844)335-4178		(844)335-4178		(844)335-3553		(844)335-3553		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4672	4	0	1	1	1	H4672_004_0	6	1			08/02/2019	2020.01	08/02/2019 09:17:21 AM Central Daylight Time	08/01/2019 11:26:41 AM Central Daylight Time	08/01/2019 11:22:18 AM Central Daylight Time			08/03/2019 06:06:56 AM Central Daylight Time	MEDICARE ADVANTAGE INSURANCE COMPANY OF OMAHA	Mutual of Omaha Medicare Advantage	https://www.mutualofomahacareadvantage.com	Mutual of Omaha CareAdvantage Plus (HMO)	1	1		1			H4672	4	0	2020	Denver Metropolitan Area		2		2			2						www.mutualofomahacareadvantage.com	www.mutualofomahacareadvantage.com	https://www.mutualofomahacareadvantage.com	(844)335-4178		(844)335-4178		(844)335-3553		(844)335-3553		(844)335-4178		(844)335-4178		(844)335-3553		(844)335-3553		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4672	5	0	1	1	1	H4672_005_0	5	1			08/02/2019	2020.01	08/02/2019 09:12:18 AM Central Daylight Time	08/01/2019 11:39:55 AM Central Daylight Time	08/01/2019 11:37:25 AM Central Daylight Time			08/03/2019 06:06:56 AM Central Daylight Time	MEDICARE ADVANTAGE INSURANCE COMPANY OF OMAHA	Mutual of Omaha Medicare Advantage	https://www.mutualofomahacareadvantage.com	Mutual of Omaha CareAdvantage Complete (HMO)	1	1		1			H4672	5	0	2020	El Paso County		2		2			2						www.mutualofomahacareadvantage.com	www.mutualofomahacareadvantage.com	https://www.mutualofomahacareadvantage.com	(844)335-2918		(844)335-2918		(844)335-4249		(844)335-4249		(844)335-2918		(844)335-2918		(844)335-4249		(844)335-4249		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4672	801	0	1	1	1	H4672_801_0	2	1			05/16/2019	2020.01	05/16/2019 11:30:42 AM Central Daylight Time					05/30/2019 02:23:04 PM Central Daylight Time	MEDICARE ADVANTAGE INSURANCE COMPANY OF OMAHA	Mutual of Omaha Medicare Advantage	https://www.mutualofomahacareadvantage.com	EGWP MAPD Calendar year (HMO)	1	1		1			H4672	801	0	2020	Certain Counties in Texas and Colorado		1	300	2			2						www.mutualofomahacareadvantage.com	www.mutualofomahacareadvantage.com	https://www.mutualofomahacareadvantage.com	(844)335-2918		(844)335-2918		(844)335-4249		(844)335-4249		(844)335-2918		(844)335-2918		(844)335-4249		(844)335-4249		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;17a;18a;	1					1				
H4672	802	0	1	1	1	H4672_802_0	2	1			05/21/2019	2020.01	05/21/2019 12:14:40 PM Central Daylight Time					05/30/2019 02:23:04 PM Central Daylight Time	MEDICARE ADVANTAGE INSURANCE COMPANY OF OMAHA	Mutual of Omaha Medicare Advantage	https://www.mutualofomahacareadvantage.com	EGWP MAPD Non-Calendar year (HMO)	1	1		1			H4672	802	0	2020	Certain Counties in Texas and Colorado		1	300	2			2						www.mutualofomahacareadvantage.com	www.mutualofomahacareadvantage.com	https://www.mutualofomahacareadvantage.com	(844)335-2918		(844)335-2918		(844)335-4249		(844)335-4249		(844)335-2918		(844)335-2918		(844)335-4249		(844)335-4249		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;17a;18a;	1					1				
H4676	1	0	1	1	1	H4676_001_0	8	1			08/05/2019	2020.01	08/05/2019 03:40:44 PM Eastern Daylight Time	08/06/2019 12:04:55 PM Eastern Daylight Time	08/06/2019 12:04:55 PM Eastern Daylight Time			08/06/2019 03:45:47 PM Eastern Daylight Time	"TROY HEALTH, INC."	Troy Medicare	www.troymedicare.com	Troy Medicare (HMO)	1	1		1			H4676	1	0	2020	"Cabarrus, Iredell, Rowan, and Robeson"		2	6363	2			2						www.troymedicare.com	www.troymedicare.com	www.troymedicare.com			(704)275-8900				(704)275-8900		(866)533-5492		(267)298-2410		(866)533-5492		(267)298-2410		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	1	0	1	1	1	H4709_001_0	6	1			06/01/2019	2020.01	06/01/2019 11:46:39 AM Central Daylight Time	08/02/2019 04:22:36 PM Central Daylight Time	08/02/2019 04:50:57 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage (HMO)	1	1		1			H4709	1	0	2020	Volusia County		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-7736		(844)221-7736		(833)412-6729		(833)412-6729		(844)221-7736		(844)221-7736		(833)412-6729		(833)412-6729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	3	0	1	1	1	H4709_003_0	6	1			06/01/2019	2020.01	06/01/2019 11:30:59 AM Central Daylight Time	08/02/2019 04:19:02 PM Central Daylight Time	08/02/2019 04:50:12 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage (HMO)	1	1		1			H4709	3	0	2020	"Orange, Osceola, Pasco, and Seminole Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-7642		(844)221-7642		(833)412-6731		(833)412-6731		(844)221-7642		(844)221-7642		(833)412-6731		(833)412-6731		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4709	5	0	1	1	1	H4709_005_0	7	1			06/03/2019	2020.01	06/03/2019 08:49:43 AM Central Daylight Time	08/02/2019 04:21:25 PM Central Daylight Time	08/02/2019 04:49:28 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF FLORIDA	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Assist (HMO)	1	1		1			H4709	5	0	2020	Palm Beach County		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-7734		(844)221-7734		(833)412-6733		(833)412-6733		(844)221-7734		(844)221-7734		(833)412-6733		(833)412-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	1	0	1	1	1	H4711_001_0	4	1			07/31/2019	2020.01	07/31/2019 07:43:08 PM Eastern Daylight Time	08/02/2019 10:21:58 AM Eastern Daylight Time	07/31/2019 01:05:26 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF NEBRASKA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	1	1		1			H4711	1	0	2020	Clark and Nye Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	2	0	1	1	1	H4711_002_0	3	1			07/31/2019	2020.01	07/31/2019 07:43:59 PM Eastern Daylight Time	08/02/2019 10:23:22 AM Eastern Daylight Time	07/31/2019 01:06:43 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF NEBRASKA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	1	1		1			H4711	2	0	2020	Clark and Nye Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	5	0	1	1	1	H4711_005_0	3	1			08/01/2019	2020.01	08/01/2019 01:53:22 PM Eastern Daylight Time	08/02/2019 10:24:15 AM Eastern Daylight Time	07/31/2019 01:07:59 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF NEBRASKA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	1	1		1			H4711	5	0	2020	"CAR, DOU, CHU, STO, WAS"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	6	0	1	1	1	H4711_006_0	4	1			08/01/2019	2020.01	08/01/2019 11:42:08 AM Central Daylight Time	08/01/2019 03:46:40 PM Central Daylight Time	07/31/2019 12:09:15 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	"COVENTRY HEALTH CARE OF NEBRASKA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Prime (HMO)	1	1		1			H4711	6	0	2020	Denver Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	7	0	1	1	1	H4711_007_0	4	1			08/01/2019	2020.01	08/01/2019 11:42:21 AM Central Daylight Time	08/01/2019 03:47:19 PM Central Daylight Time	07/31/2019 12:10:30 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	"COVENTRY HEALTH CARE OF NEBRASKA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Prime (HMO)	1	1		1			H4711	7	0	2020	Southern Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4711	801	0	1	1	1	H4711_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:47:51 AM Eastern Daylight Time					05/30/2019 06:48:01 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF NEBRASKA, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H4711	801	0	2020	Colorado and Nevada		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4711	802	0	1	1	1	H4711_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:48:02 AM Eastern Daylight Time					05/30/2019 06:48:01 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF NEBRASKA, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H4711	802	0	2020	Colorado and Nevada		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4711	803	0	1	1	1	H4711_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:48:16 AM Eastern Daylight Time					05/30/2019 06:48:01 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF NEBRASKA, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H4711	803	0	2020	Colorado and Nevada		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4714	1	0	1	20	8	H4714_001_0	1	1			05/21/2019	2020.01	05/21/2019 10:37:26 AM Eastern Daylight Time		05/19/2019 03:20:27 PM Eastern Daylight Time			05/21/2019 10:40:21 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)	8	20		1			H4714	1	0	2020	PACE of  the Southern Piedmont - Dual		2		2			2						www.seniorscript.com	Not applicable										(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	2	0	1	20	8	H4714_002_0	1	1			05/21/2019	2020.01	05/21/2019 10:38:01 AM Eastern Daylight Time		05/19/2019 03:22:00 PM Eastern Daylight Time			05/21/2019 10:40:21 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)	8	20		1			H4714	2	0	2020	PACE of  the Southern Piedmont - Medicare only		2		2			2						www.seniorscript.com	Not applicable										(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840										(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840																
H4754	4	0	1	4	1	H4754_004_0	5	1			07/11/2019	2020.01	07/11/2019 11:23:37 AM Pacific Daylight Time	07/31/2019 12:10:06 PM Pacific Daylight Time	07/31/2019 01:30:46 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 4 (PPO)	1	4		1			H4754	4	0	2020	Lane County		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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			
H4754	6	0	1	4	1	H4754_006_0	3	1			07/11/2019	2020.01	07/11/2019 11:24:06 AM Pacific Daylight Time	06/03/2019 01:31:06 PM Pacific Daylight Time				07/12/2019 08:30:40 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 6 (PPO)	1	4		1			H4754	6	0	2020	Southwest and Southern Idaho		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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						2			
H4754	7	0	1	4	1	H4754_007_0	6	1			07/11/2019	2020.01	07/11/2019 11:24:41 AM Pacific Daylight Time	07/31/2019 12:11:24 PM Pacific Daylight Time	07/31/2019 01:31:18 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 7 (PPO)	1	4		1			H4754	7	0	2020	Coos and Curry Counties		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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			
H4754	8	0	1	4	1	H4754_008_0	3	1			07/11/2019	2020.01	07/11/2019 11:25:17 AM Pacific Daylight Time	06/03/2019 01:31:16 PM Pacific Daylight Time				07/12/2019 08:30:40 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 8 (PPO)	1	4		1			H4754	8	0	2020	"Coos, Curry and Lane Counties"		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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						2			
H4754	9	0	1	4	1	H4754_009_0	6	1			07/11/2019	2020.01	07/11/2019 11:26:01 AM Pacific Daylight Time	08/01/2019 03:47:06 PM Pacific Daylight Time	07/31/2019 01:31:50 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 9 (PPO)	1	4		1			H4754	9	0	2020	Eastern Idaho		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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			
H4754	11	0	1	4	1	H4754_011_0	5	1			07/11/2019	2020.01	07/11/2019 11:26:51 AM Pacific Daylight Time	07/31/2019 12:13:46 PM Pacific Daylight Time	07/31/2019 01:32:22 PM Pacific Daylight Time			08/05/2019 03:42:40 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 11 (PPO)	1	4		1			H4754	11	0	2020	North Idaho		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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			
H4754	12	0	1	4	1	H4754_012_0	3	1			07/11/2019	2020.01	07/11/2019 11:27:30 AM Pacific Daylight Time	06/03/2019 01:29:49 PM Pacific Daylight Time				07/12/2019 08:30:40 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 12 (PPO)	1	4		1			H4754	12	0	2020	North and Eastern Idaho		2		2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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						2			
H4754	801	0	1	4	1	H4754_801_0	1	1			06/02/2019	2020.01	06/02/2019 09:16:49 AM Pacific Daylight Time					06/02/2019 05:18:03 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 801 (PPO)	1	4		1			H4754	801	0	2020	Statewide - Idaho and Oregon		1	1200	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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			
H4754	802	0	1	4	1	H4754_802_0	1	1			06/02/2019	2020.01	06/02/2019 09:16:43 AM Pacific Daylight Time					06/02/2019 05:18:03 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 802 (PPO)	1	4		1			H4754	802	0	2020	Statewide - Idaho and Oregon		1	1200	2			2						https://medicare.pacificsource.com/Search/Pharmacy	https://medicare.pacificsource.com/Search/Drug	https://medicare.pacificsource.com/Search/Provider	(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			
H4778	1	0	1	1	1	H4778_001_0	8	1		1	07/24/2019	2020.01	07/24/2019 01:07:23 PM Central Daylight Time	08/01/2019 11:34:53 AM Central Daylight Time	07/31/2019 02:54:58 PM Central Daylight Time			08/05/2019 06:27:26 PM Central Daylight Time	"SPARTAN PLAN IL, INC."	Sunrise Advantage Plan	www.sunriseadvantageplan.com	Sunrise Advantage Plan (HMO I-SNP)	1	1		1			H4778	1	0	2020	Illinois (partial)		2	720	2			1	1	3				www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4778	2	0	1	1	1	H4778_002_0	8	1		1	07/24/2019	2020.01	07/24/2019 01:07:38 PM Central Daylight Time	08/01/2019 11:38:43 AM Central Daylight Time	07/31/2019 02:56:25 PM Central Daylight Time			08/05/2019 06:27:26 PM Central Daylight Time	"SPARTAN PLAN IL, INC."	Sunrise Advantage Plan	www.sunriseadvantageplan.com	Reflections (HMO C-SNP)	1	1		1			H4778	2	0	2020	Illinois (partial)		2	720	2			1	4			1E+14		www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4778	3	0	1	1	1	H4778_003_0	9	1			07/24/2019	2020.01	07/24/2019 01:07:53 PM Central Daylight Time	08/01/2019 11:41:40 AM Central Daylight Time	07/31/2019 02:56:13 PM Central Daylight Time			08/05/2019 06:27:26 PM Central Daylight Time	"SPARTAN PLAN IL, INC."	Sunrise Advantage Plan	www.sunriseadvantageplan.com	Sunrise Advantage Community Plan (HMO)	1	1		1			H4778	3	0	2020	Illinois (partial)		2	328	2			2						www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(844)502-4149		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4835	1	0	1	1	1	H4835_001_0	4	1			07/31/2019	2020.01	07/31/2019 05:01:38 PM Eastern Daylight Time	08/02/2019 07:17:53 AM Pacific Daylight Time	07/30/2019 10:11:42 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	"AETNA BETTER HEALTH OF OKLAHOMA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plus Plan (HMO)	1	1		1			H4835	1	0	2020	Maricopa County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4835	2	0	1	1	1	H4835_002_0	3	1			07/31/2019	2020.01	07/31/2019 05:02:21 PM Eastern Daylight Time	08/02/2019 07:17:04 AM Pacific Daylight Time	07/30/2019 10:12:52 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	"AETNA BETTER HEALTH OF OKLAHOMA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	1	1		1			H4835	2	0	2020	Maricopa County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4835	3	0	1	1	1	H4835_003_0	3	1			07/31/2019	2020.01	07/31/2019 05:03:49 PM Eastern Daylight Time	08/02/2019 07:15:46 AM Pacific Daylight Time	07/30/2019 10:14:01 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	"AETNA BETTER HEALTH OF OKLAHOMA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	1	1		1			H4835	3	0	2020	Pinal County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4835	4	0	1	1	1	H4835_004_0	3	1			07/31/2019	2020.01	07/31/2019 04:54:48 PM Pacific Daylight Time	08/02/2019 07:48:08 AM Pacific Daylight Time	07/30/2019 10:15:11 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	"AETNA BETTER HEALTH OF OKLAHOMA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	1	1		1			H4835	4	0	2020	Pima County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4835	5	0	1	1	1	H4835_005_0	4	1			07/12/2019	2020.01	07/12/2019 06:40:34 AM Pacific Daylight Time	08/02/2019 07:12:34 AM Pacific Daylight Time	07/30/2019 10:16:20 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	"AETNA BETTER HEALTH OF OKLAHOMA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	1	1		1			H4835	5	0	2020	Mohave and Yavapai Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4835	6	0	1	1	1	H4835_006_0	3	1			07/03/2019	2020.01	07/03/2019 03:07:36 PM Eastern Daylight Time	08/02/2019 07:11:47 AM Pacific Daylight Time	07/30/2019 10:17:30 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	"AETNA BETTER HEALTH OF OKLAHOMA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	1	1		1			H4835	6	0	2020	"CHS, CNO, GLA, GHM and SCZ"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4835	801	0	1	1	1	H4835_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:48:29 AM Eastern Daylight Time					05/30/2019 06:50:13 PM Eastern Daylight Time	"AETNA BETTER HEALTH OF OKLAHOMA, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H4835	801	0	2020	Arizona		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4835	802	0	1	1	1	H4835_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:48:40 AM Eastern Daylight Time					05/30/2019 06:50:13 PM Eastern Daylight Time	"AETNA BETTER HEALTH OF OKLAHOMA, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H4835	802	0	2020	Arizona		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4835	803	0	1	1	1	H4835_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:48:50 AM Eastern Daylight Time					05/30/2019 06:50:13 PM Eastern Daylight Time	"AETNA BETTER HEALTH OF OKLAHOMA, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H4835	803	0	2020	Arizona		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4847	1	0	1	1	1	H4847_001_0	6	1			05/29/2019	2020.01	05/29/2019 10:06:09 AM Eastern Daylight Time	08/02/2019 06:37:30 AM Eastern Daylight Time	07/30/2019 10:30:24 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF SOUTH CAROLINA, INC."	WELLCARE	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H4847	1	0	2020	Select counties in SC		2	18309	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4847	2	0	1	1	1	H4847_002_0	6	1			05/29/2019	2020.01	05/29/2019 10:01:54 AM Eastern Daylight Time	08/02/2019 06:39:09 AM Eastern Daylight Time	07/30/2019 10:31:01 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF SOUTH CAROLINA, INC."	WELLCARE	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H4847	2	0	2020	Select counties in SC		2	5436	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4847	3	0	1	1	1	H4847_003_0	7	1			07/12/2019	2020.01	07/12/2019 11:39:50 AM Eastern Daylight Time	08/02/2019 03:18:30 PM Eastern Daylight Time	07/30/2019 10:31:37 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF SOUTH CAROLINA, INC."	WELLCARE	www.wellcare.com/medicare	WellCare Plus (HMO)	1	1		1			H4847	3	0	2020	Select counties in SC		2	71	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4847	4	0	1	1	1	H4847_004_0	8	1	2	1	07/11/2019	2020.01	07/11/2019 01:05:21 PM Eastern Daylight Time	08/02/2019 03:20:13 PM Eastern Daylight Time	07/30/2019 10:32:13 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF SOUTH CAROLINA, INC."	WELLCARE	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H4847	4	0	2020	Select counties in SC		2	2948	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4847	5	0	1	1	1	H4847_005_0	6	1			07/11/2019	2020.01	07/11/2019 01:03:37 PM Eastern Daylight Time	08/04/2019 08:02:42 PM Eastern Daylight Time	07/30/2019 10:32:49 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF SOUTH CAROLINA, INC."	WELLCARE	www.wellcare.com/medicare	WellCare Compass (HMO)	1	1		1			H4847	5	0	2020	Select counties in SC		2	5876	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4853	1	0	1	1	1	H4853_001_0	7	1			07/16/2019	2020.01	07/16/2019 01:24:24 PM Central Daylight Time	08/02/2019 04:19:28 PM Central Daylight Time	08/02/2019 04:49:22 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage (HMO)	1	1		1			H4853	1	0	2020	Maricopa County		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4853	2	0	1	1	1	H4853_002_0	7	1			07/16/2019	2020.01	07/16/2019 01:25:39 PM Central Daylight Time	08/02/2019 04:19:22 PM Central Daylight Time	08/02/2019 04:48:42 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Assist (HMO)	1	1		1			H4853	2	0	2020	Maricopa County		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4853	3	0	1	2	1	H4853_003_0	6	1			07/16/2019	2020.01	07/16/2019 01:27:11 PM Central Daylight Time	08/02/2019 04:19:17 PM Central Daylight Time	08/02/2019 04:48:14 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Choice (HMO-POS)	1	2		1			H4853	3	0	2020	Maricopa County		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4853	4	0	1	2	1	H4853_004_0	6	1			07/16/2019	2020.01	07/16/2019 01:28:09 PM Central Daylight Time	08/02/2019 04:19:10 PM Central Daylight Time	08/02/2019 04:47:34 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH COMPANY OF ARIZONA	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Choice Plus (HMO-POS)	1	2		1			H4853	4	0	2020	Maricopa County		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	1	0	1	1	1	H4868_001_0	9	1			07/12/2019	2020.01	07/12/2019 11:11:54 AM Eastern Daylight Time	08/02/2019 06:45:46 AM Eastern Daylight Time	07/30/2019 10:33:25 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Today's Options Classic (HMO)	1	1		1			H4868	1	0	2020	Select counties in NY		2	35711	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	2	0	1	1	1	H4868_002_0	9	1	2	1	07/12/2019	2020.01	07/12/2019 11:12:27 AM Eastern Daylight Time	08/02/2019 06:47:24 AM Eastern Daylight Time	07/30/2019 10:34:01 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H4868	2	0	2020	Select counties in NY		2	22419	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	3	0	1	1	1	H4868_003_0	7	1			05/29/2019	2020.01	05/29/2019 11:35:19 AM Eastern Daylight Time	06/02/2019 07:14:53 AM Eastern Daylight Time				06/02/2019 05:59:51 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO)	1	1		1			H4868	3	0	2020	Select counties in NY		2	3848	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H4868	4	0	1	1	1	H4868_004_0	11	1	2	1	07/12/2019	2020.01	07/12/2019 11:13:08 AM Eastern Daylight Time	08/02/2019 06:50:42 AM Eastern Daylight Time	07/30/2019 10:34:37 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H4868	4	0	2020	Select counties in NY		2	27475	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	7	0	1	1	1	H4868_007_0	9	1			07/12/2019	2020.01	07/12/2019 11:14:45 AM Eastern Daylight Time	08/02/2019 06:52:16 AM Eastern Daylight Time	07/30/2019 10:35:12 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Choice (HMO)	1	1		1			H4868	7	0	2020	Select counties in NY		2	5878	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	8	0	1	1	1	H4868_008_0	9	1			07/12/2019	2020.01	07/12/2019 01:35:24 PM Eastern Daylight Time	08/02/2019 06:53:50 AM Eastern Daylight Time	07/30/2019 10:35:48 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Choice (HMO)	1	1		1			H4868	8	0	2020	Select counties in NY		2	4411	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	10	0	1	1	1	H4868_010_0	10	1			07/12/2019	2020.01	07/12/2019 11:15:40 AM Eastern Daylight Time	08/02/2019 06:55:26 AM Eastern Daylight Time	07/30/2019 10:36:24 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Preferred (HMO)	1	1		1			H4868	10	0	2020	Select counties in NY		2	6310	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	14	0	1	1	1	H4868_014_0	9	1	2	1	07/12/2019	2020.01	07/12/2019 11:16:27 AM Eastern Daylight Time	08/02/2019 06:57:01 AM Eastern Daylight Time	07/30/2019 10:37:00 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H4868	14	0	2020	Select counties in NY		2	120182	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	15	0	1	1	1	H4868_015_0	9	1	2	1	07/12/2019	2020.01	07/12/2019 11:17:14 AM Eastern Daylight Time	08/02/2019 06:58:34 AM Eastern Daylight Time	07/30/2019 10:37:36 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H4868	15	0	2020	Select counties in NY		2	50706	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	16	0	1	1	1	H4868_016_0	9	1			07/12/2019	2020.01	07/12/2019 11:17:45 AM Eastern Daylight Time	08/04/2019 06:34:20 PM Eastern Daylight Time	07/30/2019 10:38:11 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	1	1		1			H4868	16	0	2020	Select counties in NY		2	31624	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	17	0	1	1	1	H4868_017_0	9	1			07/12/2019	2020.01	07/12/2019 11:18:20 AM Eastern Daylight Time	08/04/2019 06:42:57 PM Eastern Daylight Time	07/30/2019 10:38:47 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Rx (HMO)	1	1		1			H4868	17	0	2020	Select counties in NY		2	34031	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	18	0	1	1	1	H4868_018_0	9	1			07/12/2019	2020.01	07/12/2019 01:36:49 PM Eastern Daylight Time	08/02/2019 07:03:21 AM Eastern Daylight Time	07/30/2019 10:39:23 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H4868	18	0	2020	Select counties in NY		2	4503	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	19	0	1	1	1	H4868_019_0	9	1			07/11/2019	2020.01	07/11/2019 02:23:02 PM Eastern Daylight Time	08/02/2019 07:04:58 AM Eastern Daylight Time	07/30/2019 10:39:59 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H4868	19	0	2020	Select counties in NY		2	29616	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	20	0	1	1	1	H4868_020_0	9	1			07/12/2019	2020.01	07/12/2019 11:19:18 AM Eastern Daylight Time	08/02/2019 07:06:30 AM Eastern Daylight Time	07/30/2019 10:40:35 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Choice (HMO)	1	1		1			H4868	20	0	2020	Select counties in NY		2	31696	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	21	0	1	1	1	H4868_021_0	9	1			07/12/2019	2020.01	07/12/2019 11:20:07 AM Eastern Daylight Time	08/02/2019 07:08:05 AM Eastern Daylight Time	07/30/2019 10:41:11 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Choice (HMO)	1	1		1			H4868	21	0	2020	Select counties in NY		2	62941	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4868	22	0	1	1	1	H4868_022_0	9	1			05/31/2019	2020.01	05/31/2019 10:01:42 PM Eastern Daylight Time	08/02/2019 07:09:39 AM Eastern Daylight Time	07/30/2019 10:41:47 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE OF NEW YORK, INC."	WellCare	www.wellcare.com/medicare	WellCare Element (HMO)	1	1		1			H4868	22	0	2020	Select counties in NY		2	2774	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4875	16	1	1	4	1	H4875_016_1	9	1			08/06/2019	2020.01	08/06/2019 11:13:18 AM Eastern Daylight Time	08/02/2019 01:00:02 PM Eastern Daylight Time	07/31/2019 11:47:12 AM Eastern Daylight Time			08/06/2019 11:15:25 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	1	4		1			H4875	16	1	2020	68 lower peninsula Michigan counties	Region 3	2	30991	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	16	2	1	4	1	H4875_016_2	8	1			07/12/2019	2020.01	07/12/2019 02:19:09 PM Eastern Daylight Time	08/02/2019 01:01:38 PM Eastern Daylight Time	07/31/2019 11:47:42 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	1	4		1			H4875	16	2	2020	68 lower peninsula Michigan counties	Region 4	2	14806	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	16	3	1	4	1	H4875_016_3	8	1			07/12/2019	2020.01	07/12/2019 02:07:26 PM Eastern Daylight Time	08/02/2019 01:03:14 PM Eastern Daylight Time	07/31/2019 11:48:12 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	1	4		1			H4875	16	3	2020	68 lower peninsula Michigan counties	Region 5	2	41445	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	16	4	1	4	1	H4875_016_4	8	1			07/12/2019	2020.01	07/12/2019 02:07:40 PM Eastern Daylight Time	08/02/2019 01:04:48 PM Eastern Daylight Time	07/31/2019 11:48:42 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	1	4		1			H4875	16	4	2020	68 lower peninsula Michigan counties	Region 1	2	134916	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	16	5	1	4	1	H4875_016_5	8	1			07/12/2019	2020.01	07/12/2019 02:07:57 PM Eastern Daylight Time	08/02/2019 01:06:22 PM Eastern Daylight Time	07/31/2019 11:49:14 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	1	4		1			H4875	16	5	2020	68 lower peninsula Michigan counties	Region 2	2	61984	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	17	1	1	4	1	H4875_017_1	8	1			07/12/2019	2020.01	07/12/2019 01:28:34 PM Eastern Daylight Time	08/02/2019 01:07:58 PM Eastern Daylight Time	07/31/2019 11:49:46 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	1	4		1			H4875	17	1	2020	68 lower peninsula Michigan counties	Region 1	2	24351	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	17	2	1	4	1	H4875_017_2	8	1			07/12/2019	2020.01	07/12/2019 02:08:58 PM Eastern Daylight Time	08/02/2019 01:09:32 PM Eastern Daylight Time	07/31/2019 11:50:20 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	1	4		1			H4875	17	2	2020	68 lower peninsula Michigan counties	Region 2	2	11848	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	17	3	1	4	1	H4875_017_3	8	1			07/12/2019	2020.01	07/12/2019 02:09:14 PM Eastern Daylight Time	08/02/2019 01:11:08 PM Eastern Daylight Time	07/31/2019 11:50:56 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	1	4		1			H4875	17	3	2020	68 lower peninsula Michigan counties	Region 3	2	6427	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	17	4	1	4	1	H4875_017_4	8	1			07/12/2019	2020.01	07/12/2019 02:09:30 PM Eastern Daylight Time	08/02/2019 01:12:44 PM Eastern Daylight Time	07/31/2019 11:51:28 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	1	4		1			H4875	17	4	2020	68 lower peninsula Michigan counties	Region 4	2	2487	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	17	5	1	4	1	H4875_017_5	8	1			07/12/2019	2020.01	07/12/2019 02:18:26 PM Eastern Daylight Time	08/02/2019 01:14:18 PM Eastern Daylight Time	07/31/2019 11:51:56 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	1	4		1			H4875	17	5	2020	68 lower peninsula Michigan counties	Region 5	2	8086	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	18	1	1	4	1	H4875_018_1	9	1			07/26/2019	2020.01	07/26/2019 05:51:27 PM Eastern Daylight Time	08/02/2019 01:15:52 PM Eastern Daylight Time	07/31/2019 11:52:26 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	1	4		1			H4875	18	1	2020	68 lower peninsula Michigan counties	Region 1	2	10464	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	18	2	1	4	1	H4875_018_2	9	1			07/26/2019	2020.01	07/26/2019 04:07:07 PM Eastern Daylight Time	08/02/2019 01:17:28 PM Eastern Daylight Time	07/31/2019 11:52:56 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	1	4		1			H4875	18	2	2020	68 lower peninsula Michigan counties	Region 2	2	23217	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	18	3	1	4	1	H4875_018_3	9	1			07/26/2019	2020.01	07/26/2019 04:07:45 PM Eastern Daylight Time	08/02/2019 01:19:02 PM Eastern Daylight Time	07/31/2019 11:53:24 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	1	4		1			H4875	18	3	2020	68 lower peninsula Michigan counties	Region 3	2	23341	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	18	4	1	4	1	H4875_018_4	9	1			07/26/2019	2020.01	07/26/2019 04:08:27 PM Eastern Daylight Time	08/02/2019 01:19:56 PM Eastern Daylight Time	07/31/2019 11:53:56 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	1	4		1			H4875	18	4	2020	68 lower peninsula Michigan counties	Region 4	2	17736	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	18	5	1	4	1	H4875_018_5	9	1			07/26/2019	2020.01	07/26/2019 04:09:06 PM Eastern Daylight Time	08/02/2019 01:21:32 PM Eastern Daylight Time	07/31/2019 11:54:26 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	1	4		1			H4875	18	5	2020	68 lower peninsula Michigan counties	Region 5	2	45850	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	19	0	1	4	1	H4875_019_0	9	1			07/26/2019	2020.01	07/26/2019 03:56:50 PM Eastern Daylight Time	08/02/2019 01:23:08 PM Eastern Daylight Time	07/31/2019 11:54:56 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Edge (PPO)	1	4		1			H4875	19	0	2020	Region 5		2	26694	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	803	0	1	4	1	H4875_803_0	6	1			07/12/2019	2020.01	07/12/2019 12:36:03 PM Eastern Daylight Time					07/12/2019 05:18:23 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare PPO EG Non-Calendar Year (PPO)	1	4		1			H4875	803	0	2020	National		1	3	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	804	0	1	4	1	H4875_804_0	6	1			07/12/2019	2020.01	07/12/2019 12:36:54 PM Eastern Daylight Time					07/12/2019 05:18:23 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare PPO EG Calendar Year (PPO)	1	4		1			H4875	804	0	2020	National		1	5166	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4875	805	0	1	4	1	H4875_805_0	6	1			07/12/2019	2020.01	07/12/2019 12:37:50 PM Eastern Daylight Time					07/12/2019 05:18:23 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare PPO No RX EGWP Calendar (PPO)	1	4		1			H4875	805	0	2020	National		1	3	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4875	806	0	1	4	1	H4875_806_0	6	1			07/12/2019	2020.01	07/12/2019 12:38:13 PM Eastern Daylight Time					07/12/2019 05:18:23 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare PPO No RX EGWP Non-Calendar (PPO)	1	4		1			H4875	806	0	2020	National		1	3	2			2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4882	1	0	1	4	1	H4882_001_0	5	1			08/02/2019	2020.01	08/02/2019 11:56:20 AM Central Daylight Time	08/06/2019 02:22:14 PM Central Daylight Time	08/06/2019 02:24:04 PM Central Daylight Time			08/06/2019 03:47:00 PM Central Daylight Time	"HEALTHPARTNERS, INC."	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Stride (PPO)	1	4		1			H4882	1	0	2020	Metro and Central MN Counties		2	121332	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4882	2	0	1	4	1	H4882_002_0	5	1			08/02/2019	2020.01	08/02/2019 11:55:36 AM Central Daylight Time	08/06/2019 02:22:04 PM Central Daylight Time	08/06/2019 02:23:52 PM Central Daylight Time			08/06/2019 03:47:00 PM Central Daylight Time	"HEALTHPARTNERS, INC."	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Pace (PPO)	1	4		1			H4882	2	0	2020	Metro and Central MN Counties		2	4896	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4882	3	0	1	4	1	H4882_003_0	6	1			08/02/2019	2020.01	08/02/2019 11:59:08 AM Central Daylight Time	08/06/2019 02:21:49 PM Central Daylight Time	08/06/2019 02:23:41 PM Central Daylight Time			08/06/2019 03:47:00 PM Central Daylight Time	"HEALTHPARTNERS, INC."	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Steady (PPO)	1	4		1			H4882	3	0	2020	Metro and Central MN Counties		2	82560	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4882	4	0	1	4	1	H4882_004_0	5	1			08/02/2019	2020.01	08/02/2019 12:11:34 PM Central Daylight Time	08/06/2019 02:21:39 PM Central Daylight Time	08/06/2019 02:23:31 PM Central Daylight Time			08/06/2019 03:47:00 PM Central Daylight Time	"HEALTHPARTNERS, INC."	HealthPartners	healthpartners.com/medicare	HealthPartners Robin Birch (PPO)	1	4		1			H4882	4	0	2020	"NE WI - Brown, Outagamie: 13 additional counties"		2	2870	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(866)233-8734		(866)233-8734		(833)256-7046		(833)256-7046		(866)233-8734		(866)233-8734		(833)256-7046		(833)256-7046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4882	5	0	1	4	1	H4882_005_0	5	1			08/02/2019	2020.01	08/02/2019 12:13:05 PM Central Daylight Time	08/06/2019 02:21:29 PM Central Daylight Time	08/06/2019 02:23:21 PM Central Daylight Time			08/06/2019 03:47:00 PM Central Daylight Time	"HEALTHPARTNERS, INC."	HealthPartners	healthpartners.com/medicare	HealthPartners Robin Maple (PPO)	1	4		1			H4882	5	0	2020	"NE WI - Brown, Outagamie: 13 additional counties"		2	6730	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(866)233-8734		(866)233-8734		(833)256-7046		(833)256-7046		(866)233-8734		(866)233-8734		(833)256-7046		(833)256-7046		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4882	6	0	1	4	1	H4882_006_0	5	1			08/02/2019	2020.01	08/02/2019 11:56:55 AM Central Daylight Time	08/06/2019 02:21:16 PM Central Daylight Time	08/06/2019 02:23:10 PM Central Daylight Time			08/06/2019 03:47:00 PM Central Daylight Time	"HEALTHPARTNERS, INC."	HealthPartners	healthpartners.com/medicare	HealthPartners Journey Dash (PPO)	1	4		1			H4882	6	0	2020	Metro and Central MN Counties		2	18000	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4882	801	0	1	4	1	H4882_801_0	4	1			07/08/2019	2020.01	07/08/2019 12:52:44 PM Central Daylight Time					07/08/2019 02:17:00 PM Central Daylight Time	"HEALTHPARTNERS, INC."	HealthPartners	healthpartners.com/medicare	HealthPartners Group MAPD Calendar Year (PPO)	1	4		1			H4882	801	0	2020	All States Excluding Cost Counties		1	60300	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4882	803	0	1	4	1	H4882_803_0	4	1			07/08/2019	2020.01	07/08/2019 09:49:14 AM Central Daylight Time					07/08/2019 02:17:00 PM Central Daylight Time	"HEALTHPARTNERS, INC."	HealthPartners	healthpartners.com/medicare	HealthPartners Group MA Only (PPO)	1	4		1			H4882	803	0	2020	All States Excluding Cost Counties		1	0	2			2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx	healthpartners.com/medicarenetworks	(866)233-8734		(952)883-6655		(844)363-8979		(952)883-5090										(711)-		(711)-		(711)-		(711)-										2					2						2			
H4909	14	0	1	4	1	H4909_014_0	7	1			07/12/2019	2020.01	07/12/2019 09:38:50 AM Eastern Daylight Time	08/05/2019 10:04:31 AM Eastern Daylight Time	07/30/2019 07:07:37 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Access (PPO)	1	4		1			H4909	14	0	2020	Mathews County		2		2			2						www.anthem.com/medicare	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		(844)364-2119		(844)364-2119		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	15	0	1	4	1	H4909_015_0	7	1			07/31/2019	2020.01	07/31/2019 06:01:51 PM Eastern Daylight Time	08/05/2019 10:04:31 AM Eastern Daylight Time	07/30/2019 07:08:14 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com	Anthem MediBlue Access (PPO)	1	4		1			H4909	15	0	2020	Select Counties in Missouri		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7798		(855)690-7798		(800)797-5937		(800)797-5937		(855)690-7798		(855)690-7798		(844)364-2119		(844)364-2119		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	16	0	1	4	1	H4909_016_0	6	1			07/31/2019	2020.01	07/31/2019 06:02:43 PM Eastern Daylight Time	08/05/2019 10:04:31 AM Eastern Daylight Time	07/30/2019 07:08:51 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Basic (PPO)	1	4		1			H4909	16	0	2020	Select Counties in Missouri		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(855)690-7798		(855)690-7798		(800)797-5937		(800)797-5937		(855)690-7798		(855)690-7798		(844)364-2119		(844)364-2119		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4909	804	0	1	4	1	H4909_804_0	2	1			05/30/2019	2020.01	05/30/2019 04:49:58 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4909	804	0	2020	Virginia		1	483324	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	805	0	1	4	1	H4909_805_0	2	1			05/30/2019	2020.01	05/30/2019 04:50:11 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4909	805	0	2020	Virginia		1	2580742	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	806	0	1	4	1	H4909_806_0	2	1			05/30/2019	2020.01	05/30/2019 04:50:18 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4909	806	0	2020	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	810	0	2	4	1	H4909_810_0	2	1			05/30/2019	2020.01	05/30/2019 04:50:24 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H4909	810	0	2020	National		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	811	0	1	4	1	H4909_811_0	2	1			05/30/2019	2020.01	05/30/2019 04:50:34 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4909	811	0	2020	National		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	812	0	1	4	1	H4909_812_0	2	1			05/30/2019	2020.01	05/30/2019 04:50:46 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4909	812	0	2020	Virginia		1	16387	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	813	0	2	4	1	H4909_813_0	2	1			05/30/2019	2020.01	05/30/2019 04:50:54 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H4909	813	0	2020	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	814	0	2	4	1	H4909_814_0	2	1			05/30/2019	2020.01	05/30/2019 04:51:06 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H4909	814	0	2020	Virginia		1	33523	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	815	0	2	4	1	H4909_815_0	2	1			05/30/2019	2020.01	05/30/2019 04:51:19 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H4909	815	0	2020	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	816	0	1	4	1	H4909_816_0	2	1			05/30/2019	2020.01	05/30/2019 04:51:26 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4909	816	0	2020	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	817	0	1	4	1	H4909_817_0	2	1			05/30/2019	2020.01	05/30/2019 04:51:35 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4909	817	0	2020	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4909	818	0	1	4	1	H4909_818_0	2	1			05/30/2019	2020.01	05/30/2019 04:51:43 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H4909	818	0	2020	Virginia		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H4922	3	0	1	1	1	H4922_003_0	7	1	2	1	08/06/2019	2020.01	08/06/2019 11:04:22 AM Eastern Daylight Time	08/07/2019 01:18:49 PM Eastern Daylight Time	08/05/2019 07:05:00 PM Eastern Daylight Time			08/07/2019 04:54:25 PM Eastern Daylight Time	"AGEWELL NEW YORK, LLC"	AgeWell New York	www.agewellnewyork.com	AgeWell New York FeelWell (HMO D-SNP)	1	1		1			H4922	3	0	2020	"New York City Metro Area, Nassau, Westchester"		2	4672	2			1	3		1		1	www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(844)782-7670		(844)782-7670		(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	2			
H4922	4	0	1	1	1	H4922_004_0	7	1		1	08/06/2019	2020.01	08/06/2019 01:17:28 PM Eastern Daylight Time	08/07/2019 01:19:50 PM Eastern Daylight Time	08/05/2019 07:05:53 PM Eastern Daylight Time			08/07/2019 04:54:25 PM Eastern Daylight Time	"AGEWELL NEW YORK, LLC"	AgeWell New York	www.agewellnewyork.com	AgeWell New York CareWell (HMO I-SNP)	1	1		1			H4922	4	0	2020	"New York City Metro Area, Long Island, Westchester"		2	8259	2			1	1	1				www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(844)782-7670		(844)782-7670		(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	2			
H4922	10	0	1	1	1	H4922_010_0	7	1	2	1	08/05/2019	2020.01	08/05/2019 02:49:56 PM Eastern Daylight Time	08/07/2019 01:22:46 PM Eastern Daylight Time	08/05/2019 07:07:05 PM Eastern Daylight Time			08/07/2019 04:54:25 PM Eastern Daylight Time	"AGEWELL NEW YORK, LLC"	AgeWell New York	www.agewellnewyork.com	AgeWell New York Advantage Plus (HMO D-SNP)	1	1		1			H4922	10	0	2020	"New York City Metro Area, Nassau, Westchester"		2	180	2			1	3		1		1	www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(844)782-7670		(844)782-7670		(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	2			
H4922	11	0	1	1	1	H4922_011_0	7	1			08/05/2019	2020.01	08/05/2019 02:51:14 PM Eastern Daylight Time	08/07/2019 01:21:36 PM Eastern Daylight Time	08/05/2019 07:08:08 PM Eastern Daylight Time			08/07/2019 04:54:25 PM Eastern Daylight Time	"AGEWELL NEW YORK, LLC"	AgeWell New York	www.agewellnewyork.com	AgeWell New York LiveWell (HMO)	1	1		1			H4922	11	0	2020	"New York City Metro Area, Nassau, Westchester"		2	9957	2			2						www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(844)782-7670		(844)782-7670		(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	2			
H4931	1	0	1	1	1	H4931_001_0	8	1	2	1	08/06/2019	2020.01	08/06/2019 10:24:03 AM US Mountain Standard Time	08/06/2019 10:18:30 AM US Mountain Standard Time	08/06/2019 10:18:30 AM US Mountain Standard Time			08/06/2019 10:34:05 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner - University Care Advantage	www.banneruca.com	Banner - University Care Advantage (HMO D-SNP)	1	1		1			H4931	1	0	2020	"Cochise, Gila, Graham, Greenlee, La Paz"		2		2			1	3		2		2	www.banneruca.com/find-a-pharmacy	www.banneruca.com/plan-information/2020-plan-materials#Drug-Formulary	www.banneruca.com/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	6	0	1	1	1	H4931_006_0	8	1	2	1	08/06/2019	2020.01	08/06/2019 10:24:38 AM US Mountain Standard Time	08/06/2019 10:18:30 AM US Mountain Standard Time	08/06/2019 10:18:31 AM US Mountain Standard Time			08/06/2019 10:34:05 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner - University Care Advantage	www.banneruca.com	Banner - University Care Advantage (HMO D-SNP)	1	1		1			H4931	6	0	2020	Pima County		2		2			1	3		2		2	www.banneruca.com/find-a-pharmacy	www.banneruca.com/plan-information/2020-plan-materials#Drug-Formulary	www.banneruca.com/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	7	0	1	1	1	H4931_007_0	8	1	2	1	08/06/2019	2020.01	08/06/2019 10:24:48 AM US Mountain Standard Time	08/06/2019 10:18:31 AM US Mountain Standard Time	08/06/2019 10:18:31 AM US Mountain Standard Time			08/06/2019 10:34:05 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner - University Care Advantage	www.banneruca.com	Banner - University Care Advantage (HMO D-SNP)	1	1		1			H4931	7	0	2020	"Pinal, Maricopa"		2		2			1	3		2		2	www.banneruca.com/find-a-pharmacy	www.banneruca.com/plan-information/2020-plan-materials#Drug-Formulary	www.banneruca.com/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	8	0	1	1	1	H4931_008_0	8	1	2	1	08/06/2019	2020.01	08/06/2019 10:25:00 AM US Mountain Standard Time	08/06/2019 10:18:32 AM US Mountain Standard Time	08/06/2019 10:18:32 AM US Mountain Standard Time			08/06/2019 10:34:05 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner - University Care Advantage	www.banneruca.com	Banner - University Care Advantage (HMO D-SNP)	1	1		1			H4931	8	0	2020	"Santa Cruz, Yuma"		2		2			1	3		2		2	www.banneruca.com/find-a-pharmacy	www.banneruca.com/plan-information/2020-plan-materials#Drug-Formulary	www.banneruca.com/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	13	0	1	1	1	H4931_013_0	8	1	2	1	08/06/2019	2020.01	08/06/2019 10:25:17 AM US Mountain Standard Time	08/06/2019 10:18:27 AM US Mountain Standard Time	08/06/2019 10:18:27 AM US Mountain Standard Time			08/06/2019 10:34:05 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner - University Care Advantage	www.banneruca.com	Banner - University Care Advantage (HMO D-SNP)	1	1		1			H4931	13	0	2020	"ALTCS: Cochise, Gila, Graham, Greenlee, La Paz"		2		2			1	3		2		2	www.banneruca.com/find-a-pharmacy	www.banneruca.com/plan-information/2020-plan-materials#Drug-Formulary	www.banneruca.com/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	14	0	1	1	1	H4931_014_0	8	1	2	1	08/06/2019	2020.01	08/06/2019 10:25:29 AM US Mountain Standard Time	08/06/2019 10:18:28 AM US Mountain Standard Time	08/06/2019 10:18:28 AM US Mountain Standard Time			08/06/2019 10:34:05 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner - University Care Advantage	www.banneruca.com	Banner - University Care Advantage (HMO D-SNP)	1	1		1			H4931	14	0	2020	ALTCS: Pima		2		2			1	3		2		2	www.banneruca.com/find-a-pharmacy	www.banneruca.com/plan-information/2020-plan-materials#Drug-Formulary	www.banneruca.com/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	15	0	1	1	1	H4931_015_0	8	1	2	1	08/06/2019	2020.01	08/06/2019 10:25:41 AM US Mountain Standard Time	08/06/2019 10:18:28 AM US Mountain Standard Time	08/06/2019 10:18:29 AM US Mountain Standard Time			08/06/2019 10:34:05 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner - University Care Advantage	www.banneruca.com	Banner - University Care Advantage (HMO D-SNP)	1	1		1			H4931	15	0	2020	"ALTCS: Maricopa, Pinal"		2		2			1	3		2		2	www.banneruca.com/find-a-pharmacy	www.banneruca.com/plan-information/2020-plan-materials#Drug-Formulary	www.banneruca.com/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4931	16	0	1	1	1	H4931_016_0	8	1	2	1	08/06/2019	2020.01	08/06/2019 10:25:59 AM US Mountain Standard Time	08/06/2019 10:18:29 AM US Mountain Standard Time	08/06/2019 10:18:29 AM US Mountain Standard Time			08/06/2019 10:34:05 AM US Mountain Standard Time	BANNER - UNIVERSITY CARE ADVANTAGE	Banner - University Care Advantage	www.banneruca.com	Banner - University Care Advantage (HMO D-SNP)	1	1		1			H4931	16	0	2020	"ALTCS: Santa Cruz, Yuma"		2		2			1	3		2		2	www.banneruca.com/find-a-pharmacy	www.banneruca.com/plan-information/2020-plan-materials#Drug-Formulary	www.banneruca.com/find-a-provider	(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(877)874-3930		(520)874-3930		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4937	1	0	1	4	1	H4937_001_0	14	1			09/18/2019	2020.01	09/18/2019 10:29:45 AM Pacific Daylight Time	08/06/2019 09:49:52 AM Pacific Daylight Time	08/06/2019 09:46:29 AM Pacific Daylight Time			09/18/2019 10:39:09 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield Medicare (PPO)	1	4		1			H4937	1	0	2020	Alameda County		2		2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(800)776-4466		(800)776-4466		(888)510-8074		(888)510-8074		(800)776-4466		(800)776-4466		(888)510-8074		(888)510-8074		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4937	801	0	1	4	1	H4937_801_0	1	1			05/29/2019	2020.01	05/29/2019 05:02:39 PM Pacific Daylight Time					05/31/2019 01:38:42 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield Medicare (PPO)	1	4		1			H4937	801	0	2020	MA-PD Employer Group Plan		1	9000	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(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	1b;2;3-1;3-2;3-3;3-4;5;6;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;17a;17b;18a;	1	7k;17a;17b;18a;	2									
H4937	802	0	1	4	1	H4937_802_0	1	1			05/29/2019	2020.01	05/29/2019 04:59:31 PM Pacific Daylight Time					05/31/2019 01:38:42 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield Medicare (PPO)	1	4		1			H4937	802	0	2020	MA-PD Employer Group Plan		1	1500	2			2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary	www.blueshieldca.com/find-a-doctor	(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	1b;2;3-1;3-2;3-3;3-4;5;6;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;17a;17b;18a;	1	7k;17a;17b;18a;	2									
H4961	1	0	1	4	1	H4961_001_0	4	1			08/08/2019	2020.01	08/08/2019 11:14:49 AM Pacific Daylight Time	07/31/2019 02:12:32 PM Pacific Daylight Time	07/31/2019 10:23:40 AM Pacific Daylight Time			08/08/2019 11:19:59 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	My Choice (PPO)	1	4		1			H4961	1	0	2020	"Sacramento, Placer & Yolo Counties"		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4961	2	0	1	4	1	H4961_002_0	4	1			08/08/2019	2020.01	08/08/2019 11:15:14 AM Pacific Daylight Time	07/31/2019 02:11:26 PM Pacific Daylight Time	07/31/2019 10:26:38 AM Pacific Daylight Time			08/08/2019 11:19:59 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	My Choice (PPO)	1	4		1			H4961	2	0	2020	San Mateo County		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4961	3	0	1	4	1	H4961_003_0	4	1			08/08/2019	2020.01	08/08/2019 11:15:33 AM Pacific Daylight Time	07/31/2019 02:08:16 PM Pacific Daylight Time	07/31/2019 10:30:26 AM Pacific Daylight Time			08/08/2019 11:19:59 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	My Choice (PPO)	1	4		1			H4961	3	0	2020	Sonoma County		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4961	4	0	1	4	1	H4961_004_0	4	1			08/08/2019	2020.01	08/08/2019 11:15:48 AM Pacific Daylight Time	07/31/2019 02:10:18 PM Pacific Daylight Time	07/31/2019 10:32:48 AM Pacific Daylight Time			08/08/2019 11:19:59 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	My Choice (PPO)	1	4		1			H4961	4	0	2020	San Joaquin & Stanislaus		2		2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4961	801	0	1	4	1	H4961_801_0	1	1			06/03/2019	2020.01	06/03/2019 11:22:17 AM Pacific Daylight Time					06/03/2019 11:22:30 AM Pacific Daylight Time	ALIGNMENT HEALTH PLAN	Alignment Health Plan	www.alignmenthealthplan.com	Alignment Health Plan Retiree Options (PPO)	1	4		1			H4961	801	0	2020	"Sac, Placer, Yolo, SM, Sonoma, ST & SJ Counties"		1	6200	2			2						www.alignmenthealthplan.com	www.alignmenthealthplan.com	www.alignmenthealthplan.com	(866)634-2247		(323)728-7232	5550	(888)979-2247	1	(323)728-7232	6	(844)227-7616		(844)227-7616		(888)979-2247	1	(323)728-7232	6	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H4982	1	0	1	1	1	H4982_001_0	3	1			07/31/2019	2020.01	07/31/2019 04:52:42 PM Eastern Daylight Time	08/01/2019 07:47:18 AM Pacific Daylight Time	07/30/2019 10:18:40 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	1	1		1			H4982	1	0	2020	Los Angeles and Orange Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	2	0	1	1	1	H4982_002_0	2	1			07/31/2019	2020.01	07/31/2019 09:36:59 PM Eastern Daylight Time	08/01/2019 07:50:35 AM Pacific Daylight Time	07/30/2019 10:19:50 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	1	1		1			H4982	2	0	2020	Riverside and San Bernardino Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	3	0	1	1	1	H4982_003_0	2	1			07/31/2019	2020.01	07/31/2019 09:37:14 PM Eastern Daylight Time	08/01/2019 07:58:12 AM Pacific Daylight Time	07/30/2019 10:21:00 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	1	1		1			H4982	3	0	2020	Kern County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	4	0	1	1	1	H4982_004_0	2	1			07/31/2019	2020.01	07/31/2019 04:54:07 PM Eastern Daylight Time	08/01/2019 07:59:21 AM Pacific Daylight Time	07/30/2019 10:22:11 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	1	1		1			H4982	4	0	2020	San Diego County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	5	0	1	1	1	H4982_005_0	3	1			07/31/2019	2020.01	07/31/2019 04:54:30 PM Eastern Daylight Time	08/01/2019 08:00:51 AM Pacific Daylight Time	07/30/2019 10:23:22 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	1	1		1			H4982	5	0	2020	Alameda County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	6	0	1	1	1	H4982_006_0	2	1			07/31/2019	2020.01	07/31/2019 04:55:38 PM Eastern Daylight Time	08/01/2019 08:01:50 AM Pacific Daylight Time	07/30/2019 10:24:32 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	1	1		1			H4982	6	0	2020	Santa Clara County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	7	0	1	1	1	H4982_007_0	3	1			07/31/2019	2020.01	07/31/2019 04:56:10 PM Eastern Daylight Time	08/01/2019 08:03:24 AM Pacific Daylight Time	07/30/2019 10:25:42 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plus Plan (HMO)	1	1		1			H4982	7	0	2020	San Francisco County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H4982	801	0	1	1	1	H4982_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:49:35 AM Eastern Daylight Time					05/30/2019 06:52:09 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H4982	801	0	2020	California		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4982	802	0	1	1	1	H4982_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:49:46 AM Eastern Daylight Time					05/30/2019 06:52:09 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H4982	802	0	2020	California		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4982	803	0	1	1	1	H4982_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:49:57 AM Eastern Daylight Time					05/30/2019 06:52:09 PM Eastern Daylight Time	AETNA BETTER HEALTH OF CALIFORNIA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H4982	803	0	2020	California		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H4999	1	0	1	20	8	H4999_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:02:34 PM Eastern Daylight Time		05/22/2019 12:51:26 PM Eastern Daylight Time			05/22/2019 01:05:28 PM Eastern Daylight Time	THE LUTHERAN HOME FOR THE AGED	LIFE Northwestern Pennsylvania	www.lifenwpa.org	LIFE Northwestern Pennsylvania (PACE)	8	20		1			H4999	1	0	2020	"Counties: Erie, War, Craw, Mer, Ven, McK, For, Cla"		2		2			2						www.lifenwpa.org	www.lifenwpa.org										(844)456-5433		(814)456-5433		(844)456-5433		(814)456-5433										(814)456-5433		(814)456-5433		(814)456-5433		(814)456-5433																
H4999	2	0	1	20	8	H4999_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:03:24 PM Eastern Daylight Time		05/22/2019 12:51:04 PM Eastern Daylight Time			05/22/2019 01:05:28 PM Eastern Daylight Time	THE LUTHERAN HOME FOR THE AGED	LIFE Northwestern Pennsylvania	www.lifenwpa.org	LIFE Northwestern Pennsylvania (PACE)	8	20		1			H4999	2	0	2020	"Counties: Erie, War, Craw, Mer, Ven, McK, For, Cla"		2		2			2						www.lifenwpa.org	www.lifenwpa.org										(844)456-5433		(814)456-5433		(844)456-5433		(814)456-5433										(814)456-5433		(814)456-5433		(814)456-5433		(814)456-5433																
H5007	1	0	1	20	8	H5007_001_0	1	1			05/29/2019	2020.01	05/29/2019 09:42:11 AM Pacific Daylight Time		05/22/2019 02:52:19 PM Pacific Daylight Time			05/29/2019 09:45:54 AM Pacific Daylight Time	PROVIDENCE HEALTH SYSTEM	Providence Health System	washington.providence.org/senior-care/elderplace	Providence ElderPlace - Seattle (PACE)	8	20		1			H5007	1	0	2020	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	2	0	1	20	8	H5007_002_0	1	1			05/29/2019	2020.01	05/29/2019 09:42:57 AM Pacific Daylight Time		05/22/2019 02:51:56 PM Pacific Daylight Time			05/29/2019 09:45:54 AM Pacific Daylight Time	PROVIDENCE HEALTH SYSTEM	Providence Health System	washington.providence.org/senior-care/elderplace	Providence ElderPlace - Seattle (PACE)	8	20		1			H5007	2	0	2020	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	1	0	1	1	1	H5008_001_0	2	1		1	05/30/2019	2020.01	05/30/2019 07:53:18 AM Central Daylight Time	08/02/2019 11:29:34 AM Central Daylight Time	07/30/2019 09:03:37 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO I-SNP)	1	1		1			H5008	1	0	2020	"King, Kitsap, Pierce, and Snohomish Counties"		2		2			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	2			
H5008	2	0	1	1	1	H5008_002_0	2	1	2	1	06/03/2019	2020.01	06/03/2019 10:03:00 PM Central Daylight Time	08/02/2019 11:30:02 AM Central Daylight Time	07/30/2019 09:04:14 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H5008	2	0	2020	Select Counties in Washington		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-4984		(866)944-4984		(888)834-3721		(888)834-3721		(866)944-4984		(866)944-4984		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5008	9	0	1	2	1	H5008_009_0	4	1	2	1	08/06/2019	2020.01	08/06/2019 12:17:30 PM Central Daylight Time	08/02/2019 11:30:29 AM Central Daylight Time	07/30/2019 09:04:52 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO-POS D-SNP)	1	2		1			H5008	9	0	2020	Select counties in New Mexico		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)393-0208		(866)393-0208		(888)834-3721		(888)834-3721		(866)393-0208		(866)393-0208		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5008	10	0	1	1	1	H5008_010_0	3	1	2	1	08/02/2019	2020.01	08/02/2019 09:07:57 AM Central Daylight Time	08/02/2019 11:30:56 AM Central Daylight Time	07/30/2019 09:05:28 PM Central Daylight Time			08/06/2019 12:14:20 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H5008	10	0	2020	New Orleans Metro area		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)263-0627		(866)263-0627		(888)834-3721		(888)834-3721		(866)263-0627		(866)263-0627		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5008	11	0	1	1	1	H5008_011_0	3	1	2	1	08/02/2019	2020.01	08/02/2019 09:08:24 AM Central Daylight Time	08/02/2019 11:31:23 AM Central Daylight Time	07/30/2019 09:06:01 PM Central Daylight Time			08/06/2019 12:14:20 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H5008	11	0	2020	Select Counties in Mississippi		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)263-1164		(866)263-1164		(888)834-3721		(888)834-3721		(866)263-1164		(866)263-1164		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5008	12	0	1	1	1	H5008_012_0	3	1	2	1	08/05/2019	2020.01	08/05/2019 05:37:22 PM Central Daylight Time	08/02/2019 11:31:51 AM Central Daylight Time	07/30/2019 09:06:35 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP1 (HMO D-SNP)	1	1		1			H5008	12	0	2020	Gila County		2		2			1	3		2		2	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	2			
H5009	1	0	1	4	1	H5009_001_0	10	1			07/18/2019	2020.01	07/18/2019 09:50:01 PM Mountain Daylight Time	07/05/2019 02:41:55 PM Mountain Daylight Time				07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	1	4		1			H5009	1	0	2020	Select Counties in Washington		2	7324	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						2			
H5009	2	0	1	4	1	H5009_002_0	11	1			07/18/2019	2020.01	07/18/2019 09:50:15 PM Mountain Daylight Time	08/05/2019 10:43:22 AM Mountain Daylight Time	07/31/2019 12:31:57 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	1	4		1			H5009	2	0	2020	Select Counties in Washington		2	154426	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						2			
H5009	8	0	1	4	1	H5009_008_0	11	1			07/18/2019	2020.01	07/18/2019 09:50:40 PM Mountain Daylight Time	08/05/2019 10:44:33 AM Mountain Daylight Time	07/31/2019 12:34:05 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	1	4		1			H5009	8	0	2020	Select Counties in Washington		2	17244	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						2			
H5009	9	0	1	4	1	H5009_009_0	11	1			07/18/2019	2020.01	07/18/2019 09:51:19 PM Mountain Daylight Time	08/05/2019 10:45:54 AM Mountain Daylight Time	07/31/2019 02:56:11 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Primary (PPO)	1	4		1			H5009	9	0	2020	Select Counties in Washington		2	10104	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						2			
H5009	801	0	1	4	1	H5009_801_0	3	1			07/18/2019	2020.01	07/18/2019 09:51:40 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage (PPO)	1	4		1			H5009	801	0	2020	Nationwide except territories		1	12	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)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H5009	802	0	1	4	1	H5009_802_0	3	1			07/18/2019	2020.01	07/18/2019 09:51:56 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	1	4		1			H5009	802	0	2020	Nationwide except territories		1	8654	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)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H5009	803	0	1	4	1	H5009_803_0	3	1			07/18/2019	2020.01	07/18/2019 09:52:16 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx 02 (PPO)	1	4		1			H5009	803	0	2020	Nationwide except Territories		1	12	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)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H5009	804	0	1	4	1	H5009_804_0	3	1			07/18/2019	2020.01	07/18/2019 09:52:31 PM Mountain Daylight Time					07/19/2019 12:12:41 PM Mountain Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx 03 (PPO)	1	4		1			H5009	804	0	2020	Nationwide except Territories		1	12	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)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H5010	1	0	1	4	1	H5010_001_0	9	1			07/18/2019	2020.01	07/18/2019 09:27:34 PM Mountain Daylight Time	07/05/2019 02:46:14 PM Mountain Daylight Time				07/19/2019 12:12:41 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage Basic (PPO)	1	4		1			H5010	1	0	2020	Spokane and Chelan Counties		2	454	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						2			
H5010	2	0	1	4	1	H5010_002_0	11	1			07/18/2019	2020.01	07/18/2019 09:27:58 PM Mountain Daylight Time	08/05/2019 10:48:22 AM Mountain Daylight Time	07/31/2019 02:57:56 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Classic (PPO)	1	4		1			H5010	2	0	2020	Spokane and Chelan Counties		2	6907	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						2			
H5010	4	0	1	4	1	H5010_004_0	11	1			07/18/2019	2020.01	07/18/2019 09:28:23 PM Mountain Daylight Time	08/05/2019 10:49:43 AM Mountain Daylight Time	07/31/2019 02:59:37 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Enhanced (PPO)	1	4		1			H5010	4	0	2020	Spokane County		2	2813	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						2			
H5010	7	0	1	4	1	H5010_007_0	11	1			07/18/2019	2020.01	07/18/2019 09:28:47 PM Mountain Daylight Time	08/05/2019 10:50:58 AM Mountain Daylight Time	07/31/2019 03:01:28 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Primary (PPO)	1	4		1			H5010	7	0	2020	Spokane and Chelan Counties		2	3222	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						2			
H5015	1	0	1	1	1	H5015_001_0	15	1		1	08/06/2019	2020.01	08/06/2019 10:51:34 AM Eastern Daylight Time	08/06/2019 12:47:41 AM Eastern Daylight Time	08/06/2019 12:47:42 AM Eastern Daylight Time			08/06/2019 11:04:13 AM Eastern Daylight Time	"TEXAS INDEPENDENCE HEALTH PLAN, INC."	Texas Independence Health Plan	www.pphealthplan.com	"Texas Independence Health Plan, Inc. (HMO I-SNP)"	1	1		1			H5015	1	0	2020	Texas (Partial)		2	10296	2			1	1	1				pphealthplan.com	www.pphealthplan.com	www.pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5037	1	0	1	20	8	H5037_001_0	1	1			05/31/2019	2020.01	05/31/2019 12:04:31 PM Eastern Daylight Time		05/31/2019 11:50:34 AM Eastern Daylight Time			05/31/2019 12:15:21 PM Eastern Daylight Time	"MOUNTAIN EMPIRE OLDER CITIZENS, INC."	Mountain Empire PACE	www.meoc.org	Mountain Empire PACE - Dual (PACE)	8	20		1			H5037	1	0	2020	"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	2	0	1	20	8	H5037_002_0	1	1			05/31/2019	2020.01	05/31/2019 12:06:04 PM Eastern Daylight Time		05/31/2019 11:51:22 AM Eastern Daylight Time			05/31/2019 12:15:21 PM Eastern Daylight Time	"MOUNTAIN EMPIRE OLDER CITIZENS, INC."	Mountain Empire PACE	www.meoc.org	Mountain Empire PACE  - Medicare only (PACE)	8	20		1			H5037	2	0	2020	"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	9	0	1	4	1	H5042_009_0	16	1			09/23/2019	2020.01	09/23/2019 09:01:26 AM Eastern Daylight Time	07/31/2019 01:38:14 PM Eastern Daylight Time	07/30/2019 05:02:28 PM Eastern Daylight Time			09/23/2019 09:07:18 AM Eastern Daylight Time	"CDPHP UNIVERSAL BENEFITS, INC."	CDPHP Medicare Advantage	www.cdphp.com	CDPHP Vital Rx (PPO)	1	4		1			H5042	9	0	2020	Greater Capital Region of New York State		2	235	2			2						www.cdphp.com	www.cdphp.com	www.cdphp.com	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(518)641-3950		(888)519-4455		(518)641-3400		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5042	11	0	1	4	1	H5042_011_0	19	1			09/20/2019	2020.01	09/20/2019 04:08:54 PM Eastern Daylight Time	07/31/2019 01:40:10 PM Eastern Daylight Time	08/06/2019 11:15:28 AM Eastern Daylight Time			09/20/2019 07:02:06 PM Eastern Daylight Time	"CDPHP UNIVERSAL BENEFITS, INC."	CDPHP Medicare Advantage	http://www.CDPHP.com/medicare	CDPHP Flex Rx (PPO)	1	4		1			H5042	11	0	2020	Greater Capital District of New York		2	579	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5042	12	0	1	4	1	H5042_012_0	12	1			09/20/2019	2020.01	09/20/2019 04:12:56 PM Eastern Daylight Time	07/25/2019 06:47:24 PM Eastern Daylight Time				09/20/2019 07:02:06 PM Eastern Daylight Time	"CDPHP UNIVERSAL BENEFITS, INC."	CDPHP Medicare Advantage	http://www.CDPHP.com/medicare	CDPHP Flex (PPO)	1	4		1			H5042	12	0	2020	Greater Capital District of New York		2	579	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										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5042	801	0	1	4	1	H5042_801_0	4	1			06/03/2019	2020.01	06/03/2019 11:57:29 AM Eastern Daylight Time					06/03/2019 03:47:19 PM Eastern Daylight Time	"CDPHP UNIVERSAL BENEFITS, INC."	CDPHP Medicare Advantage		CDPHP Group Medicare Rx (PPO)	1	4		1			H5042	801	0	2020	Greater Capital Region of New York State		1	840	2			2									(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(888)831-3039		(518)641-3950		(888)519-4455		(518)641-3400		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1b;2;7d;7j;8a;9a1;9b;9d;10a;11a;11b;15;	1	1a;1b;2;5;6;8a;8b1;8b2;8b3;14d;	1									
H5042	802	0	1	4	1	H5042_802_0	4	1			05/31/2019	2020.01	05/31/2019 04:38:58 PM Eastern Daylight Time					06/03/2019 03:47:19 PM Eastern Daylight Time	"CDPHP UNIVERSAL BENEFITS, INC."	CDPHP Medicare Advantage		CDPHP Group Medicare Rx (PPO)	1	4		1			H5042	802	0	2020	Greater Capital Region of New York State		1	39058	2			2									(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(888)831-3039		(518)641-3950		(888)519-4455		(518)641-3400		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1b;2;7d;7i;8a;9a1;9b;9d;10a;11a;11b;15;	1	1a;1b;2;5;8b1;8b2;8b3;14d;	1									
H5042	803	0	1	4	1	H5042_803_0	4	1			05/31/2019	2020.01	05/31/2019 04:41:26 PM Eastern Daylight Time					06/03/2019 03:47:19 PM Eastern Daylight Time	"CDPHP UNIVERSAL BENEFITS, INC."	CDPHP Medicare Advantage		CDPHP Group Medicare (PPO)	1	4		1			H5042	803	0	2020	Greater Capital Region of New York State		1	5398	2			2									(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(711)-		(711)-		(711)-		(711)-										1	1	1b;2;7d;7i;8a;9a1;9b;9d;10a;11a;11b;15;	1	1a;1b;2;5;8b1;8b2;8b3;	1									
H5050	1	0	1	1	1	H5050_001_0	6	1			05/30/2019	2020.01	05/30/2019 11:10:36 AM Pacific Daylight Time	06/03/2019 11:53:31 AM Pacific Daylight Time				06/03/2019 12:46:53 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Basic (HMO)	1	1		1			H5050	1	0	2020	"Puget Sound Area and Counties: GY, TH, LE, SP"		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5050	4	0	1	1	1	H5050_004_0	9	1			05/31/2019	2020.01	05/31/2019 05:08:59 PM Pacific Daylight Time	07/31/2019 03:53:49 PM Pacific Daylight Time	07/31/2019 04:12:21 PM Pacific Daylight Time			08/02/2019 12:06:55 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Optimal (HMO)	1	1		1			H5050	4	0	2020	"Counties: KI, PI, KP, SN, GY, LE, MA, TH"		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	9	0	1	1	1	H5050_009_0	9	1			05/31/2019	2020.01	05/31/2019 05:08:37 PM Pacific Daylight Time	07/31/2019 03:56:20 PM Pacific Daylight Time	07/31/2019 04:13:54 PM Pacific Daylight Time			08/02/2019 12:06:55 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Essential (HMO)	1	1		1			H5050	9	0	2020	"Counties: KI, PI, KP, SN, GY, LE, MA, TH"		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	13	0	1	1	1	H5050_013_0	9	1			05/31/2019	2020.01	05/31/2019 05:07:49 PM Pacific Daylight Time	07/31/2019 03:58:42 PM Pacific Daylight Time	07/31/2019 04:15:25 PM Pacific Daylight Time			08/02/2019 12:06:55 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Vital (HMO)	1	1		1			H5050	13	0	2020	"Counties: KI, PI, KP, SN, GY, LE, MA, TH"		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	17	0	1	1	1	H5050_017_0	8	1			05/31/2019	2020.01	05/31/2019 05:07:25 PM Pacific Daylight Time	07/31/2019 04:01:03 PM Pacific Daylight Time	07/31/2019 04:16:59 PM Pacific Daylight Time			08/02/2019 12:06:55 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Harbor (HMO)	1	1		1			H5050	17	0	2020	"Counties: IS, SK, WM"		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	19	0	1	1	1	H5050_019_0	8	1			05/31/2019	2020.01	05/31/2019 05:07:02 PM Pacific Daylight Time	07/31/2019 04:03:58 PM Pacific Daylight Time	07/31/2019 04:18:24 PM Pacific Daylight Time			08/02/2019 12:06:55 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Columbia (HMO)	1	1		1			H5050	19	0	2020	Spokane		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	21	0	1	1	1	H5050_021_0	9	1			05/31/2019	2020.01	05/31/2019 05:06:33 PM Pacific Daylight Time	07/31/2019 04:06:38 PM Pacific Daylight Time	07/31/2019 04:20:01 PM Pacific Daylight Time			08/02/2019 12:06:55 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Centennial (HMO)	1	1		1			H5050	21	0	2020	Spokane		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	22	0	1	1	1	H5050_022_0	9	1			05/31/2019	2020.01	05/31/2019 05:06:07 PM Pacific Daylight Time	07/31/2019 04:08:54 PM Pacific Daylight Time	07/31/2019 04:21:25 PM Pacific Daylight Time			08/02/2019 12:06:55 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Key (HMO)	1	1		1			H5050	22	0	2020	"King, Pierce and Thurston counties"		2		2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(888)901-4600		(206)630-4600		(800)598-2296		(800)598-2296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5050	801	0	1	1	1	H5050_801_0	4	1			05/29/2019	2020.01	05/29/2019 06:54:33 AM Pacific Daylight Time					06/03/2019 12:46:53 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Group [AB] (HMO)	1	1		1			H5050	801	0	2020	"Puget Sound Area and Counties: GY, TH, LE, SP"		1	338313	2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)446-8882		(800)446-8882										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7e;7f;7g;7h;7i;7k;8b1;8b2;9a1;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;18a;	1					2				
H5050	802	0	1	1	1	H5050_802_0	4	1			05/29/2019	2020.01	05/29/2019 06:54:50 AM Pacific Daylight Time					06/03/2019 12:46:53 PM Pacific Daylight Time	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Kaiser Foundation Health Plan of Washington	kp.org/wa/medicare	Kaiser Permanente Medicare Advantage Group [ABD] (HMO)	1	1		1			H5050	802	0	2020	"Puget Sound Area and Counties: GY, TH, LE, SP"		1	46134	2			2						kp.org/wa/medicare/providers	kp.org/wa/medicare/formulary	kp.org/wa/medicare/providers	(888)901-4600		(206)630-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)630-4600		(800)446-8882		(800)446-8882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7e;7f;7g;7h;7i;7k;8b1;8b2;9a1;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;15;16b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7f;7g;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;16b;18a;	1					2				
H5085	3	0	1	20	8	H5085_003_0	1	1			05/28/2019	2020.01	05/28/2019 02:03:06 PM Eastern Daylight Time		05/28/2019 02:11:41 PM Eastern Daylight Time			05/28/2019 02:12:48 PM Eastern Daylight Time	"COMMUNITY PACE AT HOME, INC."	"Community PACE at Home, Inc,"	www.communitypace.com	"Community PACE at Home, Inc. - Dual Eligible (PACE)"	8	20		1			H5085	3	0	2020	"Lake, Newaygo, Oceana, Osceola, Mason, Mecosta"		2		2			2						N/A	N/A												(231)689-6675				(231)689-6675												(231)689-6675				(231)689-6675																
H5085	4	0	1	20	8	H5085_004_0	1	1			05/28/2019	2020.01	05/28/2019 02:03:21 PM Eastern Daylight Time		05/28/2019 02:11:41 PM Eastern Daylight Time			05/28/2019 02:12:48 PM Eastern Daylight Time	"COMMUNITY PACE AT HOME, INC."	"Community PACE at Home, Inc,"	www.communitypace.com	"Community PACE at Home, Inc - Medicare Only (PACE)"	8	20		1			H5085	4	0	2020	"Lake, Newaygo, Oceana, Osceola, Mason, Mecosta"		2		2			2						N/A	N/A												(231)689-6675				(231)689-6675												(231)689-6675				(231)689-6675																
H5087	1	0	1	1	1	H5087_001_0	4	1	2	1	07/12/2019	2020.01	07/12/2019 12:36:06 PM Eastern Daylight Time	08/04/2019 06:53:08 PM Eastern Daylight Time	07/30/2019 10:42:23 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.wellcare.com/medicare	WellCare Freedom (HMO D-SNP)	1	1		1			H5087	1	0	2020	Select counties in CA		2	46311	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	2	0	1	1	1	H5087_002_0	4	1			07/12/2019	2020.01	07/12/2019 12:36:36 PM Eastern Daylight Time	08/02/2019 07:12:46 AM Eastern Daylight Time	07/30/2019 10:42:59 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.wellcare.com/medicare	WellCare Plus (HMO)	1	1		1			H5087	2	0	2020	Select Counties in CA		2	64403	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	5	0	1	1	1	H5087_005_0	4	1			05/29/2019	2020.01	05/29/2019 09:35:42 AM Eastern Daylight Time	08/02/2019 07:14:20 AM Eastern Daylight Time	07/30/2019 10:43:35 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.wellcare.com/medicare	WellCare Best (HMO)	1	1		1			H5087	5	0	2020	Select counties in CA		2	150431	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	16	0	1	1	1	H5087_016_0	4	1			07/12/2019	2020.01	07/12/2019 12:37:12 PM Eastern Daylight Time	08/02/2019 07:15:54 AM Eastern Daylight Time	07/30/2019 10:44:11 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.wellcare.com/medicare	WellCare Best (HMO)	1	1		1			H5087	16	0	2020	Select counties in CA		2	25766	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	17	0	1	1	1	H5087_017_0	4	1			07/12/2019	2020.01	07/12/2019 12:37:48 PM Eastern Daylight Time	08/02/2019 07:17:29 AM Eastern Daylight Time	07/30/2019 10:44:47 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.wellcare.com/medicare	WellCare Plus (HMO)	1	1		1			H5087	17	0	2020	Select counties in CA		2	153570	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	24	0	1	1	1	H5087_024_0	4	1			05/31/2019	2020.01	05/31/2019 02:20:35 PM Eastern Daylight Time	08/02/2019 07:19:02 AM Eastern Daylight Time	07/30/2019 10:45:23 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.wellcare.com/medicare	WellCare Best (HMO)	1	1		1			H5087	24	0	2020	Select counties in CA		2	11384	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5087	25	0	1	1	1	H5087_025_0	4	1			05/31/2019	2020.01	05/31/2019 02:20:56 PM Eastern Daylight Time	08/02/2019 07:20:36 AM Eastern Daylight Time	07/30/2019 10:46:00 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H5087	25	0	2020	Select counties in CA		2	5562	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5106	13	0	1	4	1	H5106_013_0	4	1			07/17/2019	2020.01	07/17/2019 02:06:28 PM Eastern Daylight Time	08/01/2019 11:07:03 AM Eastern Daylight Time	07/31/2019 01:10:00 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Standard (PPO)	1	4		1			H5106	13	0	2020	West Virginia Region 1 counties		2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5106	29	1	1	4	1	H5106_029_1	4	1			07/17/2019	2020.01	07/17/2019 02:06:22 PM Eastern Daylight Time	08/01/2019 11:07:37 AM Eastern Daylight Time	07/31/2019 01:12:48 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Distinct (PPO)	1	4		1			H5106	29	1	2020	Region 2 WV Counties	North WV	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5106	29	2	1	4	1	H5106_029_2	4	1			07/17/2019	2020.01	07/17/2019 02:07:23 PM Eastern Daylight Time	08/01/2019 11:08:09 AM Eastern Daylight Time	07/31/2019 01:15:43 PM Eastern Daylight Time			08/02/2019 01:50:30 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO Distinct (PPO)	1	4		1			H5106	29	2	2020	Region 2 WV Counties	South WV	2		2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5106	806	0	1	4	1	H5106_806_0	2	1			05/17/2019	2020.01	05/17/2019 01:25:00 PM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MAPD WV NON-CALENDAR (PPO)	1	4		1			H5106	806	0	2020	ALL WV COUNTIES		1	0	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H5106	807	0	1	4	1	H5106_807_0	2	1			05/17/2019	2020.01	05/17/2019 01:25:12 PM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MA WV Calendar (PPO)	1	4		1			H5106	807	0	2020	ALL WV COUNTIES		1	1068	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H5106	808	0	1	4	1	H5106_808_0	2	1			05/17/2019	2020.01	05/17/2019 01:25:21 PM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HIGHMARK SENIOR SOLUTIONS COMPANY	Highmark Inc.	medicare.highmark.com	Freedom Blue PPO MAPD WV CALENDAR (PPO)	1	4		1			H5106	808	0	2020	ALL WV COUNTIES		1	5700	2			2						medicare.highmark.com	medicare.highmark.com	medicare.highmark.com	(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)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	2		1									
H5117	3	0	1	1	1	H5117_003_0	3	1			08/01/2019	2020.01	08/01/2019 04:53:25 PM Eastern Daylight Time	08/05/2019 04:18:01 PM Central Daylight Time	08/05/2019 03:15:49 PM Central Daylight Time			08/06/2019 12:30:05 PM Central Daylight Time	"LOUISIANA HEALTHCARE CONNECTIONS, INC."	Allwell	allwell.louisianahealthconnect.com	Allwell Medicare (HMO)	1	1		1			H5117	3	0	2020	"Baton Rouge, Lafayette & Surrounding Areas"		2		2			2						allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5117	4	0	1	1	1	H5117_004_0	2	1	2	1	05/24/2019	2020.01	05/24/2019 01:02:28 PM Pacific Daylight Time	07/15/2019 10:48:45 AM Pacific Daylight Time	07/15/2019 10:13:29 AM Pacific Daylight Time			07/15/2019 04:19:44 PM Pacific Daylight Time	"LOUISIANA HEALTHCARE CONNECTIONS, INC."	Allwell	allwell.louisianahealthconnect.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H5117	4	0	2020	"Baton Rouge, North LA & Surrounding Areas"		2		2			1	3		1		1	allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5117	5	0	1	1	1	H5117_005_0	3	1	2	1	08/02/2019	2020.01	08/02/2019 12:32:39 PM Eastern Daylight Time	08/05/2019 04:17:57 PM Central Daylight Time	08/05/2019 03:15:44 PM Central Daylight Time			08/06/2019 12:30:05 PM Central Daylight Time	"LOUISIANA HEALTHCARE CONNECTIONS, INC."	Allwell	allwell.louisianahealthconnect.com	Allwell Dual Medicare Essentials (HMO D-SNP)	1	1		1			H5117	5	0	2020	"Baton Rouge, North LA & Surrounding Areas"		2		2			1	3		2		2	allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(833)541-0767		(833)541-0767		(877)891-6099		(877)891-6099		(833)541-0767		(833)541-0767		(877)891-6099		(877)891-6099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5117	801	0	1	1	1	H5117_801_0	2	1			05/03/2019	2020.01	05/03/2019 01:06:08 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"LOUISIANA HEALTHCARE CONNECTIONS, INC."	Allwell	allwell.louisianahealthconnect.com	Allwell Group (HMO)	1	1		1			H5117	801	0	2020	Louisiana		1	100	2			2						allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5117	802	0	1	1	1	H5117_802_0	2	1			05/03/2019	2020.01	05/03/2019 01:06:20 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"LOUISIANA HEALTHCARE CONNECTIONS, INC."	Allwell	allwell.louisianahealthconnect.com	Allwell Group (HMO)	1	1		1			H5117	802	0	2020	Louisiana		1	100	2			2						allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5117	803	0	1	1	1	H5117_803_0	2	1			05/03/2019	2020.01	05/03/2019 01:06:33 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"LOUISIANA HEALTHCARE CONNECTIONS, INC."	Allwell	allwell.louisianahealthconnect.com	Allwell Group (HMO)	1	1		1			H5117	803	0	2020	Louisiana		1	100	2			2						allwell.louisianahealthconnect.com/findadoctor	allwell.louisianahealthconnect.com/formulary	allwell.louisianahealthconnect.com/findadoctor	(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(855)766-1572		(855)766-1572		(877)891-6099		(877)891-6099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5124	1	0	1	20	8	H5124_001_0	1	1			05/28/2019	2020.01	05/28/2019 01:14:18 PM US Eastern Daylight Time		05/28/2019 11:09:40 AM US Eastern Daylight Time			05/28/2019 01:18:21 PM US Eastern Daylight Time	"FRANCISCAN ACO, INC."	Franciscan  Senior Health & Wellness	FranciscanStFrancis.org	Franciscan Senior Health and Wellness (PACE)	8	20		1			H5124	1	0	2020	Central and Northern Indiana		2		2			2						carekinesis.org	franciscanalliance.org										(844)817-7223		(317)528-7223		(844)817-7223		(317)528-7223										(800)743-3333		(317)528-6395		(800)743-3333		(317)528-6395																
H5124	2	0	1	20	8	H5124_002_0	1	1			05/28/2019	2020.01	05/28/2019 01:14:57 PM US Eastern Daylight Time		05/28/2019 11:09:28 AM US Eastern Daylight Time			05/28/2019 01:18:21 PM US Eastern Daylight Time	"FRANCISCAN ACO, INC."	Franciscan  Senior Health & Wellness	FranciscanStFrancis.org	Franciscan Senior Health and Wellness (PACE)	8	20		1			H5124	2	0	2020	Central and Northern Indiana		2		2			2						carekinesis.org	franciscanalliance.org										(844)817-7223		(317)528-7223		(844)817-7223		(317)528-7223										(800)743-3333		(317)528-6395		(800)743-3333		(317)528-6395																
H5126	1	0	1	1	1	H5126_001_0	4	1			07/15/2019	2020.01	07/15/2019 11:15:21 AM Eastern Daylight Time	06/03/2019 05:06:20 PM Eastern Daylight Time	06/03/2019 05:39:29 PM Eastern Daylight Time			07/15/2019 11:39:45 AM Eastern Daylight Time	OSCAR INSURANCE COMPANY	Oscar	www.hioscar.com/medicare	Oscar Easy Care (HMO)	1	1		1			H5126	1	0	2020	"Harris, Fort Bend, and Montgomery Counties"		2	12000	2			2						www.hioscar.com/search	www.hioscar.com/search	www.hioscar.com/search	(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		2					2					2	2			
H5140	1	0	1	4	1	H5140_001_0	9	1			07/11/2019	2020.01	07/11/2019 02:55:02 PM US Mountain Standard Time	08/06/2019 11:51:27 AM US Mountain Standard Time	08/06/2019 11:51:27 AM US Mountain Standard Time			08/06/2019 05:02:40 PM US Mountain Standard Time	"BLUE CROSS AND BLUE SHIELD OF ARIZONA, INC."	Blue Cross Blue Shield of Arizona	azbluemedicare.com	BlueJourney (PPO)	1	4		1			H5140	1	0	2020	Maricopa County		2		2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5140	2	0	1	4	1	H5140_002_0	9	1			07/11/2019	2020.01	07/11/2019 02:55:32 PM US Mountain Standard Time	08/06/2019 11:51:27 AM US Mountain Standard Time	08/06/2019 11:51:27 AM US Mountain Standard Time			08/06/2019 05:02:40 PM US Mountain Standard Time	"BLUE CROSS AND BLUE SHIELD OF ARIZONA, INC."	Blue Cross Blue Shield of Arizona	azbluemedicare.com	BlueJourney (PPO)	1	4		1			H5140	2	0	2020	Pima County		2		2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	1	0	1	4	1	H5141_001_0	10	1			08/05/2019	2020.01	08/05/2019 04:19:05 PM Pacific Daylight Time	08/06/2019 06:19:35 PM Pacific Daylight Time	08/06/2019 06:20:09 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	1	4		1			H5141	1	0	2020	Hudson County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	4	0	1	4	1	H5141_004_0	10	1			08/05/2019	2020.01	08/05/2019 04:17:39 PM Pacific Daylight Time	08/06/2019 06:19:35 PM Pacific Daylight Time	08/06/2019 06:20:11 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	1	4		1			H5141	4	0	2020	Select NJ Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	7	0	1	4	1	H5141_007_0	10	1			08/05/2019	2020.01	08/05/2019 04:23:56 PM Pacific Daylight Time	08/06/2019 06:19:35 PM Pacific Daylight Time	08/06/2019 06:19:46 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	1	4		1			H5141	7	0	2020	Select NJ Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	25	0	1	4	1	H5141_025_0	9	1			08/05/2019	2020.01	08/05/2019 04:26:31 PM Pacific Daylight Time	08/06/2019 06:19:30 PM Pacific Daylight Time	08/06/2019 06:19:47 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	1	4		1			H5141	25	0	2020	Bexar County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(210)526-3962		(888)466-5044		(210)526-3962		(888)657-1207		(210)526-3962		(888)466-5044		(210)526-3962		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	26	0	1	4	1	H5141_026_0	9	1			08/05/2019	2020.01	08/05/2019 04:30:39 PM Pacific Daylight Time	08/06/2019 06:19:31 PM Pacific Daylight Time	08/06/2019 06:19:48 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	1	4		1			H5141	26	0	2020	Select GA Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(912)805-3271		(888)466-5044		(912)805-3269		(888)657-1207		(912)805-3271		(888)466-5044		(912)805-3269		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	32	0	1	4	1	H5141_032_0	9	1			08/05/2019	2020.01	08/05/2019 04:34:36 PM Pacific Daylight Time	08/06/2019 06:19:31 PM Pacific Daylight Time	08/06/2019 06:19:50 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	1	4		1			H5141	32	0	2020	Select NJ Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	33	0	1	4	1	H5141_033_0	9	1			08/05/2019	2020.01	08/05/2019 04:36:40 PM Pacific Daylight Time	08/06/2019 06:19:31 PM Pacific Daylight Time	08/06/2019 06:19:51 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	1	4		1			H5141	33	0	2020	"Davidson, Rutherford & Williamson Counties"		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	34	0	1	4	1	H5141_034_0	9	1			08/05/2019	2020.01	08/05/2019 04:42:42 PM Pacific Daylight Time	08/06/2019 06:19:31 PM Pacific Daylight Time	08/06/2019 06:19:52 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	1	4		1			H5141	34	0	2020	"Davidson, Rutherford & Williamson Counties"		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	35	0	1	4	1	H5141_035_0	9	1			08/05/2019	2020.01	08/05/2019 04:43:56 PM Pacific Daylight Time	08/06/2019 06:19:32 PM Pacific Daylight Time	08/06/2019 06:19:54 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	1	4		1			H5141	35	0	2020	El Paso County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	36	0	1	4	1	H5141_036_0	9	1			08/05/2019	2020.01	08/05/2019 04:47:24 PM Pacific Daylight Time	08/06/2019 06:19:32 PM Pacific Daylight Time	08/06/2019 06:19:55 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	1	4		1			H5141	36	0	2020	"Charleston, Beaufort & Jasper Counties"		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	37	0	1	4	1	H5141_037_0	9	1			05/31/2019	2020.01	05/31/2019 11:08:42 AM Pacific Daylight Time	08/06/2019 06:19:32 PM Pacific Daylight Time	08/06/2019 06:19:57 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	1	4		1			H5141	37	0	2020	"Charleston, Beaufort & Jasper Counties"		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	38	0	1	4	1	H5141_038_0	9	1			08/05/2019	2020.01	08/05/2019 04:50:31 PM Pacific Daylight Time	08/06/2019 06:19:32 PM Pacific Daylight Time	08/06/2019 06:19:58 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	1	4		1			H5141	38	0	2020	"Bucks, Philadelphia & Delaware Counties"		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	39	0	1	4	1	H5141_039_0	10	1			08/05/2019	2020.01	08/05/2019 04:52:47 PM Pacific Daylight Time	08/07/2019 11:07:27 AM Pacific Daylight Time	08/07/2019 11:07:47 AM Pacific Daylight Time			08/07/2019 11:09:10 AM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	1	4		1			H5141	39	0	2020	"Bucks, Philadelphia & Delaware Counties"		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	40	0	1	4	1	H5141_040_0	9	1			08/05/2019	2020.01	08/05/2019 04:53:51 PM Pacific Daylight Time	08/06/2019 06:19:33 PM Pacific Daylight Time	08/06/2019 06:20:01 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice (PPO)	1	4		1			H5141	40	0	2020	Pima County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	42	0	1	4	1	H5141_042_0	10	1			08/05/2019	2020.01	08/05/2019 04:57:33 PM Pacific Daylight Time	08/06/2019 06:19:33 PM Pacific Daylight Time	08/06/2019 07:22:05 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Choice Value (PPO)	1	4		1			H5141	42	0	2020	Select NJ Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5141	801	0	1	4	1	H5141_801_0	8	1			07/10/2019	2020.01	07/10/2019 12:13:40 PM Pacific Daylight Time					07/10/2019 08:12:57 PM Pacific Daylight Time	CLOVER INSURANCE COMPANY	Clover Health	www.cloverhealth.com	Clover Health Employer Group Plan (PPO)	1	4		1			H5141	801	0	2020	Select NJ & PA Counties		1	2400	2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H5167	1	0	1	20	8	H5167_001_0	1	1			05/23/2019	2020.01	05/23/2019 02:47:17 PM Mountain Daylight Time		05/23/2019 02:36:55 PM Mountain Daylight Time			05/23/2019 02:57:38 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH CARE SERVICES	Rocky Mountain PACE	rmhcare.org	Rocky Mountain PACE (PACE)	8	20		1			H5167	1	0	2020	Colorado Springs Metro Area		2		2			2						www.rmhcare.org	www.rmhcare.org										(855)207-0702	300	(719)314-2327	300	(855)207-0702	300	(719)314-2327	300									(855)207-0702	300	(719)314-2327	300	(855)207-0702	300	(719)314-2327	300															
H5167	2	0	1	20	8	H5167_002_0	1	1			05/23/2019	2020.01	05/23/2019 02:46:46 PM Mountain Daylight Time		05/23/2019 02:36:56 PM Mountain Daylight Time			05/23/2019 02:57:38 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH CARE SERVICES	Rocky Mountain PACE	rmhcare.org	Rocky Mountain PACE (PACE)	8	20		1			H5167	2	0	2020	Colorado Springs Metro Area		2		2			2						www.rmhcare.org	www.rmhcare.org										(855)207-0702	300	(719)314-2327	300	(855)207-0702	300	(719)314-2327	300									(855)207-0702	300	(719)314-2327	300	(855)207-0702	300	(719)314-2327	300															
H5172	2	0	1	48	5	H5172_002_0	3	1			08/21/2019	2020.01	08/21/2019 05:26:22 PM Pacific Daylight Time					08/21/2019 05:26:51 PM Pacific Daylight Time	COMMUNITY HEALTH GROUP	Community Health Group	www.chgsd.com	CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)	5	48		1			H5172	2	0	2020	"San Diego, California"		2	80902	2			2						http://www.chgsd.com/	www.chgsd.com	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																
H5178	1	0	1	1	1	H5178_001_0	2	1			05/28/2019	2020.01	05/28/2019 02:39:59 PM Eastern Daylight Time	08/04/2019 03:58:52 PM Eastern Daylight Time	08/02/2019 01:18:17 PM Eastern Daylight Time			08/05/2019 10:50:19 AM Eastern Daylight Time	"HUMANA HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5178-001 (HMO)	1	1		1			H5178	1	0	2020	Greenville County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5190	1	0	1	1	1	H5190_001_0	4	1	2	1	07/08/2019	2020.01	07/08/2019 01:14:57 PM Eastern Daylight Time	08/05/2019 04:18:51 PM Central Daylight Time	08/05/2019 03:16:32 PM Central Daylight Time			08/06/2019 09:57:10 AM Central Daylight Time	"SUNSHINE STATE HEALTH PLAN, INC."	Allwell	allwell.sunshinehealth.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H5190	1	0	2020	Duval and Volusia Counties		2		2			1	3		2		2	allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5190	2	0	1	1	1	H5190_002_0	4	1	2	1	07/08/2019	2020.01	07/08/2019 01:15:40 PM Eastern Daylight Time	08/05/2019 04:18:56 PM Central Daylight Time	08/05/2019 03:16:22 PM Central Daylight Time			08/06/2019 09:57:10 AM Central Daylight Time	"SUNSHINE STATE HEALTH PLAN, INC."	Allwell	allwell.sunshinehealth.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H5190	2	0	2020	"Counties: HIL, ORA, OSC, PAL, PAS, PIN, POL, SEM"		2		2			1	3		2		2	allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5190	3	0	1	1	1	H5190_003_0	4	1	2	1	07/08/2019	2020.01	07/08/2019 01:20:42 PM Eastern Daylight Time	08/05/2019 04:18:42 PM Central Daylight Time	08/05/2019 03:16:25 PM Central Daylight Time			08/06/2019 09:57:10 AM Central Daylight Time	"SUNSHINE STATE HEALTH PLAN, INC."	Allwell	allwell.sunshinehealth.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H5190	3	0	2020	Broward County		2		2			1	3		2		2	allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5190	4	0	1	1	1	H5190_004_0	4	1	2	1	07/08/2019	2020.01	07/08/2019 01:21:24 PM Eastern Daylight Time	08/05/2019 04:18:46 PM Central Daylight Time	08/05/2019 03:16:28 PM Central Daylight Time			08/06/2019 09:57:10 AM Central Daylight Time	"SUNSHINE STATE HEALTH PLAN, INC."	Allwell	allwell.sunshinehealth.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H5190	4	0	2020	Miami-Dade County		2		2			1	3		2		2	allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5199	7	0	1	4	1	H5199_007_0	5	1			05/29/2019	2020.01	05/29/2019 09:17:03 AM Eastern Daylight Time	08/02/2019 06:22:10 AM Central Daylight Time	07/30/2019 09:46:35 PM Central Daylight Time			08/05/2019 03:36:31 PM Central Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H5199	7	0	2020	Select Counties in FL		2	5422	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	8	0	1	4	1	H5199_008_0	5	1			05/29/2019	2020.01	05/29/2019 09:35:50 AM Eastern Daylight Time	08/02/2019 06:23:50 AM Central Daylight Time	07/30/2019 09:47:11 PM Central Daylight Time			08/05/2019 03:36:31 PM Central Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H5199	8	0	2020	Select Counties in FL		2	4610	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	10	0	1	4	1	H5199_010_0	5	1			05/29/2019	2020.01	05/29/2019 09:48:47 AM Eastern Daylight Time	08/02/2019 06:25:28 AM Central Daylight Time	07/30/2019 09:47:47 PM Central Daylight Time			08/05/2019 03:36:31 PM Central Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Prime (PPO)	1	4		1			H5199	10	0	2020	Select Counties in FL		2	459	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	12	0	1	4	1	H5199_012_0	5	1			05/29/2019	2020.01	05/29/2019 10:00:38 AM Eastern Daylight Time	08/02/2019 06:27:07 AM Central Daylight Time	07/30/2019 09:48:22 PM Central Daylight Time			08/05/2019 03:36:31 PM Central Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H5199	12	0	2020	Select Counties in FL		2	5204	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5199	13	0	1	4	1	H5199_013_0	5	1			05/29/2019	2020.01	05/29/2019 10:12:48 AM Eastern Daylight Time	08/02/2019 06:28:46 AM Central Daylight Time	07/30/2019 09:48:58 PM Central Daylight Time			08/05/2019 03:36:31 PM Central Daylight Time	"WELLCARE HEALTH INSURANCE OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Prime (PPO)	1	4		1			H5199	13	0	2020	Select Counties in FL		2	1848	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5209	2	0	1	1	1	H5209_002_0	4	1	2	1	06/03/2019	2020.01	06/03/2019 08:26:38 AM Central Daylight Time	08/05/2019 11:13:20 AM Central Daylight Time	08/05/2019 11:13:22 AM Central Daylight Time			08/05/2019 03:25:20 PM Central Daylight Time	"CARE WISCONSIN HEALTH PLAN, INC."	"Care Wisconsin Health Plan, Inc."	www.carewisc.org	Care Wisconsin Partnership Plan (HMO D-SNP)	1	1		1			H5209	2	0	2020	Southcentral and Eastern Wisconsin		2	21510	2			1	3		1		1	www.carewisc.org	www.carewisc.org	www.carewisc.org	(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7g;7i;8a;8b1;8b2;9a1;9b;11a;11b;15;16b;17b;	2		1					1				
H5209	4	0	1	1	1	H5209_004_0	6	1	2	1	07/11/2019	2020.01	07/11/2019 05:52:25 PM Central Daylight Time	08/05/2019 11:12:47 AM Central Daylight Time	08/05/2019 11:12:51 AM Central Daylight Time			08/05/2019 03:25:20 PM Central Daylight Time	"CARE WISCONSIN HEALTH PLAN, INC."	"Care Wisconsin Health Plan, Inc."	www.carewisc.org	Care Wisconsin Medicare Dual Advantage Plan (HMO D-SNP)	1	1		1			H5209	4	0	2020	"Southern, Central and Northeastern Wisconsin"		2	7257	2			1	3		1		1	www.carewisc.org	www.carewisc.org	www.carewisc.org	(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(800)963-0035		(608)240-0035		(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	2			
H5211	1	0	1	2	1	H5211_001_0	10	1			07/25/2019	2020.01	07/25/2019 07:23:04 PM Central Daylight Time	06/01/2019 06:31:49 PM Central Daylight Time				07/25/2019 07:59:32 PM Central Daylight Time	"SECURITY HEALTH PLAN OF WISCONSIN, INC."	"Security Health Plan of Wisconsin, Inc."	www.securityhealth.org/medicareadvantage	Spirit (HMO-POS)	1	2		1			H5211	1	0	2020	"Central, Northern, Western and South Central WI"		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicareproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5211	2	0	1	2	1	H5211_002_0	11	1			07/25/2019	2020.01	07/25/2019 07:27:34 PM Central Daylight Time	08/01/2019 02:04:49 PM Central Daylight Time	08/01/2019 02:28:33 PM Central Daylight Time			08/06/2019 03:19:14 PM Central Daylight Time	"SECURITY HEALTH PLAN OF WISCONSIN, INC."	"Security Health Plan of Wisconsin, Inc."	www.securityhealth.org/medicareadvantage	Essence Rx (HMO-POS)	1	2		1			H5211	2	0	2020	"Central, Northern, Western WI"		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicareproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	3	0	1	2	1	H5211_003_0	7	1			07/25/2019	2020.01	07/25/2019 07:32:02 PM Central Daylight Time	06/01/2019 06:38:07 PM Central Daylight Time				07/25/2019 07:59:32 PM Central Daylight Time	"SECURITY HEALTH PLAN OF WISCONSIN, INC."	"Security Health Plan of Wisconsin, Inc."	www.securityhealth.org/medicareadvantage	Essence (HMO-POS)	1	2		1			H5211	3	0	2020	"Central, Northern, Western  WI"		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicareproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5211	4	0	1	2	1	H5211_004_0	8	1			07/25/2019	2020.01	07/25/2019 07:34:27 PM Central Daylight Time	08/01/2019 02:39:59 PM Central Daylight Time	08/01/2019 02:41:23 PM Central Daylight Time			08/06/2019 03:19:14 PM Central Daylight Time	"SECURITY HEALTH PLAN OF WISCONSIN, INC."	"Security Health Plan of Wisconsin, Inc."	www.securityhealth.org/medicareadvantage	Spirit Rx (HMO-POS)	1	2		1			H5211	4	0	2020	"Central, Northern, Western and South Central WI"		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicareproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	7	0	1	2	1	H5211_007_0	8	1			07/25/2019	2020.01	07/25/2019 07:37:13 PM Central Daylight Time	08/01/2019 02:43:44 PM Central Daylight Time	08/01/2019 02:45:08 PM Central Daylight Time			08/06/2019 03:19:14 PM Central Daylight Time	"SECURITY HEALTH PLAN OF WISCONSIN, INC."	"Security Health Plan of Wisconsin, Inc."	www.securityhealth.org/medicareadvantage	Assurance Rx (HMO-POS)	1	2		1			H5211	7	0	2020	Southern Wisconsin		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicareproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	8	0	1	2	1	H5211_008_0	8	1			07/25/2019	2020.01	07/25/2019 07:40:55 PM Central Daylight Time	08/01/2019 02:46:55 PM Central Daylight Time	08/01/2019 02:48:37 PM Central Daylight Time			08/06/2019 03:19:14 PM Central Daylight Time	"SECURITY HEALTH PLAN OF WISCONSIN, INC."	"Security Health Plan of Wisconsin, Inc."	www.securityhealth.org/medicareadvantage	Surety Rx (HMO-POS)	1	2		1			H5211	8	0	2020	Eastern Wisconsin		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/providersmedicare	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	9	0	1	2	1	H5211_009_0	6	1			07/25/2019	2020.01	07/25/2019 07:43:12 PM Central Daylight Time	08/01/2019 02:50:50 PM Central Daylight Time	08/01/2019 02:52:42 PM Central Daylight Time			08/06/2019 03:19:14 PM Central Daylight Time	"SECURITY HEALTH PLAN OF WISCONSIN, INC."	"Security Health Plan of Wisconsin, Inc."	www.securityhealth.org/medicareadvantage	Promise Rx (HMO-POS)	1	2		1			H5211	9	0	2020	Eastern Wisconsin		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/providersmedicare	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	10	0	1	1	1	H5211_010_0	9	1	2	1	08/06/2019	2020.01	08/06/2019 02:58:57 PM Central Daylight Time	08/05/2019 02:50:01 PM Central Daylight Time	07/31/2019 08:27:38 AM Central Daylight Time			08/06/2019 03:19:14 PM Central Daylight Time	"SECURITY HEALTH PLAN OF WISCONSIN, INC."	"Security Health Plan of Wisconsin, Inc."	www.securityhealth.org/medicareadvantage	Ally Rx (HMO D-SNP)	1	1		1			H5211	10	0	2020	Central Wisconsin		2		2			1	3		1		1	www.securityhealth.org/allypharmacies	www.securityhealth.org/allyformulary	www.securityhealth.org/allyproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5211	12	0	1	2	1	H5211_012_0	8	1			07/25/2019	2020.01	07/25/2019 07:53:24 PM Central Daylight Time	08/01/2019 02:54:48 PM Central Daylight Time	08/01/2019 02:56:05 PM Central Daylight Time			08/06/2019 03:19:14 PM Central Daylight Time	"SECURITY HEALTH PLAN OF WISCONSIN, INC."	"Security Health Plan of Wisconsin, Inc."	www.securityhealth.org/medicareadvantage	Esteem Rx (HMO-POS)	1	2		1			H5211	12	0	2020	"Central, Northern, Western WI"		2		2			2						www.securityhealth.org/medicarepharmacies	www.securityhealth.org/medicareformulary	www.securityhealth.org/medicareproviders	(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(877)998-0998		(715)221-9897		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5212	1	0	1	20	8	H5212_001_0	1	1			05/03/2019	2020.01	05/03/2019 02:33:51 PM Central Daylight Time		05/29/2019 01:51:16 PM Central Daylight Time			05/29/2019 02:54:55 PM Central Daylight Time	"COMMUNITY CARE, INC."	Community Care	www.communitycareinc.org	Community Care's PACE Program (PACE)	8	20		1			H5212	1	0	2020	"Milwaukee County, Waukesha County, Racine County"		2	6711	2			2						www.communitycareinc.org	www.communitycareinc.org	www.communitycareinc.org									(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000										(711)-		(711)-		(711)-		(711)-																
H5212	2	0	1	20	8	H5212_002_0	1	1			05/01/2019	2020.01	05/01/2019 12:57:09 PM Central Daylight Time		05/29/2019 01:51:16 PM Central Daylight Time			05/29/2019 02:54:55 PM Central Daylight Time	"COMMUNITY CARE, INC."	Community Care	www.communitycareinc.org	Community Care's PACE Program (PACE)	8	20		1			H5212	2	0	2020	"Milwaukee County, Waukesha County, Racine County"		2	14	2			2						www.communitycareinc.org	www.communitycareinc.org	www.communitycareinc.org									(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000										(711)-		(711)-		(711)-		(711)-																
H5213	1	0	1	20	8	H5213_001_0	2	1			05/30/2019	2020.01	05/30/2019 05:52:14 PM Mountain Daylight Time		05/30/2019 05:49:04 PM Mountain Daylight Time			05/30/2019 05:54:30 PM Mountain Daylight Time	"TOTAL COMMUNITY CARE, L.L.C."	InnovAge New Mexico PACE	www.MyInnovAge.com	Total Community Care (PACE)	8	20		1			H5213	1	0	2020	Albuquerque Metro Area		2		2			2						www.granerx.com	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H5213	2	0	1	20	8	H5213_002_0	2	1			05/30/2019	2020.01	05/30/2019 05:52:44 PM Mountain Daylight Time		05/30/2019 05:49:05 PM Mountain Daylight Time			05/30/2019 05:54:30 PM Mountain Daylight Time	"TOTAL COMMUNITY CARE, L.L.C."	InnovAge New Mexico PACE	www.myinnovage.com	Total Community Care (PACE)	8	20		1			H5213	2	0	2020	Albuquerque Metro Area		2		2			2						www.granerx.com	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H5215	1	0	1	4	1	H5215_001_0	7	1			06/28/2019	2020.01	06/28/2019 08:32:01 AM Central Daylight Time	07/01/2019 11:10:41 AM Central Daylight Time				07/19/2019 03:36:34 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealth.com	Network PlatinumPlus (PPO)	1	4		1			H5215	1	0	2020	East Central Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(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						2			
H5215	2	0	1	4	1	H5215_002_0	8	1			06/28/2019	2020.01	06/28/2019 08:33:09 AM Central Daylight Time	08/04/2019 10:42:53 AM Central Daylight Time	08/04/2019 09:25:36 AM Central Daylight Time			08/06/2019 11:59:36 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealth.com	Network PlatinumPlus Pharmacy (PPO)	1	4		1			H5215	2	0	2020	East Central Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(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						2			
H5215	5	0	1	4	1	H5215_005_0	8	1			06/28/2019	2020.01	06/28/2019 08:35:41 AM Central Daylight Time	08/04/2019 10:43:27 AM Central Daylight Time	08/04/2019 09:25:37 AM Central Daylight Time			08/06/2019 11:59:36 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealth.com	Network PlatinumPremier Pharmacy (PPO)	1	4		1			H5215	5	0	2020	East Central Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(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						2			
H5215	6	0	1	4	1	H5215_006_0	6	1			06/28/2019	2020.01	06/28/2019 08:36:46 AM Central Daylight Time	05/29/2019 09:01:20 PM Central Daylight Time				07/08/2019 12:54:57 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier (PPO)	1	4		1			H5215	6	0	2020	East Central Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(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						2			
H5215	7	0	1	4	1	H5215_007_0	10	1	2	1	08/05/2019	2020.01	08/05/2019 09:08:54 AM Central Daylight Time	08/04/2019 10:44:02 AM Central Daylight Time	08/04/2019 09:25:38 AM Central Daylight Time			08/06/2019 11:59:36 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealth.com	NetworkCares (PPO D-SNP)	1	4		1			H5215	7	0	2020	East Central Wisconsin		2		2			1	3		2		2	www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(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						2			
H5215	8	0	1	4	1	H5215_008_0	8	1			08/05/2019	2020.01	08/05/2019 09:10:24 AM Central Daylight Time	08/04/2019 10:44:38 AM Central Daylight Time	08/04/2019 09:25:39 AM Central Daylight Time			08/06/2019 11:59:36 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealth.com	Network PlatinumSelect (PPO)	1	4		1			H5215	8	0	2020	East Central Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(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						2			
H5215	9	0	1	4	1	H5215_009_0	8	1			08/05/2019	2020.01	08/05/2019 09:11:49 AM Central Daylight Time	08/04/2019 10:45:13 AM Central Daylight Time	08/04/2019 09:25:40 AM Central Daylight Time			08/06/2019 11:59:36 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealth.com	Network Health Medicare Go (PPO)	1	4		1			H5215	9	0	2020	Southeast Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(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						2			
H5215	10	0	1	4	1	H5215_010_0	8	1			08/05/2019	2020.01	08/05/2019 09:22:46 AM Central Daylight Time	08/04/2019 10:45:49 AM Central Daylight Time	08/04/2019 09:25:42 AM Central Daylight Time			08/06/2019 11:59:36 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealth.com	Network Health Medicare Anywhere (PPO)	1	4		1			H5215	10	0	2020	Southeast Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(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						2			
H5215	11	0	1	4	1	H5215_011_0	8	1			06/28/2019	2020.01	06/28/2019 08:42:20 AM Central Daylight Time	08/04/2019 10:46:25 AM Central Daylight Time	08/04/2019 09:25:43 AM Central Daylight Time			08/06/2019 11:59:36 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealth.com	Network PlatinumChoice (PPO)	1	4		1			H5215	11	0	2020	East Central Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(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						2			
H5215	806	0	1	4	1	H5215_806_0	5	1			05/09/2019	2020.01	05/09/2019 01:27:06 PM Central Daylight Time					05/31/2019 04:41:37 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPlus Pharmacy EGP (PPO)	1	4		1			H5215	806	0	2020	Wisconsin		1	1200	2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H5215	807	0	1	4	1	H5215_807_0	5	1			05/09/2019	2020.01	05/09/2019 01:28:09 PM Central Daylight Time					05/31/2019 04:41:37 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier EGP (PPO)	1	4		1			H5215	807	0	2020	Wisconsin		1	1200	2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H5215	808	0	1	4	1	H5215_808_0	5	1			05/09/2019	2020.01	05/09/2019 01:28:53 PM Central Daylight Time					05/31/2019 04:41:37 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier Pharmacy EGP (PPO)	1	4		1			H5215	808	0	2020	Wisconsin		1	1200	2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H5216	1	0	1	4	1	H5216_001_0	3	1			07/15/2019	2020.01	07/15/2019 04:52:27 PM Eastern Daylight Time	08/04/2019 03:10:13 PM Eastern Daylight Time	08/02/2019 01:18:17 PM Eastern Daylight Time			08/05/2019 10:54:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-001 (PPO)	1	4		1			H5216	1	0	2020	Select Counties in Eastern Wisconsin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	6	0	1	4	1	H5216_006_0	3	1			07/15/2019	2020.01	07/15/2019 04:26:03 PM Eastern Daylight Time	08/04/2019 02:49:17 PM Eastern Daylight Time	08/02/2019 01:18:17 PM Eastern Daylight Time			08/05/2019 10:54:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-006 (PPO)	1	4		1			H5216	6	0	2020	Madison area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	9	0	1	4	1	H5216_009_0	4	1			07/15/2019	2020.01	07/15/2019 03:58:36 PM Eastern Daylight Time	08/04/2019 02:31:49 PM Eastern Daylight Time	08/02/2019 01:18:17 PM Eastern Daylight Time			08/05/2019 11:00:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-009 (PPO)	1	4		1			H5216	9	0	2020	Select Counties in Western Michigan		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	11	0	1	4	1	H5216_011_0	5	1			07/23/2019	2020.01	07/23/2019 01:19:48 PM Eastern Daylight Time	08/04/2019 02:56:07 PM Eastern Daylight Time	08/02/2019 01:18:18 PM Eastern Daylight Time			08/05/2019 11:00:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-011 (PPO)	1	4		1			H5216	11	0	2020	"Oakland, Macomb, and Wayne counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	13	0	1	4	1	H5216_013_0	3	1			07/15/2019	2020.01	07/15/2019 04:40:19 PM Eastern Daylight Time	08/04/2019 03:17:23 PM Eastern Daylight Time	08/02/2019 01:18:18 PM Eastern Daylight Time			08/05/2019 10:54:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-013 (PPO)	1	4		1			H5216	13	0	2020	Select Counties in Illinois		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	14	0	1	4	1	H5216_014_0	4	1			07/15/2019	2020.01	07/15/2019 03:58:34 PM Eastern Daylight Time	08/04/2019 03:06:31 PM Eastern Daylight Time	08/02/2019 01:18:18 PM Eastern Daylight Time			08/05/2019 11:23:48 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-014 (PPO)	1	4		1			H5216	14	0	2020	Select Counties in Iowa		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	17	0	1	4	1	H5216_017_0	3	1			08/01/2019	2020.01	08/01/2019 07:23:50 PM Eastern Daylight Time	08/04/2019 04:44:00 PM Eastern Daylight Time	08/02/2019 01:18:18 PM Eastern Daylight Time			08/05/2019 11:23:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-017 (PPO)	1	4		1			H5216	17	0	2020	Greensboro		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	18	0	1	4	1	H5216_018_0	3	1			07/15/2019	2020.01	07/15/2019 04:05:14 PM Eastern Daylight Time	08/04/2019 06:32:30 PM Eastern Daylight Time	08/02/2019 01:18:18 PM Eastern Daylight Time			08/05/2019 12:22:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-018 (PPO)	1	4		1			H5216	18	0	2020	Louisville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	19	0	1	4	1	H5216_019_0	3	1			07/16/2019	2020.01	07/16/2019 05:59:45 PM Eastern Daylight Time	08/04/2019 06:34:24 PM Eastern Daylight Time	08/02/2019 01:18:18 PM Eastern Daylight Time			08/05/2019 12:22:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-019 (PPO)	1	4		1			H5216	19	0	2020	Lexington Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	20	0	1	4	1	H5216_020_0	3	1			07/15/2019	2020.01	07/15/2019 04:13:56 PM Eastern Daylight Time	08/04/2019 06:15:21 PM Eastern Daylight Time	08/02/2019 01:18:18 PM Eastern Daylight Time			08/05/2019 12:22:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-020 (PPO)	1	4		1			H5216	20	0	2020	"Barren, Metcalfe and Warren counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	21	0	1	4	1	H5216_021_0	5	1			07/15/2019	2020.01	07/15/2019 03:51:01 PM Eastern Daylight Time	08/04/2019 06:07:40 PM Eastern Daylight Time	08/02/2019 01:18:18 PM Eastern Daylight Time			08/05/2019 11:16:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-021 (PPO)	1	4		1			H5216	21	0	2020	Charleston-Huntington Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	22	0	1	4	1	H5216_022_0	5	1			07/15/2019	2020.01	07/15/2019 03:57:57 PM Eastern Daylight Time	08/04/2019 06:17:13 PM Eastern Daylight Time	08/02/2019 01:18:19 PM Eastern Daylight Time			08/05/2019 11:16:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-022 (PPO)	1	4		1			H5216	22	0	2020	Martinsburg Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	23	0	1	4	1	H5216_023_0	3	1			07/15/2019	2020.01	07/15/2019 04:49:00 PM Eastern Daylight Time	08/04/2019 02:32:35 PM Eastern Daylight Time	08/02/2019 01:18:19 PM Eastern Daylight Time			08/05/2019 11:00:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-023 (PPO)	1	4		1			H5216	23	0	2020	Cincinnati and Dayton Metro Areas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	24	0	1	4	1	H5216_024_0	3	1			07/15/2019	2020.01	07/15/2019 05:01:04 PM Eastern Daylight Time	08/04/2019 02:56:52 PM Eastern Daylight Time	08/02/2019 01:18:19 PM Eastern Daylight Time			08/05/2019 11:08:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-024 (PPO)	1	4		1			H5216	24	0	2020	Cleveland-Akron Metro Areas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	27	0	1	4	1	H5216_027_0	3	1			07/15/2019	2020.01	07/15/2019 03:55:35 PM Eastern Daylight Time	08/04/2019 04:46:26 PM Eastern Daylight Time	08/02/2019 01:18:19 PM Eastern Daylight Time			08/05/2019 11:23:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-027 (PPO)	1	4		1			H5216	27	0	2020	Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	28	0	1	4	1	H5216_028_0	3	1			07/15/2019	2020.01	07/15/2019 03:57:49 PM Eastern Daylight Time	08/04/2019 04:34:06 PM Eastern Daylight Time	08/02/2019 01:18:19 PM Eastern Daylight Time			08/05/2019 11:23:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-028 (PPO)	1	4		1			H5216	28	0	2020	"Kent, New Castle and Sussex Counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	29	0	1	4	1	H5216_029_0	3	1			07/15/2019	2020.01	07/15/2019 03:59:47 PM Eastern Daylight Time	08/04/2019 04:34:54 PM Eastern Daylight Time	08/02/2019 01:18:19 PM Eastern Daylight Time			08/05/2019 11:23:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-029 (PPO)	1	4		1			H5216	29	0	2020	Select Counties in Western Maryland		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	32	0	1	4	1	H5216_032_0	2	1			07/15/2019	2020.01	07/15/2019 11:48:11 AM Eastern Daylight Time	08/02/2019 09:57:59 AM Eastern Daylight Time	08/02/2019 01:18:19 PM Eastern Daylight Time			08/05/2019 11:12:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-032 (PPO)	1	4		1			H5216	32	0	2020	"Select Counties in Illinois, Kansas and Missouri"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	33	1	1	4	1	H5216_033_1	3	1			07/15/2019	2020.01	07/15/2019 04:30:32 PM Eastern Daylight Time	08/02/2019 10:00:18 AM Eastern Daylight Time	08/02/2019 01:18:19 PM Eastern Daylight Time			08/05/2019 11:12:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-033 (PPO)	1	4		1			H5216	33	1	2020	"Select Counties in Illinois, Kansas, and Missouri"	Select Counties in Kansas and Missouri	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	33	2	1	4	1	H5216_033_2	2	1			08/04/2019	2020.01	08/04/2019 10:45:56 AM Eastern Daylight Time	08/02/2019 10:18:56 AM Eastern Daylight Time	08/02/2019 01:18:20 PM Eastern Daylight Time			08/05/2019 11:12:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-033 (PPO)	1	4		1			H5216	33	2	2020	"Select Counties in Illinois, Kansas, and Missouri"	Select Counties in Illinois and Missouri	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	34	0	1	4	1	H5216_034_0	4	1			07/12/2019	2020.01	07/12/2019 05:01:48 PM Eastern Daylight Time	08/04/2019 10:52:13 AM Eastern Daylight Time	08/02/2019 01:18:20 PM Eastern Daylight Time			08/05/2019 11:34:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-034 (PPO)	1	4		1			H5216	34	0	2020	"Maricopa, Pima, Pinal and Santa Cruz counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	35	0	1	4	1	H5216_035_0	3	1			05/28/2019	2020.01	05/28/2019 11:22:41 AM Eastern Daylight Time	08/04/2019 10:47:18 AM Eastern Daylight Time	08/02/2019 01:18:20 PM Eastern Daylight Time			08/05/2019 11:34:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-035 (PPO)	1	4		1			H5216	35	0	2020	"La Paz, Mohave and Yavapai counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	36	0	1	4	1	H5216_036_0	3	1			07/15/2019	2020.01	07/15/2019 03:25:28 PM Eastern Daylight Time	08/03/2019 11:02:04 AM Eastern Daylight Time	08/02/2019 01:18:20 PM Eastern Daylight Time			08/05/2019 11:12:37 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-036 (PPO)	1	4		1			H5216	36	0	2020	Clark and Nye (partial) counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	37	0	1	4	1	H5216_037_0	4	1			07/15/2019	2020.01	07/15/2019 03:27:25 PM Eastern Daylight Time	08/03/2019 10:23:40 AM Eastern Daylight Time	08/02/2019 01:18:20 PM Eastern Daylight Time			08/05/2019 11:12:37 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-037 (PPO)	1	4		1			H5216	37	0	2020	Clark and Nye (partial) counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	39	0	1	4	1	H5216_039_0	3	1			08/01/2019	2020.01	08/01/2019 05:21:38 PM Eastern Daylight Time	08/03/2019 10:55:20 AM Eastern Daylight Time	08/02/2019 01:18:20 PM Eastern Daylight Time			08/05/2019 11:12:37 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-039 (PPO)	1	4		1			H5216	39	0	2020	Washoe County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	40	0	1	4	1	H5216_040_0	2	1			08/01/2019	2020.01	08/01/2019 05:23:51 PM Eastern Daylight Time	08/03/2019 10:11:53 AM Eastern Daylight Time	08/02/2019 01:18:20 PM Eastern Daylight Time			08/05/2019 11:12:37 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-040 (PPO)	1	4		1			H5216	40	0	2020	"Honolulu, Kauai and Maui counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	41	0	1	4	1	H5216_041_0	2	1			08/01/2019	2020.01	08/01/2019 05:25:47 PM Eastern Daylight Time	08/03/2019 10:41:00 AM Eastern Daylight Time	08/02/2019 01:18:20 PM Eastern Daylight Time			08/05/2019 11:12:37 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-041 (PPO)	1	4		1			H5216	41	0	2020	"Honolulu, Kauai and Maui counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	42	0	1	4	1	H5216_042_0	4	1			07/15/2019	2020.01	07/15/2019 03:23:39 PM Eastern Daylight Time	08/04/2019 03:35:25 PM Eastern Daylight Time	08/02/2019 01:18:21 PM Eastern Daylight Time			08/05/2019 11:25:37 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-042 (PPO)	1	4		1			H5216	42	0	2020	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	43	1	1	4	1	H5216_043_1	3	1			07/15/2019	2020.01	07/15/2019 03:23:35 PM Eastern Daylight Time	08/04/2019 03:36:33 PM Eastern Daylight Time	08/02/2019 01:18:21 PM Eastern Daylight Time			08/05/2019 11:29:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-043 (PPO)	1	4		1			H5216	43	1	2020	Select Counties in Texas	Select Counties in Texas	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	43	2	1	4	1	H5216_043_2	3	1			07/15/2019	2020.01	07/15/2019 03:28:42 PM Eastern Daylight Time	08/04/2019 03:37:41 PM Eastern Daylight Time	08/02/2019 01:18:21 PM Eastern Daylight Time			08/05/2019 11:29:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-043 (PPO)	1	4		1			H5216	43	2	2020	Select Counties in Texas	Select Counties in Texas	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	44	0	1	4	1	H5216_044_0	5	1			07/15/2019	2020.01	07/15/2019 03:30:07 PM Eastern Daylight Time	08/04/2019 04:34:02 PM Eastern Daylight Time	08/02/2019 01:18:21 PM Eastern Daylight Time			08/05/2019 12:13:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-044 (PPO)	1	4		1			H5216	44	0	2020	Select counties in Idaho and Oregon		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	45	0	1	4	1	H5216_045_0	3	1			07/15/2019	2020.01	07/15/2019 05:02:59 PM Eastern Daylight Time	08/04/2019 02:35:40 PM Eastern Daylight Time	08/02/2019 01:18:21 PM Eastern Daylight Time			08/05/2019 11:08:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-045 (PPO)	1	4		1			H5216	45	0	2020	Columbus Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	46	0	1	4	1	H5216_046_0	3	1			07/15/2019	2020.01	07/15/2019 03:40:58 PM Eastern Daylight Time	05/31/2019 04:31:41 PM Eastern Daylight Time				07/16/2019 04:29:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-046 (PPO)	1	4		1			H5216	46	0	2020	"Select Counties in ID, OR, WA and UT"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	47	0	1	4	1	H5216_047_0	5	1			07/15/2019	2020.01	07/15/2019 03:31:57 PM Eastern Daylight Time	08/04/2019 04:40:17 PM Eastern Daylight Time	08/02/2019 01:18:21 PM Eastern Daylight Time			08/05/2019 12:13:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-047 (PPO)	1	4		1			H5216	47	0	2020	Select Counties in Washington and Oregon		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	48	0	1	4	1	H5216_048_0	3	1			05/31/2019	2020.01	05/31/2019 02:44:27 PM Eastern Daylight Time	08/04/2019 04:44:42 PM Eastern Daylight Time	08/02/2019 01:18:21 PM Eastern Daylight Time			08/05/2019 12:13:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-048 (PPO)	1	4		1			H5216	48	0	2020	"Select Counties in ID, OR and WA"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	50	0	1	4	1	H5216_050_0	3	1			07/15/2019	2020.01	07/15/2019 05:04:20 PM Eastern Daylight Time	08/04/2019 02:37:59 PM Eastern Daylight Time	08/02/2019 01:18:21 PM Eastern Daylight Time			08/05/2019 11:08:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-050 (PPO)	1	4		1			H5216	50	0	2020	Northwest Ohio Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	51	0	1	4	1	H5216_051_0	3	1			07/15/2019	2020.01	07/15/2019 05:06:16 PM Eastern Daylight Time	08/04/2019 02:37:13 PM Eastern Daylight Time	08/02/2019 01:18:22 PM Eastern Daylight Time			08/05/2019 11:08:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-051 (PPO)	1	4		1			H5216	51	0	2020	Canton-Youngstown Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	52	1	1	4	1	H5216_052_1	3	1			07/15/2019	2020.01	07/15/2019 05:08:00 PM Eastern Daylight Time	08/04/2019 02:59:07 PM Eastern Daylight Time	08/02/2019 01:18:22 PM Eastern Daylight Time			08/05/2019 11:08:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-052 (PPO)	1	4		1			H5216	52	1	2020	Select counties in Ohio	Select counties in Ohio	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	52	2	1	4	1	H5216_052_2	3	1			07/15/2019	2020.01	07/15/2019 05:10:30 PM Eastern Daylight Time	08/04/2019 02:57:37 PM Eastern Daylight Time	08/02/2019 01:18:22 PM Eastern Daylight Time			08/05/2019 11:08:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-052 (PPO)	1	4		1			H5216	52	2	2020	Select counties in Ohio	Select counties in northwest West Virginia	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	53	0	1	4	1	H5216_053_0	3	1			07/15/2019	2020.01	07/15/2019 04:10:36 PM Eastern Daylight Time	08/04/2019 02:38:45 PM Eastern Daylight Time	08/02/2019 01:18:22 PM Eastern Daylight Time			08/05/2019 11:00:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-053 (PPO)	1	4		1			H5216	53	0	2020	Central Indiana Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	54	0	1	4	1	H5216_054_0	3	1			07/15/2019	2020.01	07/15/2019 04:11:57 PM Eastern Daylight Time	08/04/2019 02:34:06 PM Eastern Daylight Time	08/02/2019 01:18:22 PM Eastern Daylight Time			08/05/2019 11:00:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-054 (PPO)	1	4		1			H5216	54	0	2020	Southern Indiana Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	55	0	1	4	1	H5216_055_0	3	1			07/15/2019	2020.01	07/15/2019 04:52:11 PM Eastern Daylight Time	08/04/2019 02:34:54 PM Eastern Daylight Time	08/02/2019 01:18:22 PM Eastern Daylight Time			08/05/2019 11:00:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-055 (PPO)	1	4		1			H5216	55	0	2020	Northern Indiana Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	57	0	1	4	1	H5216_057_0	3	1			07/15/2019	2020.01	07/15/2019 04:04:23 PM Eastern Daylight Time	08/01/2019 04:38:27 PM Eastern Daylight Time	08/02/2019 01:18:22 PM Eastern Daylight Time			08/05/2019 11:17:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-057 (PPO)	1	4		1			H5216	57	0	2020	Select Counties in New Hampshire		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	58	0	1	4	1	H5216_058_0	3	1			08/01/2019	2020.01	08/01/2019 07:00:58 PM Eastern Daylight Time	08/01/2019 04:43:26 PM Eastern Daylight Time	08/02/2019 01:18:22 PM Eastern Daylight Time			08/05/2019 11:17:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-058 (PPO)	1	4		1			H5216	58	0	2020	Select Counties in New Hampshire		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	59	0	1	4	1	H5216_059_0	2	1			07/15/2019	2020.01	07/15/2019 03:49:12 PM Eastern Daylight Time	05/31/2019 05:54:15 PM Eastern Daylight Time				07/16/2019 05:12:37 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-059 (PPO)	1	4		1			H5216	59	0	2020	Select Counties in Maine and New Hampshire		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	61	0	1	4	1	H5216_061_0	4	1			08/01/2019	2020.01	08/01/2019 05:46:13 PM Eastern Daylight Time	08/04/2019 05:14:30 PM Eastern Daylight Time	08/02/2019 01:18:23 PM Eastern Daylight Time			08/05/2019 11:15:45 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-061 (PPO)	1	4		1			H5216	61	0	2020	Select Counties in Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	62	0	1	4	1	H5216_062_0	4	1			08/01/2019	2020.01	08/01/2019 06:54:55 PM Eastern Daylight Time	08/04/2019 05:15:54 PM Eastern Daylight Time	08/02/2019 01:18:23 PM Eastern Daylight Time			08/05/2019 11:10:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-062 (PPO)	1	4		1			H5216	62	0	2020	Select Counties in Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	63	0	1	4	1	H5216_063_0	4	1			07/15/2019	2020.01	07/15/2019 04:40:50 PM Eastern Daylight Time	08/04/2019 03:20:48 PM Eastern Daylight Time	08/02/2019 01:18:23 PM Eastern Daylight Time			08/05/2019 10:54:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-063 (PPO)	1	4		1			H5216	63	0	2020	Select Counties in Minnesota		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	64	0	1	4	1	H5216_064_0	4	1			07/15/2019	2020.01	07/15/2019 03:49:54 PM Eastern Daylight Time	08/03/2019 11:23:58 AM Eastern Daylight Time	08/02/2019 01:18:23 PM Eastern Daylight Time			08/05/2019 11:43:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-064 (PPO)	1	4		1			H5216	64	0	2020	Select Louisiana Parishes		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	65	0	1	4	1	H5216_065_0	4	1			07/16/2019	2020.01	07/16/2019 01:25:34 PM Eastern Daylight Time	08/04/2019 05:07:28 PM Eastern Daylight Time	08/02/2019 01:18:23 PM Eastern Daylight Time			08/05/2019 11:10:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-065 (PPO)	1	4		1			H5216	65	0	2020	"Broward, Miami-Dade and Palm Beach Counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	66	0	1	4	1	H5216_066_0	5	1			07/15/2019	2020.01	07/15/2019 04:04:06 PM Eastern Daylight Time	08/03/2019 11:20:05 AM Eastern Daylight Time	08/02/2019 01:18:23 PM Eastern Daylight Time			08/05/2019 12:14:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-066 (PPO)	1	4		1			H5216	66	0	2020	Gulf Coast / Biloxi Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	67	0	1	4	1	H5216_067_0	5	1			07/15/2019	2020.01	07/15/2019 04:05:21 PM Eastern Daylight Time	08/03/2019 11:22:02 AM Eastern Daylight Time	08/02/2019 01:18:23 PM Eastern Daylight Time			08/05/2019 12:14:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-067 (PPO)	1	4		1			H5216	67	0	2020	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	68	0	1	4	1	H5216_068_0	4	1			08/01/2019	2020.01	08/01/2019 06:56:42 PM Eastern Daylight Time	08/04/2019 05:13:11 PM Eastern Daylight Time	08/02/2019 01:18:23 PM Eastern Daylight Time			08/05/2019 11:10:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-068 (PPO)	1	4		1			H5216	68	0	2020	"Broward, Miami-Dade and Palm Beach Counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	70	0	1	4	1	H5216_070_0	3	1			08/02/2019	2020.01	08/02/2019 09:54:30 AM Eastern Daylight Time	08/04/2019 05:11:54 PM Eastern Daylight Time	08/02/2019 01:18:24 PM Eastern Daylight Time			08/05/2019 11:15:45 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-070 (PPO)	1	4		1			H5216	70	0	2020	Select Counties in Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	71	0	1	4	1	H5216_071_0	4	1			07/15/2019	2020.01	07/15/2019 03:47:04 PM Eastern Daylight Time	08/04/2019 11:49:36 AM Eastern Daylight Time	08/02/2019 01:18:24 PM Eastern Daylight Time			08/05/2019 10:50:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-071 (PPO)	1	4		1			H5216	71	0	2020	"Counties: Cobb, Paulding, Douglas"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	72	0	1	4	1	H5216_072_0	7	1			08/01/2019	2020.01	08/01/2019 03:17:10 PM Eastern Daylight Time	08/04/2019 05:09:14 PM Eastern Daylight Time	08/02/2019 01:18:24 PM Eastern Daylight Time			08/05/2019 11:15:13 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-072 (PPO)	1	4		1			H5216	72	0	2020	Select Counties in Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	73	0	1	4	1	H5216_073_0	3	1			07/15/2019	2020.01	07/15/2019 03:49:27 PM Eastern Daylight Time	08/04/2019 11:41:33 AM Eastern Daylight Time	08/02/2019 01:18:24 PM Eastern Daylight Time			08/05/2019 10:50:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-073 (PPO)	1	4		1			H5216	73	0	2020	Atlanta Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	74	0	1	4	1	H5216_074_0	3	1			08/01/2019	2020.01	08/01/2019 05:47:20 PM Eastern Daylight Time	08/04/2019 05:10:38 PM Eastern Daylight Time	08/02/2019 01:18:24 PM Eastern Daylight Time			08/05/2019 11:15:45 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice Florida H5216-074 (PPO)	1	4		1			H5216	74	0	2020	"Lake, Marion and Sumter counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	75	0	1	4	1	H5216_075_0	3	1			07/15/2019	2020.01	07/15/2019 03:51:46 PM Eastern Daylight Time	08/04/2019 11:42:54 AM Eastern Daylight Time	08/02/2019 01:18:24 PM Eastern Daylight Time			08/05/2019 10:50:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-075 (PPO)	1	4		1			H5216	75	0	2020	Charleston Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	76	0	1	4	1	H5216_076_0	3	1			07/15/2019	2020.01	07/15/2019 03:53:16 PM Eastern Daylight Time	08/04/2019 11:44:00 AM Eastern Daylight Time	08/02/2019 01:18:24 PM Eastern Daylight Time			08/05/2019 10:50:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-076 (PPO)	1	4		1			H5216	76	0	2020	Spartanburg/Greenville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	77	0	1	4	1	H5216_077_0	3	1			07/12/2019	2020.01	07/12/2019 05:06:19 PM Eastern Daylight Time	07/14/2019 02:57:32 PM Eastern Daylight Time				07/16/2019 05:50:44 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-077 (PPO)	1	4		1			H5216	77	0	2020	Select Counties in Colorado and New Mexico		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						1	1	4b;8a1;8a2;8b3;	
H5216	78	1	1	4	1	H5216_078_1	4	1			05/24/2019	2020.01	05/24/2019 09:35:24 AM Eastern Daylight Time	08/04/2019 10:54:42 AM Eastern Daylight Time	08/02/2019 01:18:24 PM Eastern Daylight Time			08/05/2019 11:34:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-078 (PPO)	1	4		1			H5216	78	1	2020	Select Counties in Colorado	Select Counties in Colorado	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	1	4b;8a1;8a2;8b3;	
H5216	78	2	1	4	1	H5216_078_2	3	1			08/01/2019	2020.01	08/01/2019 02:56:23 PM Eastern Daylight Time	08/04/2019 10:57:06 AM Eastern Daylight Time	08/02/2019 01:18:24 PM Eastern Daylight Time			08/05/2019 11:34:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-078 (PPO)	1	4		1			H5216	78	2	2020	Select Counties in Colorado	Colorado Springs/Grand Junction	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	1	4b;8a1;8a2;8b3;	
H5216	80	1	1	4	1	H5216_080_1	3	1			07/15/2019	2020.01	07/15/2019 03:39:59 PM Eastern Daylight Time	08/04/2019 03:12:35 PM Eastern Daylight Time	08/02/2019 01:18:25 PM Eastern Daylight Time			08/05/2019 10:56:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-080 (PPO)	1	4		1			H5216	80	1	2020	Select Counties in Minnesota and Wisconsin	Twin Cities	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	80	2	1	4	1	H5216_080_2	3	1			07/15/2019	2020.01	07/15/2019 03:42:42 PM Eastern Daylight Time	08/04/2019 03:13:45 PM Eastern Daylight Time	08/02/2019 01:18:25 PM Eastern Daylight Time			08/05/2019 10:56:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-080 (PPO)	1	4		1			H5216	80	2	2020	Select Counties in Minnesota and Wisconsin	Rochester	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	80	3	1	4	1	H5216_080_3	3	1			07/15/2019	2020.01	07/15/2019 03:45:04 PM Eastern Daylight Time	08/04/2019 03:18:37 PM Eastern Daylight Time	08/02/2019 01:18:25 PM Eastern Daylight Time			08/05/2019 10:56:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-080 (PPO)	1	4		1			H5216	80	3	2020	Select Counties in Minnesota and Wisconsin	Duluth	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	81	0	1	4	1	H5216_081_0	3	1			07/15/2019	2020.01	07/15/2019 03:38:48 PM Eastern Daylight Time	08/02/2019 10:10:46 AM Eastern Daylight Time	08/02/2019 01:18:25 PM Eastern Daylight Time			08/05/2019 11:12:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-081 (PPO)	1	4		1			H5216	81	0	2020	Select Counties in Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	83	0	1	4	1	H5216_083_0	3	1			08/01/2019	2020.01	08/01/2019 02:36:11 PM Eastern Daylight Time	08/02/2019 12:53:38 PM Eastern Daylight Time	08/02/2019 01:18:25 PM Eastern Daylight Time			08/05/2019 11:12:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-083 (PPO)	1	4		1			H5216	83	0	2020	"Select Counties in AR, KS, MO, and OK"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	85	0	1	4	1	H5216_085_0	4	1			07/15/2019	2020.01	07/15/2019 03:58:49 PM Eastern Daylight Time	08/04/2019 02:50:30 PM Eastern Daylight Time	08/02/2019 01:18:25 PM Eastern Daylight Time			08/05/2019 11:23:48 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-085 (PPO)	1	4		1			H5216	85	0	2020	Omaha Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	86	0	1	4	1	H5216_086_0	2	1			07/15/2019	2020.01	07/15/2019 03:45:37 PM Eastern Daylight Time	05/31/2019 10:35:56 AM Eastern Daylight Time				07/16/2019 04:23:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-086 (PPO)	1	4		1			H5216	86	0	2020	"Select Counties in IA, MN, MT, ND, NE, SD"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	88	0	1	4	1	H5216_088_0	4	1			07/15/2019	2020.01	07/15/2019 03:46:23 PM Eastern Daylight Time	08/04/2019 02:55:32 PM Eastern Daylight Time	08/02/2019 01:18:25 PM Eastern Daylight Time			08/05/2019 10:56:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-088 (PPO)	1	4		1			H5216	88	0	2020	Select Counties in North and South Dakota		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	89	0	1	4	1	H5216_089_0	4	1			07/15/2019	2020.01	07/15/2019 03:59:04 PM Eastern Daylight Time	08/04/2019 03:04:08 PM Eastern Daylight Time	08/02/2019 01:18:25 PM Eastern Daylight Time			08/05/2019 11:23:48 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-089 (PPO)	1	4		1			H5216	89	0	2020	Select Counties in Montana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	91	0	1	4	1	H5216_091_0	4	1			07/15/2019	2020.01	07/15/2019 03:59:23 PM Eastern Daylight Time	08/04/2019 03:07:40 PM Eastern Daylight Time	08/02/2019 01:18:26 PM Eastern Daylight Time			08/05/2019 11:23:48 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-091 (PPO)	1	4		1			H5216	91	0	2020	Select Counties in Iowa		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	92	0	1	4	1	H5216_092_0	3	1			07/03/2019	2020.01	07/03/2019 05:02:00 PM Eastern Daylight Time	08/04/2019 03:14:57 PM Eastern Daylight Time	08/02/2019 01:18:26 PM Eastern Daylight Time			08/05/2019 10:56:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-092 (PPO)	1	4		1			H5216	92	0	2020	"Select Counties in MN, ND and SD"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	93	0	1	4	1	H5216_093_0	4	1			07/15/2019	2020.01	07/15/2019 03:22:25 PM Eastern Daylight Time	08/02/2019 05:40:23 PM Eastern Daylight Time	08/02/2019 01:18:26 PM Eastern Daylight Time			08/05/2019 10:49:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-093 (PPO)	1	4		1			H5216	93	0	2020	Memphis Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	96	0	1	4	1	H5216_096_0	3	1			07/15/2019	2020.01	07/15/2019 03:24:11 PM Eastern Daylight Time	08/02/2019 05:44:41 PM Eastern Daylight Time	08/02/2019 01:18:26 PM Eastern Daylight Time			08/05/2019 10:49:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-096 (PPO)	1	4		1			H5216	96	0	2020	Dothan Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	97	0	1	4	1	H5216_097_0	3	1			07/15/2019	2020.01	07/15/2019 03:25:46 PM Eastern Daylight Time	08/02/2019 05:41:21 PM Eastern Daylight Time	08/02/2019 01:18:26 PM Eastern Daylight Time			08/05/2019 10:49:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-097 (PPO)	1	4		1			H5216	97	0	2020	Nashville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	98	0	1	4	1	H5216_098_0	3	1			07/15/2019	2020.01	07/15/2019 03:27:26 PM Eastern Daylight Time	08/02/2019 05:42:15 PM Eastern Daylight Time	08/02/2019 01:18:26 PM Eastern Daylight Time			08/05/2019 10:49:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-098 (PPO)	1	4		1			H5216	98	0	2020	Chattanooga Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	99	0	1	4	1	H5216_099_0	3	1			07/15/2019	2020.01	07/15/2019 03:28:52 PM Eastern Daylight Time	08/02/2019 05:43:05 PM Eastern Daylight Time	08/02/2019 01:18:26 PM Eastern Daylight Time			08/05/2019 10:49:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-099 (PPO)	1	4		1			H5216	99	0	2020	Knoxville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	100	0	1	4	1	H5216_100_0	3	1			07/15/2019	2020.01	07/15/2019 03:30:35 PM Eastern Daylight Time	08/02/2019 05:43:53 PM Eastern Daylight Time	08/02/2019 01:18:26 PM Eastern Daylight Time			08/05/2019 10:49:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-100 (PPO)	1	4		1			H5216	100	0	2020	Select Counties in the Tri-Cities Area of Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	103	0	1	4	1	H5216_103_0	4	1			07/15/2019	2020.01	07/15/2019 03:47:21 PM Eastern Daylight Time	08/04/2019 03:23:08 PM Eastern Daylight Time	08/02/2019 01:18:26 PM Eastern Daylight Time			08/05/2019 10:56:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-103 (PPO)	1	4		1			H5216	103	0	2020	Select Counties in North Dakota and South Dakota		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	105	0	1	4	1	H5216_105_0	2	1			07/15/2019	2020.01	07/15/2019 04:17:49 PM Eastern Daylight Time	05/31/2019 05:07:57 PM Eastern Daylight Time				07/16/2019 07:16:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-105 (PPO)	1	4		1			H5216	105	0	2020	Select counties in Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	106	0	1	4	1	H5216_106_0	3	1			08/01/2019	2020.01	08/01/2019 07:23:16 PM Eastern Daylight Time	08/04/2019 02:59:52 PM Eastern Daylight Time	08/02/2019 01:18:27 PM Eastern Daylight Time			08/05/2019 11:08:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-106 (PPO)	1	4		1			H5216	106	0	2020	Select counties in Northeast Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	107	0	1	4	1	H5216_107_0	4	1			07/16/2019	2020.01	07/16/2019 01:42:10 PM Eastern Daylight Time	08/04/2019 06:58:52 PM Eastern Daylight Time	08/02/2019 01:18:27 PM Eastern Daylight Time			08/05/2019 12:22:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-107 (PPO)	1	4		1			H5216	107	0	2020	Select counties in Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	109	0	1	4	1	H5216_109_0	3	1			08/01/2019	2020.01	08/01/2019 07:27:00 PM Eastern Daylight Time	08/04/2019 03:00:37 PM Eastern Daylight Time	08/02/2019 01:18:27 PM Eastern Daylight Time			08/05/2019 11:08:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-109 (PPO)	1	4		1			H5216	109	0	2020	Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	111	0	1	4	1	H5216_111_0	3	1			08/01/2019	2020.01	08/01/2019 02:34:57 PM Eastern Daylight Time	08/04/2019 03:01:22 PM Eastern Daylight Time	08/02/2019 01:18:27 PM Eastern Daylight Time			08/05/2019 11:00:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-111 (PPO)	1	4		1			H5216	111	0	2020	Select Counties in Indiana and Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	112	0	1	4	1	H5216_112_0	3	1			08/01/2019	2020.01	08/01/2019 02:35:32 PM Eastern Daylight Time	08/04/2019 03:02:52 PM Eastern Daylight Time	08/02/2019 01:18:27 PM Eastern Daylight Time			08/05/2019 11:00:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-112 (PPO)	1	4		1			H5216	112	0	2020	Select counties in Northeast and Fort Wayne IN		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	114	0	1	4	1	H5216_114_0	3	1			08/01/2019	2020.01	08/01/2019 02:35:52 PM Eastern Daylight Time	08/04/2019 03:02:07 PM Eastern Daylight Time	08/02/2019 01:18:27 PM Eastern Daylight Time			08/05/2019 11:00:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-114 (PPO)	1	4		1			H5216	114	0	2020	Select counties in Indianapolis		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	115	0	1	4	1	H5216_115_0	3	1			05/26/2019	2020.01	05/26/2019 10:43:43 AM Eastern Daylight Time	08/04/2019 07:04:43 PM Eastern Daylight Time	08/02/2019 01:18:27 PM Eastern Daylight Time			08/05/2019 12:22:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-115 (PPO)	1	4		1			H5216	115	0	2020	Select counties in Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	116	0	1	4	1	H5216_116_0	4	1			07/15/2019	2020.01	07/15/2019 04:07:35 PM Eastern Daylight Time	07/14/2019 03:31:01 PM Eastern Daylight Time				07/16/2019 06:37:28 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-116 (PPO)	1	4		1			H5216	116	0	2020	Select Counties in Pennsylvania		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	117	0	1	4	1	H5216_117_0	4	1			05/30/2019	2020.01	05/30/2019 04:09:27 PM Eastern Daylight Time	08/04/2019 07:06:39 PM Eastern Daylight Time	08/02/2019 01:18:27 PM Eastern Daylight Time			08/05/2019 11:16:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-117 (PPO)	1	4		1			H5216	117	0	2020	Select Counties in Pennsylvania		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	119	0	1	4	1	H5216_119_0	6	1			07/16/2019	2020.01	07/16/2019 06:14:10 PM Eastern Daylight Time	08/04/2019 07:02:46 PM Eastern Daylight Time	08/02/2019 01:18:27 PM Eastern Daylight Time			08/05/2019 11:16:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-119 (PPO)	1	4		1			H5216	119	0	2020	Western Pennsylvania Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	120	0	1	4	1	H5216_120_0	7	1			07/23/2019	2020.01	07/23/2019 01:27:35 PM Eastern Daylight Time	08/04/2019 07:12:27 PM Eastern Daylight Time	08/02/2019 01:18:28 PM Eastern Daylight Time			08/05/2019 11:16:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-120 (PPO)	1	4		1			H5216	120	0	2020	South Central Pennsylvania Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	122	0	1	4	1	H5216_122_0	6	1			07/16/2019	2020.01	07/16/2019 05:58:50 PM Eastern Daylight Time	08/04/2019 07:10:30 PM Eastern Daylight Time	08/02/2019 01:18:28 PM Eastern Daylight Time			08/05/2019 11:16:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-122 (PPO)	1	4		1			H5216	122	0	2020	Greater Philadelphia Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	123	0	1	4	1	H5216_123_0	4	1			07/15/2019	2020.01	07/15/2019 04:13:34 PM Eastern Daylight Time	05/31/2019 05:09:32 PM Eastern Daylight Time				07/16/2019 06:37:28 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-123 (PPO)	1	4		1			H5216	123	0	2020	Select Counties in West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	124	0	1	4	1	H5216_124_0	6	1			07/16/2019	2020.01	07/16/2019 03:22:32 PM Eastern Daylight Time	08/04/2019 07:00:46 PM Eastern Daylight Time	08/02/2019 01:18:28 PM Eastern Daylight Time			08/05/2019 11:16:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-124 (PPO)	1	4		1			H5216	124	0	2020	Select counties in West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	125	0	1	4	1	H5216_125_0	4	1			05/30/2019	2020.01	05/30/2019 05:13:15 PM Eastern Daylight Time	08/04/2019 07:08:35 PM Eastern Daylight Time	08/02/2019 01:18:28 PM Eastern Daylight Time			08/05/2019 11:16:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-125 (PPO)	1	4		1			H5216	125	0	2020	Select counties in West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	127	0	1	4	1	H5216_127_0	2	1			07/15/2019	2020.01	07/15/2019 04:01:51 PM Eastern Daylight Time	06/01/2019 12:29:47 PM Eastern Daylight Time				07/16/2019 04:43:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-127 (PPO)	1	4		1			H5216	127	0	2020	"Kent, New Castle and Sussex Counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	128	0	1	4	1	H5216_128_0	3	1			07/15/2019	2020.01	07/15/2019 03:24:12 PM Eastern Daylight Time	05/31/2019 08:27:33 AM Eastern Daylight Time				07/16/2019 05:31:07 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-128 (PPO)	1	4		1			H5216	128	0	2020	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	129	0	1	4	1	H5216_129_0	2	1			07/15/2019	2020.01	07/15/2019 04:03:56 PM Eastern Daylight Time	06/01/2019 12:22:17 PM Eastern Daylight Time				07/16/2019 04:43:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-129 (PPO)	1	4		1			H5216	129	0	2020	Select Counties in Western Maryland		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	131	0	1	4	1	H5216_131_0	5	1			08/01/2019	2020.01	08/01/2019 07:08:57 PM Eastern Daylight Time	08/04/2019 06:00:02 PM Eastern Daylight Time	08/02/2019 01:18:28 PM Eastern Daylight Time			08/05/2019 12:13:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-131 (PPO)	1	4		1			H5216	131	0	2020	"Davis, Salt Lake, Utah and Weber Counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	132	0	1	4	1	H5216_132_0	4	1			08/01/2019	2020.01	08/01/2019 07:09:30 PM Eastern Daylight Time	08/04/2019 06:02:06 PM Eastern Daylight Time	08/02/2019 01:18:28 PM Eastern Daylight Time			08/05/2019 12:13:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-132 (PPO)	1	4		1			H5216	132	0	2020	Select Counties in Idaho and Malheur County Oregon		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	133	0	1	4	1	H5216_133_0	4	1			07/15/2019	2020.01	07/15/2019 04:28:43 PM Eastern Daylight Time	08/04/2019 03:05:07 PM Eastern Daylight Time	08/02/2019 01:18:28 PM Eastern Daylight Time			08/05/2019 11:00:58 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-133 (PPO)	1	4		1			H5216	133	0	2020	"Macomb, Oakland and Wayne counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	136	0	1	4	1	H5216_136_0	5	1			07/15/2019	2020.01	07/15/2019 04:06:25 PM Eastern Daylight Time	08/03/2019 11:33:50 AM Eastern Daylight Time	08/02/2019 01:18:28 PM Eastern Daylight Time			08/05/2019 12:14:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-136 (PPO)	1	4		1			H5216	136	0	2020	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	137	0	1	4	1	H5216_137_0	4	1			08/01/2019	2020.01	08/01/2019 02:59:18 PM Eastern Daylight Time	08/04/2019 11:01:46 AM Eastern Daylight Time	08/02/2019 01:18:28 PM Eastern Daylight Time			08/05/2019 11:34:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-137 (PPO)	1	4		1			H5216	137	0	2020	Select Counties in New Mexico		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	138	0	1	4	1	H5216_138_0	3	1			08/01/2019	2020.01	08/01/2019 07:03:05 PM Eastern Daylight Time	08/01/2019 04:47:15 PM Eastern Daylight Time	08/02/2019 01:18:29 PM Eastern Daylight Time			08/05/2019 11:17:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-138 (PPO)	1	4		1			H5216	138	0	2020	Select Counties in New Hampshire		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	139	0	1	4	1	H5216_139_0	2	1			08/02/2019	2020.01	08/02/2019 10:18:20 AM Eastern Daylight Time	08/02/2019 10:21:15 AM Eastern Daylight Time	08/02/2019 01:18:29 PM Eastern Daylight Time			08/05/2019 11:12:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-139 (PPO)	1	4		1			H5216	139	0	2020	Select Counties in Arkansas and Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	140	0	1	4	1	H5216_140_0	2	1			07/15/2019	2020.01	07/15/2019 03:45:32 PM Eastern Daylight Time	05/31/2019 03:24:38 PM Eastern Daylight Time				07/16/2019 06:08:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-140 (PPO)	1	4		1			H5216	140	0	2020	"Select Counties in AR, IL, KS, MO, and OK"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	141	0	1	4	1	H5216_141_0	3	1			08/01/2019	2020.01	08/01/2019 05:28:10 PM Eastern Daylight Time	08/03/2019 10:45:56 AM Eastern Daylight Time	08/02/2019 01:18:29 PM Eastern Daylight Time			08/05/2019 11:12:37 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-141 (PPO)	1	4		1			H5216	141	0	2020	Clark and Nye (partial) counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	142	1	1	4	1	H5216_142_1	3	1			08/01/2019	2020.01	08/01/2019 06:39:43 PM Eastern Daylight Time	08/04/2019 11:57:49 AM Eastern Daylight Time	08/02/2019 01:18:29 PM Eastern Daylight Time			08/05/2019 10:50:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-142 (PPO)	1	4		1			H5216	142	1	2020	Select Counties in Georgia and South Carolina	Columbia	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	142	2	1	4	1	H5216_142_2	3	1			07/15/2019	2020.01	07/15/2019 03:57:25 PM Eastern Daylight Time	08/04/2019 11:58:56 AM Eastern Daylight Time	08/02/2019 01:18:29 PM Eastern Daylight Time			08/05/2019 10:50:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-142 (PPO)	1	4		1			H5216	142	2	2020	Select Counties in Georgia and South Carolina	Select Counties in Georgia and South Carolina	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	143	0	1	4	1	H5216_143_0	3	1			08/01/2019	2020.01	08/01/2019 06:35:23 PM Eastern Daylight Time	08/04/2019 12:04:29 PM Eastern Daylight Time	08/02/2019 01:18:29 PM Eastern Daylight Time			08/05/2019 10:50:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-143 (PPO)	1	4		1			H5216	143	0	2020	"Barrow, Hall, and Jackson counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	144	0	1	4	1	H5216_144_0	3	1			07/15/2019	2020.01	07/15/2019 04:05:16 PM Eastern Daylight Time	08/04/2019 04:52:51 PM Eastern Daylight Time	08/02/2019 01:18:29 PM Eastern Daylight Time			08/05/2019 11:23:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-144 (PPO)	1	4		1			H5216	144	0	2020	Richmond-Tidewater Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	145	0	1	4	1	H5216_145_0	3	1			07/15/2019	2020.01	07/15/2019 04:01:07 PM Eastern Daylight Time	08/04/2019 12:03:27 PM Eastern Daylight Time	08/02/2019 01:18:29 PM Eastern Daylight Time			08/05/2019 11:06:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-145 (PPO)	1	4		1			H5216	145	0	2020	Select Counties in Georgia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	148	0	1	4	1	H5216_148_0	3	1			08/02/2019	2020.01	08/02/2019 04:52:58 PM Eastern Daylight Time	08/04/2019 04:54:25 PM Eastern Daylight Time	08/02/2019 01:18:30 PM Eastern Daylight Time			08/05/2019 11:23:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-148 (PPO)	1	4		1			H5216	148	0	2020	Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	149	0	1	4	1	H5216_149_0	2	1			08/02/2019	2020.01	08/02/2019 11:21:09 AM Eastern Daylight Time	08/04/2019 04:49:40 PM Eastern Daylight Time	08/02/2019 01:18:30 PM Eastern Daylight Time			08/05/2019 11:23:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-149 (PPO)	1	4		1			H5216	149	0	2020	Lynchburg - Winchester Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	152	0	1	4	1	H5216_152_0	3	1			07/15/2019	2020.01	07/15/2019 04:10:09 PM Eastern Daylight Time	07/16/2019 02:59:08 PM Eastern Daylight Time				07/16/2019 04:43:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-152 (PPO)	1	4		1			H5216	152	0	2020	Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	154	0	1	4	1	H5216_154_0	3	1			08/01/2019	2020.01	08/01/2019 03:59:02 PM Eastern Daylight Time	08/04/2019 12:05:44 PM Eastern Daylight Time	08/02/2019 01:18:30 PM Eastern Daylight Time			08/05/2019 11:06:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-154 (PPO)	1	4		1			H5216	154	0	2020	Select Counties in Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	155	0	1	4	1	H5216_155_0	3	1			07/15/2019	2020.01	07/15/2019 04:03:21 PM Eastern Daylight Time	08/04/2019 12:06:47 PM Eastern Daylight Time	08/02/2019 01:18:30 PM Eastern Daylight Time			08/05/2019 11:06:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-155 (PPO)	1	4		1			H5216	155	0	2020	Georgia and South Carolina Coastal		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	156	0	1	4	1	H5216_156_0	3	1			08/01/2019	2020.01	08/01/2019 04:05:01 PM Eastern Daylight Time	08/04/2019 12:07:50 PM Eastern Daylight Time	08/02/2019 01:18:30 PM Eastern Daylight Time			08/05/2019 11:06:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-156 (PPO)	1	4		1			H5216	156	0	2020	Georgia and South Carolina Coastal		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	157	0	1	4	1	H5216_157_0	2	1			07/15/2019	2020.01	07/15/2019 04:05:24 PM Eastern Daylight Time	07/14/2019 03:09:11 PM Eastern Daylight Time				07/16/2019 05:08:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-157 (PPO)	1	4		1			H5216	157	0	2020	Select Counties in Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	158	0	1	4	1	H5216_158_0	4	1			08/01/2019	2020.01	08/01/2019 12:24:06 PM Eastern Daylight Time	08/03/2019 11:40:01 AM Eastern Daylight Time	08/02/2019 01:18:30 PM Eastern Daylight Time			08/05/2019 12:14:58 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-158 (PPO)	1	4		1			H5216	158	0	2020	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	159	0	1	4	1	H5216_159_0	5	1			08/01/2019	2020.01	08/01/2019 12:27:09 PM Eastern Daylight Time	08/03/2019 11:42:04 AM Eastern Daylight Time	08/02/2019 01:18:30 PM Eastern Daylight Time			08/05/2019 12:47:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-159 (PPO)	1	4		1			H5216	159	0	2020	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	160	0	1	4	1	H5216_160_0	5	1			08/01/2019	2020.01	08/01/2019 12:28:47 PM Eastern Daylight Time	08/03/2019 11:44:08 AM Eastern Daylight Time	08/02/2019 01:18:30 PM Eastern Daylight Time			08/05/2019 12:47:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-160 (PPO)	1	4		1			H5216	160	0	2020	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	161	0	1	4	1	H5216_161_0	3	1			05/30/2019	2020.01	05/30/2019 06:38:34 PM Eastern Daylight Time	08/03/2019 11:46:10 AM Eastern Daylight Time	08/02/2019 01:18:30 PM Eastern Daylight Time			08/05/2019 11:43:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-161 (PPO)	1	4		1			H5216	161	0	2020	Select Louisiana Parishes		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	163	0	1	4	1	H5216_163_0	3	1			07/15/2019	2020.01	07/15/2019 03:48:32 PM Eastern Daylight Time	08/02/2019 09:26:23 AM Eastern Daylight Time	08/02/2019 01:18:31 PM Eastern Daylight Time			08/05/2019 11:12:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-163 (PPO)	1	4		1			H5216	163	0	2020	"Select Counties in Arkansas, Kansas and Missouri"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	164	0	1	4	1	H5216_164_0	2	1	2	1	07/15/2019	2020.01	07/15/2019 12:03:49 PM Eastern Daylight Time	08/02/2019 10:15:08 AM Eastern Daylight Time	08/02/2019 01:18:31 PM Eastern Daylight Time			08/05/2019 11:12:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-164 (PPO D-SNP)	1	4		1			H5216	164	0	2020	Select Counties in Missouri		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	165	0	1	4	1	H5216_165_0	2	1			07/15/2019	2020.01	07/15/2019 12:05:50 PM Eastern Daylight Time	08/02/2019 09:43:30 AM Eastern Daylight Time	08/02/2019 01:18:31 PM Eastern Daylight Time			08/05/2019 11:12:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-165 (PPO)	1	4		1			H5216	165	0	2020	Select Counties in Arkansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	166	0	1	4	1	H5216_166_0	2	1			07/15/2019	2020.01	07/15/2019 12:07:51 PM Eastern Daylight Time	08/02/2019 09:52:34 AM Eastern Daylight Time	08/02/2019 01:18:31 PM Eastern Daylight Time			08/05/2019 11:43:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-166 (PPO)	1	4		1			H5216	166	0	2020	Select Counties in Kansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	167	0	1	4	1	H5216_167_0	4	1			07/15/2019	2020.01	07/15/2019 04:41:19 PM Eastern Daylight Time	08/04/2019 03:25:21 PM Eastern Daylight Time	08/02/2019 01:18:31 PM Eastern Daylight Time			08/05/2019 10:54:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-167 (PPO)	1	4		1			H5216	167	0	2020	Select Counties in Minnesota		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	168	0	1	4	1	H5216_168_0	5	1			07/15/2019	2020.01	07/15/2019 04:44:02 PM Eastern Daylight Time	08/04/2019 03:26:34 PM Eastern Daylight Time	08/02/2019 01:18:31 PM Eastern Daylight Time			08/05/2019 11:17:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-168 (PPO)	1	4		1			H5216	168	0	2020	Select Counties in Wisconsin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	169	0	1	4	1	H5216_169_0	3	1			08/01/2019	2020.01	08/01/2019 07:05:14 PM Eastern Daylight Time	08/01/2019 04:52:30 PM Eastern Daylight Time	08/02/2019 01:18:31 PM Eastern Daylight Time			08/05/2019 11:17:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-169 (PPO)	1	4		1			H5216	169	0	2020	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	170	0	1	4	1	H5216_170_0	3	1			07/15/2019	2020.01	07/15/2019 04:09:10 PM Eastern Daylight Time	08/02/2019 03:11:10 PM Eastern Daylight Time	08/02/2019 01:18:31 PM Eastern Daylight Time			08/05/2019 11:17:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-170 (PPO)	1	4		1			H5216	170	0	2020	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	171	0	1	4	1	H5216_171_0	2	1			07/15/2019	2020.01	07/15/2019 03:59:41 PM Eastern Daylight Time	08/04/2019 03:27:43 PM Eastern Daylight Time	08/02/2019 01:18:31 PM Eastern Daylight Time			08/05/2019 11:23:48 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-171 (PPO)	1	4		1			H5216	171	0	2020	"Select Counties in IA, NE, ND, and SD"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	172	0	1	4	1	H5216_172_0	4	1			08/01/2019	2020.01	08/01/2019 06:45:03 PM Eastern Daylight Time	08/01/2019 04:54:19 PM Eastern Daylight Time	08/02/2019 01:18:32 PM Eastern Daylight Time			08/05/2019 11:17:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-172 (PPO)	1	4		1			H5216	172	0	2020	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	173	0	1	4	1	H5216_173_0	2	1			05/28/2019	2020.01	05/28/2019 05:23:25 PM Eastern Daylight Time	08/04/2019 03:28:49 PM Eastern Daylight Time	08/02/2019 01:18:32 PM Eastern Daylight Time			08/05/2019 11:17:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-173 (PPO)	1	4		1			H5216	173	0	2020	Select Counties in Wisconsin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	174	0	1	4	1	H5216_174_0	2	1			07/15/2019	2020.01	07/15/2019 04:05:52 PM Eastern Daylight Time	05/31/2019 06:06:31 PM Eastern Daylight Time				07/16/2019 05:12:37 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-174 (PPO)	1	4		1			H5216	174	0	2020	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	175	0	1	4	1	H5216_175_0	3	1			08/01/2019	2020.01	08/01/2019 07:06:46 PM Eastern Daylight Time	08/01/2019 04:56:08 PM Eastern Daylight Time	08/02/2019 01:18:32 PM Eastern Daylight Time			08/05/2019 11:17:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-175 (PPO)	1	4		1			H5216	175	0	2020	Select Counties in Maine		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	176	0	1	4	1	H5216_176_0	2	1			05/28/2019	2020.01	05/28/2019 05:28:09 PM Eastern Daylight Time	08/04/2019 03:31:01 PM Eastern Daylight Time	08/02/2019 01:18:32 PM Eastern Daylight Time			08/05/2019 11:17:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-176 (PPO)	1	4		1			H5216	176	0	2020	Select Counties in Minnesota		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	177	0	1	4	1	H5216_177_0	3	1			07/15/2019	2020.01	07/15/2019 03:58:46 PM Eastern Daylight Time	08/01/2019 04:58:00 PM Eastern Daylight Time	08/02/2019 01:18:32 PM Eastern Daylight Time			08/05/2019 11:17:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-177 (PPO)	1	4		1			H5216	177	0	2020	Select Counties in Maine		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	178	1	1	4	1	H5216_178_1	2	1			07/15/2019	2020.01	07/15/2019 03:47:48 PM Eastern Daylight Time	05/31/2019 10:48:39 AM Eastern Daylight Time				07/16/2019 04:23:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-178 (PPO)	1	4		1			H5216	178	1	2020	"Select Counties in IL, MI and WI"	Select Counties in Illinois and Wisconsin	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	178	2	1	4	1	H5216_178_2	2	1			07/15/2019	2020.01	07/15/2019 03:48:26 PM Eastern Daylight Time	05/31/2019 10:49:06 AM Eastern Daylight Time				07/16/2019 04:23:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-178 (PPO)	1	4		1			H5216	178	2	2020	"Select Counties in IL, MI and WI"	Select Counties in Michigan	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	179	0	1	4	1	H5216_179_0	2	1			05/30/2019	2020.01	05/30/2019 10:32:18 AM Eastern Daylight Time	08/02/2019 05:49:26 PM Eastern Daylight Time	08/02/2019 01:18:32 PM Eastern Daylight Time			08/05/2019 10:49:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-179 (PPO)	1	4		1			H5216	179	0	2020	Select Counties in Alabama		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	180	0	1	4	1	H5216_180_0	2	1			05/30/2019	2020.01	05/30/2019 10:34:20 AM Eastern Daylight Time	08/02/2019 05:48:34 PM Eastern Daylight Time	08/02/2019 01:18:32 PM Eastern Daylight Time			08/05/2019 10:49:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-180 (PPO)	1	4		1			H5216	180	0	2020	Select Counties in TN		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	181	0	1	4	1	H5216_181_0	2	1			05/30/2019	2020.01	05/30/2019 10:36:48 AM Eastern Daylight Time	08/02/2019 05:51:02 PM Eastern Daylight Time	08/02/2019 01:18:32 PM Eastern Daylight Time			08/05/2019 10:49:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-181 (PPO)	1	4		1			H5216	181	0	2020	Select VA Counties in the Tri-Cities Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	182	0	1	4	1	H5216_182_0	4	1			08/01/2019	2020.01	08/01/2019 06:46:10 PM Eastern Daylight Time	08/04/2019 07:28:01 PM Eastern Daylight Time	08/02/2019 01:18:33 PM Eastern Daylight Time			08/05/2019 11:16:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-182 (PPO)	1	4		1			H5216	182	0	2020	West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	183	0	1	4	1	H5216_183_0	4	1			07/16/2019	2020.01	07/16/2019 05:49:51 PM Eastern Daylight Time	07/16/2019 09:21:18 AM Eastern Daylight Time				07/16/2019 06:54:33 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-183 (PPO)	1	4		1			H5216	183	0	2020	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	184	0	1	4	1	H5216_184_0	3	1			07/15/2019	2020.01	07/15/2019 04:37:27 PM Eastern Daylight Time	08/04/2019 07:29:56 PM Eastern Daylight Time	08/02/2019 01:18:33 PM Eastern Daylight Time			08/05/2019 11:11:35 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-184 (PPO)	1	4		1			H5216	184	0	2020	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	185	0	1	4	1	H5216_185_0	4	1			08/01/2019	2020.01	08/01/2019 07:32:06 PM Eastern Daylight Time	08/04/2019 07:32:00 PM Eastern Daylight Time	08/02/2019 01:18:33 PM Eastern Daylight Time			08/05/2019 11:11:35 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-185 (PPO)	1	4		1			H5216	185	0	2020	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	186	0	1	4	1	H5216_186_0	3	1			08/02/2019	2020.01	08/02/2019 03:09:48 PM Eastern Daylight Time	08/04/2019 07:33:54 PM Eastern Daylight Time	08/02/2019 01:18:33 PM Eastern Daylight Time			08/05/2019 11:11:35 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-186 (PPO)	1	4		1			H5216	186	0	2020	Select Counties in New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	188	0	1	4	1	H5216_188_0	4	1			08/02/2019	2020.01	08/02/2019 05:11:03 PM Eastern Daylight Time	08/04/2019 07:18:17 PM Eastern Daylight Time	08/02/2019 01:18:33 PM Eastern Daylight Time			08/05/2019 12:22:38 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-188 (PPO)	1	4		1			H5216	188	0	2020	Select Counties in Indiana and Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	189	0	1	4	1	H5216_189_0	4	1			07/15/2019	2020.01	07/15/2019 03:35:55 PM Eastern Daylight Time	08/04/2019 06:14:03 PM Eastern Daylight Time	08/02/2019 01:18:33 PM Eastern Daylight Time			08/05/2019 12:13:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-189 (PPO)	1	4		1			H5216	189	0	2020	Iron and Washington counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	190	0	1	4	1	H5216_190_0	3	1			07/16/2019	2020.01	07/16/2019 03:11:41 PM Eastern Daylight Time	05/31/2019 10:24:34 PM Eastern Daylight Time				07/16/2019 06:44:00 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-190 (PPO)	1	4		1			H5216	190	0	2020	Select counties in Michigan		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	192	0	1	4	1	H5216_192_0	4	1			08/01/2019	2020.01	08/01/2019 02:04:07 PM Eastern Daylight Time	08/04/2019 03:08:52 PM Eastern Daylight Time	08/02/2019 01:18:33 PM Eastern Daylight Time			08/05/2019 10:59:57 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-192 (PPO)	1	4		1			H5216	192	0	2020	Select counties in Indiana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	193	0	1	4	1	H5216_193_0	2	1			05/25/2019	2020.01	05/25/2019 10:41:43 AM Eastern Daylight Time	08/04/2019 03:11:08 PM Eastern Daylight Time	08/02/2019 01:18:33 PM Eastern Daylight Time			08/05/2019 10:59:57 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-193 (PPO)	1	4		1			H5216	193	0	2020	Select counties in Indiana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	194	0	1	4	1	H5216_194_0	3	1			08/01/2019	2020.01	08/01/2019 05:30:04 PM Eastern Daylight Time	08/03/2019 10:58:11 AM Eastern Daylight Time	08/02/2019 01:18:33 PM Eastern Daylight Time			08/05/2019 11:12:37 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-194 (PPO)	1	4		1			H5216	194	0	2020	Washoe County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	195	0	1	4	1	H5216_195_0	3	1			07/02/2019	2020.01	07/02/2019 12:33:07 PM Eastern Daylight Time	08/04/2019 11:48:57 AM Eastern Daylight Time	08/02/2019 01:18:34 PM Eastern Daylight Time			08/05/2019 11:12:35 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-195 (PPO)	1	4		1			H5216	195	0	2020	Colorado		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	196	1	1	4	1	H5216_196_1	2	1			08/01/2019	2020.01	08/01/2019 03:02:47 PM Eastern Daylight Time	08/04/2019 10:59:28 AM Eastern Daylight Time	08/02/2019 01:18:34 PM Eastern Daylight Time			08/05/2019 11:34:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-196 (PPO)	1	4		1			H5216	196	1	2020	New Mexico	Southern New Mexico	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	1	4b;8a1;8a2;8b3;	
H5216	196	2	1	4	1	H5216_196_2	2	1			08/01/2019	2020.01	08/01/2019 03:06:45 PM Eastern Daylight Time	08/04/2019 11:35:37 AM Eastern Daylight Time	08/02/2019 01:18:34 PM Eastern Daylight Time			08/05/2019 11:34:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-196 (PPO)	1	4		1			H5216	196	2	2020	New Mexico	Greater New Mexico	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	1	4b;8a1;8a2;8b3;	
H5216	197	0	1	4	1	H5216_197_0	3	1			07/02/2019	2020.01	07/02/2019 12:34:42 PM Eastern Daylight Time	08/04/2019 11:06:32 AM Eastern Daylight Time	08/02/2019 01:18:34 PM Eastern Daylight Time			08/05/2019 11:12:35 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-197 (PPO)	1	4		1			H5216	197	0	2020	Select counties in Arizona		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	198	0	1	4	1	H5216_198_0	2	1			05/24/2019	2020.01	05/24/2019 09:42:35 AM Eastern Daylight Time	08/04/2019 11:08:56 AM Eastern Daylight Time	08/02/2019 01:18:34 PM Eastern Daylight Time			08/05/2019 11:34:30 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-198 (PPO)	1	4		1			H5216	198	0	2020	Coconino County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	199	0	1	4	1	H5216_199_0	3	1			07/02/2019	2020.01	07/02/2019 12:35:04 PM Eastern Daylight Time	08/04/2019 11:33:02 AM Eastern Daylight Time	08/02/2019 01:18:34 PM Eastern Daylight Time			08/05/2019 11:12:35 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H5216-199 (PPO)	1	4		1			H5216	199	0	2020	Select counties in New Mexico		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	200	0	1	4	1	H5216_200_0	3	1			07/16/2019	2020.01	07/16/2019 01:07:04 PM Eastern Daylight Time	06/01/2019 10:10:10 AM Eastern Daylight Time				07/16/2019 04:45:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-200 (PPO)	1	4		1			H5216	200	0	2020	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools			(502)580-1000				(502)580-1000										(800)475-0480		(800)475-0480		(800)475-0480		(800)475-0480										2					2						2			
H5216	201	0	1	4	1	H5216_201_0	3	1			07/16/2019	2020.01	07/16/2019 01:09:52 PM Eastern Daylight Time	06/01/2019 10:08:56 AM Eastern Daylight Time				07/16/2019 04:45:03 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-201 (PPO)	1	4		1			H5216	201	0	2020	Select Counties in Louisiana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools			(502)580-1000				(502)580-1000										(800)475-0480		(800)475-0480		(800)475-0480		(800)475-0480										2					2						2			
H5216	202	0	1	4	1	H5216_202_0	8	1			08/06/2019	2020.01	08/06/2019 11:37:36 AM Eastern Daylight Time	08/03/2019 11:51:38 AM Eastern Daylight Time	08/02/2019 01:18:34 PM Eastern Daylight Time			08/06/2019 01:33:07 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-202 (PPO)	1	4		1			H5216	202	0	2020	Select Counties in Louisiana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools			(502)580-1000				(502)580-1000		(800)475-0480		(502)580-1000		(800)475-0480		(501)580-1000		(800)475-0480		(800)475-0480		(800)475-0480		(800)475-0480		(800)475-0480		(800)475-0480		(800)475-0480		(800)475-0480		2					2						2			
H5216	203	1	1	4	1	H5216_203_1	3	1			08/01/2019	2020.01	08/01/2019 03:57:03 PM Eastern Daylight Time	08/04/2019 12:19:27 PM Eastern Daylight Time	08/02/2019 01:18:34 PM Eastern Daylight Time			08/05/2019 10:51:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-203 (PPO)	1	4		1			H5216	203	1	2020	Select Counties in Georgia	Select Counties in Georgia	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	203	2	1	4	1	H5216_203_2	3	1			08/01/2019	2020.01	08/01/2019 03:59:26 PM Eastern Daylight Time	08/04/2019 12:20:38 PM Eastern Daylight Time	08/02/2019 01:18:34 PM Eastern Daylight Time			08/05/2019 10:51:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-203 (PPO)	1	4		1			H5216	203	2	2020	Select Counties in Georgia	Select Counties in Georgia	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	204	0	1	4	1	H5216_204_0	3	1			07/15/2019	2020.01	07/15/2019 05:21:56 PM Eastern Daylight Time	08/04/2019 12:11:24 PM Eastern Daylight Time	08/02/2019 01:18:35 PM Eastern Daylight Time			08/05/2019 10:51:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-204 (PPO)	1	4		1			H5216	204	0	2020	Select Counties in South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	205	0	1	4	1	H5216_205_0	2	1	2	1	05/30/2019	2020.01	05/30/2019 10:45:06 AM Eastern Daylight Time	08/04/2019 12:13:39 PM Eastern Daylight Time	08/02/2019 01:18:35 PM Eastern Daylight Time			08/05/2019 10:51:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-205 (PPO D-SNP)	1	4		1			H5216	205	0	2020	Select Counties in Georgia		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	206	0	1	4	1	H5216_206_0	4	1	2	1	07/15/2019	2020.01	07/15/2019 05:28:04 PM Eastern Daylight Time	08/04/2019 12:15:02 PM Eastern Daylight Time	08/02/2019 01:18:35 PM Eastern Daylight Time			08/05/2019 10:51:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-206 (PPO D-SNP)	1	4		1			H5216	206	0	2020	Select Counties in Georgia		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	207	0	1	4	1	H5216_207_0	4	1			08/05/2019	2020.01	08/05/2019 11:34:37 AM Eastern Daylight Time	08/04/2019 12:16:17 PM Eastern Daylight Time	08/02/2019 01:18:35 PM Eastern Daylight Time			08/05/2019 12:28:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-207 (PPO)	1	4		1			H5216	207	0	2020	Select Counties in Georgia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	208	0	1	4	1	H5216_208_0	3	1			08/01/2019	2020.01	08/01/2019 06:54:48 PM Eastern Daylight Time	08/04/2019 12:18:24 PM Eastern Daylight Time	08/02/2019 01:18:35 PM Eastern Daylight Time			08/05/2019 11:09:48 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-208 (PPO)	1	4		1			H5216	208	0	2020	Select Counties in South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	209	0	1	4	1	H5216_209_0	3	1			08/01/2019	2020.01	08/01/2019 06:56:03 PM Eastern Daylight Time	08/04/2019 12:09:01 PM Eastern Daylight Time	08/02/2019 01:18:35 PM Eastern Daylight Time			08/05/2019 11:09:48 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-209 (PPO)	1	4		1			H5216	209	0	2020	Select Counties in South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	210	0	1	4	1	H5216_210_0	3	1			08/01/2019	2020.01	08/01/2019 06:56:51 PM Eastern Daylight Time	08/04/2019 12:10:21 PM Eastern Daylight Time	08/02/2019 01:18:35 PM Eastern Daylight Time			08/05/2019 11:09:48 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-210 (PPO)	1	4		1			H5216	210	0	2020	Select Counties in South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	211	0	1	4	1	H5216_211_0	3	1			08/01/2019	2020.01	08/01/2019 07:18:49 PM Eastern Daylight Time	08/04/2019 05:05:41 PM Eastern Daylight Time	08/02/2019 01:18:35 PM Eastern Daylight Time			08/05/2019 11:23:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-211 (PPO)	1	4		1			H5216	211	0	2020	North Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)233-8364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	212	0	1	4	1	H5216_212_0	3	1			07/31/2019	2020.01	07/31/2019 04:59:15 PM Eastern Daylight Time	08/02/2019 05:51:50 PM Eastern Daylight Time	08/02/2019 01:18:36 PM Eastern Daylight Time			08/05/2019 10:49:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-212 (PPO)	1	4		1			H5216	212	0	2020	Dothan Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	213	0	1	4	1	H5216_213_0	2	1			05/30/2019	2020.01	05/30/2019 04:17:37 PM Eastern Daylight Time	07/17/2019 12:44:41 PM Eastern Daylight Time				07/18/2019 04:20:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-213 (PPO)	1	4		1			H5216	213	0	2020	"Select Counties in Arizona, Colorado, New Mexico"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)457-4708		(800)457-4708										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	214	1	1	4	1	H5216_214_1	4	1			07/15/2019	2020.01	07/15/2019 03:33:44 PM Eastern Daylight Time	08/02/2019 05:54:16 PM Eastern Daylight Time	08/02/2019 01:18:36 PM Eastern Daylight Time			08/05/2019 10:58:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-214 (PPO)	1	4		1			H5216	214	1	2020	Select Counties in Alabama	Select Counties in Alabama	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	214	2	1	4	1	H5216_214_2	4	1			07/15/2019	2020.01	07/15/2019 03:35:13 PM Eastern Daylight Time	08/02/2019 05:53:27 PM Eastern Daylight Time	08/02/2019 01:18:36 PM Eastern Daylight Time			08/05/2019 10:58:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-214 (PPO)	1	4		1			H5216	214	2	2020	Select Counties in Alabama	Select Counties in Alabama	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	214	3	1	4	1	H5216_214_3	4	1			07/15/2019	2020.01	07/15/2019 03:36:52 PM Eastern Daylight Time	08/02/2019 05:52:39 PM Eastern Daylight Time	08/02/2019 01:18:36 PM Eastern Daylight Time			08/05/2019 10:58:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-214 (PPO)	1	4		1			H5216	214	3	2020	Select Counties in Alabama	Select Counties in Alabama	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	215	0	1	4	1	H5216_215_0	3	1			07/15/2019	2020.01	07/15/2019 04:42:06 PM Eastern Daylight Time	08/04/2019 03:36:04 PM Eastern Daylight Time	08/02/2019 01:18:36 PM Eastern Daylight Time			08/05/2019 11:17:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-215 (PPO)	1	4		1			H5216	215	0	2020	Springfield area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	216	0	1	4	1	H5216_216_0	1	1			05/31/2019	2020.01	05/31/2019 01:56:04 PM Eastern Daylight Time	05/31/2019 09:29:38 AM Eastern Daylight Time				05/31/2019 02:38:25 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-216 (PPO)	1	4		1			H5216	216	0	2020	"Clark, Nye (partial) and Washoe counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	217	0	1	4	1	H5216_217_0	2	1			07/15/2019	2020.01	07/15/2019 05:53:04 PM Eastern Daylight Time	05/31/2019 03:12:14 PM Eastern Daylight Time				07/16/2019 05:39:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-217 (PPO)	1	4		1			H5216	217	0	2020	Select Counties in Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	218	0	1	4	1	H5216_218_0	2	1			07/15/2019	2020.01	07/15/2019 04:29:48 PM Eastern Daylight Time	05/31/2019 10:45:20 PM Eastern Daylight Time				07/16/2019 07:28:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-218 (PPO)	1	4		1			H5216	218	0	2020	States of Indiana and Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)457-4708		(800)457-4708										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	219	0	1	4	1	H5216_219_0	2	1	2	1	07/15/2019	2020.01	07/15/2019 12:09:55 PM Eastern Daylight Time	08/02/2019 10:35:53 AM Eastern Daylight Time	08/02/2019 01:18:36 PM Eastern Daylight Time			08/05/2019 11:43:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-219 (PPO D-SNP)	1	4		1			H5216	219	0	2020	Select Counties in Arkansas		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	220	0	1	4	1	H5216_220_0	2	1	2	1	05/30/2019	2020.01	05/30/2019 05:15:09 PM Eastern Daylight Time	08/04/2019 07:41:33 PM Eastern Daylight Time	08/02/2019 01:18:36 PM Eastern Daylight Time			08/05/2019 11:16:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5216-220 (PPO D-SNP)	1	4		1			H5216	220	0	2020	Select Counties in West Virgina		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	221	0	1	4	1	H5216_221_0	3	1			07/16/2019	2020.01	07/16/2019 02:27:02 PM Eastern Daylight Time	07/16/2019 09:23:00 AM Eastern Daylight Time				07/16/2019 06:37:28 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-221 (PPO)	1	4		1			H5216	221	0	2020	Select Counties in Pennsylvania		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5216	222	0	1	4	1	H5216_222_0	3	1			07/15/2019	2020.01	07/15/2019 03:42:06 PM Eastern Daylight Time	08/04/2019 05:50:52 PM Eastern Daylight Time	08/02/2019 01:18:36 PM Eastern Daylight Time			08/05/2019 10:56:52 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H5216-222 (PPO)	1	4		1			H5216	222	0	2020	"Bannock, Bingham and Bonneville counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5216	805	0	1	4	1	H5216_805_0	3	1			05/29/2019	2020.01	05/29/2019 09:12:38 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5216	805	0	2020	Select Counties in Multi-States		1	2401661	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	806	0	1	4	1	H5216_806_0	1	1			05/29/2019	2020.01	05/29/2019 09:13:40 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5216	806	0	2020	Select Counties in Multi-States		1	3226149	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	808	0	2	4	1	H5216_808_0	1	1			05/29/2019	2020.01	05/29/2019 09:16:41 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		2	1		H5216	808	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	809	0	2	4	1	H5216_809_0	1	1			05/29/2019	2020.01	05/29/2019 09:16:15 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		2	1		H5216	809	0	2020	Select Counties in Multi-States		1	74554	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	811	0	1	4	1	H5216_811_0	1	1			05/29/2019	2020.01	05/29/2019 09:18:33 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5216	811	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	812	0	1	4	1	H5216_812_0	1	1			05/29/2019	2020.01	05/29/2019 09:19:25 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5216	812	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	813	0	1	4	1	H5216_813_0	1	1			05/29/2019	2020.01	05/29/2019 09:20:49 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5216	813	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	814	0	1	4	1	H5216_814_0	1	1			05/29/2019	2020.01	05/29/2019 09:21:45 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5216	814	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	815	0	1	4	1	H5216_815_0	1	1			05/29/2019	2020.01	05/29/2019 09:22:53 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5216	815	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5216	816	0	1	4	1	H5216_816_0	1	1			05/29/2019	2020.01	05/29/2019 09:24:53 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5216	816	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5232	1	0	1	4	1	H5232_001_0	6	1			07/10/2019	2020.01	07/10/2019 12:40:40 PM Eastern Daylight Time	08/06/2019 10:17:27 AM Eastern Daylight Time	08/06/2019 10:17:28 AM Eastern Daylight Time			08/06/2019 10:21:26 AM Eastern Daylight Time	"PARAMOUNT CARE, INC."	Paramount Elite/Medicare Plans	www.paramounthealthcare.com/medicareplans	Paramount Elite - Preferred PPO (PPO)	1	4		1			H5232	1	0	2020	Paramount Elite Preferred PPO (Northwestern Ohio)		2		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			
H5253	4	0	1	2	1	H5253_004_0	3	1			08/02/2019	2020.01	08/02/2019 10:54:31 AM Central Daylight Time	08/02/2019 11:31:45 AM Central Daylight Time	07/30/2019 09:07:09 PM Central Daylight Time			08/06/2019 11:19:53 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H5253	4	0	2020	Milwaukee Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	7	0	1	2	1	H5253_007_0	3	1		1	07/11/2019	2020.01	07/11/2019 02:35:40 PM Central Daylight Time	08/02/2019 11:32:04 AM Central Daylight Time	07/30/2019 09:07:43 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan 1 (HMO-POS I-SNP)	1	2		1			H5253	7	0	2020	Select Counties in Wisconsin		2		2			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	2			
H5253	11	0	1	2	1	H5253_011_0	3	1			08/02/2019	2020.01	08/02/2019 10:55:01 AM Central Daylight Time	08/02/2019 11:32:22 AM Central Daylight Time	07/30/2019 09:08:16 PM Central Daylight Time			08/06/2019 11:19:53 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H5253	11	0	2020	Select counties in Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	21	0	1	2	1	H5253_021_0	2	1			07/11/2019	2020.01	07/11/2019 01:53:11 PM Central Daylight Time	05/31/2019 11:36:05 AM Central Daylight Time				07/12/2019 11:04:46 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Essential (HMO-POS)	1	2		1			H5253	21	0	2020	Select counties in Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5253	24	0	1	1	1	H5253_024_0	3	1	2	1	07/11/2019	2020.01	07/11/2019 05:32:46 PM Central Daylight Time	08/02/2019 11:33:00 AM Central Daylight Time	07/30/2019 09:08:52 PM Central Daylight Time			08/06/2019 12:14:20 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO D-SNP)	1	1		1			H5253	24	0	2020	Select counties in Wisconsin		2		2			1	3		2		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	2			
H5253	30	0	1	2	1	H5253_030_0	3	1			08/02/2019	2020.01	08/02/2019 10:55:27 AM Central Daylight Time	08/02/2019 11:33:19 AM Central Daylight Time	07/30/2019 09:09:24 PM Central Daylight Time			08/06/2019 11:19:53 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H5253	30	0	2020	Southern Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	33	0	1	2	1	H5253_033_0	3	1			08/02/2019	2020.01	08/02/2019 10:55:55 AM Central Daylight Time	08/02/2019 11:33:38 AM Central Daylight Time	07/30/2019 09:09:55 PM Central Daylight Time			08/06/2019 11:19:53 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value (HMO-POS)	1	2		1			H5253	33	0	2020	Milwaukee Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	34	0	1	2	1	H5253_034_0	3	1			08/02/2019	2020.01	08/02/2019 10:56:19 AM Central Daylight Time	08/02/2019 11:33:57 AM Central Daylight Time	07/30/2019 09:10:32 PM Central Daylight Time			08/06/2019 11:19:53 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value (HMO-POS)	1	2		1			H5253	34	0	2020	Select Counties in Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	35	0	1	2	1	H5253_035_0	3	1			07/12/2019	2020.01	07/12/2019 09:23:30 AM Central Daylight Time	08/02/2019 11:34:15 AM Central Daylight Time	07/30/2019 09:11:06 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plus (HMO-POS)	1	2		1			H5253	35	0	2020	"Graham, Pima, and Santa Cruz counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	36	0	1	1	1	H5253_036_0	3	1			07/12/2019	2020.01	07/12/2019 09:23:14 AM Central Daylight Time	08/02/2019 11:34:34 AM Central Daylight Time	07/30/2019 09:11:42 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H5253	36	0	2020	Yavapai county		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	37	0	1	2	1	H5253_037_0	3	1			08/02/2019	2020.01	08/02/2019 03:19:14 PM Central Daylight Time	08/02/2019 11:34:53 AM Central Daylight Time	07/30/2019 09:12:18 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H5253	37	0	2020	Select counties in North Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	38	0	1	2	1	H5253_038_0	3	1			07/11/2019	2020.01	07/11/2019 04:48:12 PM Central Daylight Time	08/02/2019 11:35:12 AM Central Daylight Time	07/30/2019 09:12:53 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	1	2		1			H5253	38	0	2020	Select counties in North Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	39	0	1	2	1	H5253_039_0	3	1			07/11/2019	2020.01	07/11/2019 04:48:38 PM Central Daylight Time	08/02/2019 11:35:30 AM Central Daylight Time	07/30/2019 09:13:30 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	1	2		1			H5253	39	0	2020	Durham and Wake counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	40	0	1	2	1	H5253_040_0	2	1			07/11/2019	2020.01	07/11/2019 04:49:07 PM Central Daylight Time	05/31/2019 06:33:02 PM Central Daylight Time				07/12/2019 12:16:48 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Essential (HMO-POS)	1	2		1			H5253	40	0	2020	Select counties in North Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5253	41	0	1	2	1	H5253_041_0	3	1	2	1	07/17/2019	2020.01	07/17/2019 10:12:35 AM Central Daylight Time	08/02/2019 11:36:08 AM Central Daylight Time	07/30/2019 09:14:08 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	1	2		1			H5253	41	0	2020	Select Counties in North Carolina		2		2			1	3		2		2	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	42	0	1	1	1	H5253_042_0	2	1		1	05/30/2019	2020.01	05/30/2019 05:02:38 PM Central Daylight Time	08/02/2019 11:36:26 AM Central Daylight Time	07/30/2019 09:14:42 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO I-SNP)	1	1		1			H5253	42	0	2020	Select Counties in North Carolina		2		2			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	2			
H5253	43	0	1	2	1	H5253_043_0	2	1		1	05/24/2019	2020.01	05/24/2019 01:48:37 PM Central Daylight Time	08/02/2019 11:36:45 AM Central Daylight Time	07/30/2019 09:15:16 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP)	1	2		1			H5253	43	0	2020	Select Counties in North Carolina		2		2			1	1	2				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	2			
H5253	47	0	1	1	1	H5253_047_0	2	1			08/02/2019	2020.01	08/02/2019 11:53:10 AM Central Daylight Time	08/02/2019 11:37:04 AM Central Daylight Time	07/30/2019 09:15:50 PM Central Daylight Time			08/06/2019 10:25:59 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H5253	47	0	2020	Select Counties in Tennessee and Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	48	0	1	1	1	H5253_048_0	2	1			08/02/2019	2020.01	08/02/2019 11:53:30 AM Central Daylight Time	08/02/2019 11:37:23 AM Central Daylight Time	07/30/2019 09:16:27 PM Central Daylight Time			08/06/2019 10:25:59 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H5253	48	0	2020	Select Counties in Tennessee and Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	49	0	1	1	1	H5253_049_0	4	1			08/02/2019	2020.01	08/02/2019 12:18:07 PM Central Daylight Time	08/02/2019 11:37:41 AM Central Daylight Time	07/30/2019 09:17:01 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 7 (HMO)	1	1		1			H5253	49	0	2020	Cleveland Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	50	0	1	1	1	H5253_050_0	3	1			08/02/2019	2020.01	08/02/2019 12:18:24 PM Central Daylight Time	08/02/2019 11:38:00 AM Central Daylight Time	07/30/2019 09:17:36 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H5253	50	0	2020	Cleveland Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	51	0	1	1	1	H5253_051_0	3	1			08/02/2019	2020.01	08/02/2019 12:18:46 PM Central Daylight Time	08/02/2019 11:38:18 AM Central Daylight Time	07/30/2019 09:18:12 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	1	1		1			H5253	51	0	2020	Cleveland Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	52	0	1	1	1	H5253_052_0	3	1			08/02/2019	2020.01	08/02/2019 12:19:04 PM Central Daylight Time	08/02/2019 11:38:37 AM Central Daylight Time	07/30/2019 09:18:46 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 6 (HMO)	1	1		1			H5253	52	0	2020	Cincinnati/Dayton Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	54	0	1	1	1	H5253_054_0	3	1			08/02/2019	2020.01	08/02/2019 12:19:22 PM Central Daylight Time	08/02/2019 11:38:56 AM Central Daylight Time	07/30/2019 09:19:20 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	1	1		1			H5253	54	0	2020	Cincinnati/Dayton Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	59	0	1	1	1	H5253_059_0	3	1	2	1	07/11/2019	2020.01	07/11/2019 09:57:36 AM Central Daylight Time	08/02/2019 11:39:14 AM Central Daylight Time	07/30/2019 09:19:56 PM Central Daylight Time			08/06/2019 12:14:20 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO D-SNP)	1	1		1			H5253	59	0	2020	Select Counties in Ohio		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-3488		(866)944-3488		(888)834-3721		(888)834-3721		(866)944-3488		(866)944-3488		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	60	0	1	2	1	H5253_060_0	2	1		1	05/25/2019	2020.01	05/25/2019 05:51:30 PM Central Daylight Time	08/02/2019 11:39:33 AM Central Daylight Time	07/30/2019 09:20:31 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)	1	2		1			H5253	60	0	2020	Select Counties in Ohio		2		2			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	2			
H5253	61	0	1	2	1	H5253_061_0	2	1		1	05/28/2019	2020.01	05/28/2019 06:18:02 PM Central Daylight Time	08/02/2019 11:39:51 AM Central Daylight Time	07/30/2019 09:21:05 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP)	1	2		1			H5253	61	0	2020	"Lake, Lorain, and Lucas Counties"		2		2			1	1	2				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	2			
H5253	62	0	1	1	1	H5253_062_0	3	1			08/02/2019	2020.01	08/02/2019 12:19:40 PM Central Daylight Time	08/02/2019 11:40:10 AM Central Daylight Time	07/30/2019 09:21:41 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 5 (HMO)	1	1		1			H5253	62	0	2020	Central Ohio area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	63	0	1	1	1	H5253_063_0	3	1			08/02/2019	2020.01	08/02/2019 12:19:59 PM Central Daylight Time	08/02/2019 11:40:28 AM Central Daylight Time	07/30/2019 09:22:18 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	1	1		1			H5253	63	0	2020	Central Ohio area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	64	0	1	2	1	H5253_064_0	2	1		1	05/28/2019	2020.01	05/28/2019 06:18:18 PM Central Daylight Time	08/02/2019 11:40:47 AM Central Daylight Time	07/30/2019 09:22:55 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO-POS I-SNP)	1	2		1			H5253	64	0	2020	Select Counties in Wisconsin		2		2			1	1	2				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	2			
H5253	67	0	1	1	1	H5253_067_0	3	1			08/02/2019	2020.01	08/02/2019 12:20:19 PM Central Daylight Time	08/02/2019 11:41:06 AM Central Daylight Time	07/30/2019 09:23:33 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H5253	67	0	2020	Lexington Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	72	0	1	2	1	H5253_072_0	3	1			08/02/2019	2020.01	08/02/2019 10:56:44 AM Central Daylight Time	08/02/2019 11:41:24 AM Central Daylight Time	07/30/2019 09:24:07 PM Central Daylight Time			08/06/2019 11:19:53 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value (HMO-POS)	1	2		1			H5253	72	0	2020	Central Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	73	0	1	2	1	H5253_073_0	3	1			08/02/2019	2020.01	08/02/2019 10:57:39 AM Central Daylight Time	08/02/2019 11:41:43 AM Central Daylight Time	07/30/2019 09:24:42 PM Central Daylight Time			08/06/2019 11:19:53 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H5253	73	0	2020	Central Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	77	0	1	2	1	H5253_077_0	3	1			08/02/2019	2020.01	08/02/2019 10:58:03 AM Central Daylight Time	08/02/2019 11:42:01 AM Central Daylight Time	07/30/2019 09:25:16 PM Central Daylight Time			08/06/2019 11:19:53 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Premier (HMO-POS)	1	2		1			H5253	77	0	2020	Southern Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	79	0	1	2	1	H5253_079_0	3	1			07/11/2019	2020.01	07/11/2019 04:49:59 PM Central Daylight Time	08/02/2019 11:42:20 AM Central Daylight Time	07/30/2019 09:25:52 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	1	2		1			H5253	79	0	2020	Asheville Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	80	0	1	2	1	H5253_080_0	4	1			07/22/2019	2020.01	07/22/2019 01:54:05 PM Central Daylight Time	08/02/2019 11:42:39 AM Central Daylight Time	07/30/2019 09:26:27 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H5253	80	0	2020	Asheville Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	81	0	1	1	1	H5253_081_0	3	1			08/02/2019	2020.01	08/02/2019 11:56:14 AM Central Daylight Time	08/02/2019 11:42:57 AM Central Daylight Time	07/30/2019 09:27:05 PM Central Daylight Time			08/06/2019 10:25:59 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H5253	81	0	2020	Memphis Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	82	0	1	1	1	H5253_082_0	2	1			08/02/2019	2020.01	08/02/2019 11:55:58 AM Central Daylight Time	08/02/2019 11:43:16 AM Central Daylight Time	07/30/2019 09:27:40 PM Central Daylight Time			08/06/2019 10:25:59 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H5253	82	0	2020	Memphis Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	83	0	1	1	1	H5253_083_0	3	1			08/02/2019	2020.01	08/02/2019 11:55:44 AM Central Daylight Time	08/02/2019 11:43:34 AM Central Daylight Time	07/30/2019 09:28:17 PM Central Daylight Time			08/06/2019 10:25:59 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H5253	83	0	2020	Nashville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	84	0	1	1	1	H5253_084_0	3	1			08/02/2019	2020.01	08/02/2019 11:55:29 AM Central Daylight Time	08/02/2019 11:43:53 AM Central Daylight Time	07/30/2019 09:28:54 PM Central Daylight Time			08/06/2019 10:25:59 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H5253	84	0	2020	Nashville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	87	0	1	1	1	H5253_087_0	2	1			08/02/2019	2020.01	08/02/2019 09:44:24 AM Central Daylight Time	08/02/2019 11:44:12 AM Central Daylight Time	07/30/2019 09:29:27 PM Central Daylight Time			08/06/2019 01:35:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H5253	87	0	2020	Southeastern Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	88	0	1	1	1	H5253_088_0	2	1			08/02/2019	2020.01	08/02/2019 09:45:21 AM Central Daylight Time	08/02/2019 11:44:30 AM Central Daylight Time	07/30/2019 09:29:59 PM Central Daylight Time			08/06/2019 01:35:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H5253	88	0	2020	Southeastern Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	89	0	1	1	1	H5253_089_0	2	1			08/02/2019	2020.01	08/02/2019 09:46:27 AM Central Daylight Time	08/02/2019 11:44:49 AM Central Daylight Time	07/30/2019 09:30:34 PM Central Daylight Time			08/06/2019 01:35:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H5253	89	0	2020	Northern VA and Washington DC Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	90	0	1	1	1	H5253_090_0	2	1			08/02/2019	2020.01	08/02/2019 09:47:10 AM Central Daylight Time	08/02/2019 11:45:07 AM Central Daylight Time	07/30/2019 09:31:07 PM Central Daylight Time			08/06/2019 01:35:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H5253	90	0	2020	Northern VA and Washington DC Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	91	0	1	1	1	H5253_091_0	3	1			08/02/2019	2020.01	08/02/2019 12:20:45 PM Central Daylight Time	08/02/2019 11:45:26 AM Central Daylight Time	07/30/2019 09:31:43 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 3 (HMO)	1	1		1			H5253	91	0	2020	Lexington Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	97	0	1	1	1	H5253_097_0	3	1			08/02/2019	2020.01	08/02/2019 10:58:25 AM Central Daylight Time	08/02/2019 11:45:45 AM Central Daylight Time	07/30/2019 09:32:17 PM Central Daylight Time			08/06/2019 11:19:53 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Value (HMO)	1	1		1			H5253	97	0	2020	Southern Wisconsin		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	99	0	1	1	1	H5253_099_0	3	1			08/02/2019	2020.01	08/02/2019 12:21:06 PM Central Daylight Time	08/02/2019 11:46:03 AM Central Daylight Time	07/30/2019 09:32:50 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H5253	99	0	2020	Louisville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	100	0	1	1	1	H5253_100_0	3	1			08/02/2019	2020.01	08/02/2019 12:21:24 PM Central Daylight Time	08/02/2019 11:46:22 AM Central Daylight Time	07/30/2019 09:33:24 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H5253	100	0	2020	Louisville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	102	0	1	2	1	H5253_102_0	3	1			07/11/2019	2020.01	07/11/2019 04:50:52 PM Central Daylight Time	08/02/2019 11:46:40 AM Central Daylight Time	07/30/2019 09:33:57 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H5253	102	0	2020	Durham and Wake Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	103	0	1	1	1	H5253_103_0	3	1			07/11/2019	2020.01	07/11/2019 04:51:21 PM Central Daylight Time	08/02/2019 11:46:59 AM Central Daylight Time	07/30/2019 09:34:29 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H5253	103	0	2020	Select counties in North Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	104	0	1	2	1	H5253_104_0	3	1			07/11/2019	2020.01	07/11/2019 04:51:44 PM Central Daylight Time	08/02/2019 11:47:18 AM Central Daylight Time	07/30/2019 09:35:03 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H5253	104	0	2020	Select counties in North Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	105	0	1	1	1	H5253_105_0	7	1			07/11/2019	2020.01	07/11/2019 04:52:05 PM Central Daylight Time	08/02/2019 11:47:36 AM Central Daylight Time	07/30/2019 09:35:35 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO)	1	1		1			H5253	105	0	2020	"Buncombe, McDowell, and Transylvania counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	106	1	1	2	1	H5253_106_1	2	1			08/02/2019	2020.01	08/02/2019 10:32:17 AM Central Daylight Time	08/02/2019 11:47:55 AM Central Daylight Time	07/30/2019 09:36:09 PM Central Daylight Time			08/06/2019 11:19:53 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H5253	106	1	2020	Select counties in Iowa	Iowa Metro	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	106	2	1	2	1	H5253_106_2	3	1			08/02/2019	2020.01	08/02/2019 10:35:16 AM Central Daylight Time	08/02/2019 11:48:14 AM Central Daylight Time	07/30/2019 09:36:39 PM Central Daylight Time			08/06/2019 11:19:53 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H5253	106	2	2020	Select counties in Iowa	Iowa Rural	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	107	1	1	2	1	H5253_107_1	2	1			08/05/2019	2020.01	08/05/2019 05:39:05 PM Central Daylight Time	08/02/2019 11:48:32 AM Central Daylight Time	07/30/2019 09:37:13 PM Central Daylight Time			08/06/2019 11:19:53 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	1	2		1			H5253	107	1	2020	Select Counties in Iowa	Iowa Metro	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	107	2	1	2	1	H5253_107_2	3	1			08/02/2019	2020.01	08/02/2019 10:34:48 AM Central Daylight Time	08/02/2019 11:48:51 AM Central Daylight Time	07/30/2019 09:37:46 PM Central Daylight Time			08/06/2019 11:19:53 AM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	1	2		1			H5253	107	2	2020	Select Counties in Iowa	Iowa Rural	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	108	1	1	2	1	H5253_108_1	3	1			08/02/2019	2020.01	08/02/2019 12:21:43 PM Central Daylight Time	08/02/2019 11:49:10 AM Central Daylight Time	07/30/2019 09:38:19 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H5253	108	1	2020	Northwestern Illinois	Northwestern Illinois	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	108	2	1	2	1	H5253_108_2	2	1			08/02/2019	2020.01	08/02/2019 12:22:02 PM Central Daylight Time	08/02/2019 11:49:28 AM Central Daylight Time	07/30/2019 09:38:54 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO-POS)	1	2		1			H5253	108	2	2020	Northwestern Illinois	"Henry, Mercer and Rock Island Counties"	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	109	1	1	1	1	H5253_109_1	2	1			08/02/2019	2020.01	08/02/2019 12:22:20 PM Central Daylight Time	08/02/2019 11:49:47 AM Central Daylight Time	07/30/2019 09:39:30 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H5253	109	1	2020	Select Counties in Ohio and Kentucky	Central Ohio Area	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	109	2	1	1	1	H5253_109_2	3	1			08/02/2019	2020.01	08/02/2019 12:22:36 PM Central Daylight Time	08/02/2019 11:50:06 AM Central Daylight Time	07/30/2019 09:40:04 PM Central Daylight Time			08/05/2019 05:08:32 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H5253	109	2	2020	Select Counties in Ohio and Kentucky	Cincinnati/Dayton Metro Area	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	110	0	1	1	1	H5253_110_0	3	1			07/11/2019	2020.01	07/11/2019 04:52:29 PM Central Daylight Time	08/02/2019 11:50:24 AM Central Daylight Time	07/30/2019 09:40:38 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (HMO)	1	1		1			H5253	110	0	2020	Select Counties in North Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	111	1	1	1	1	H5253_111_1	3	1			08/02/2019	2020.01	08/02/2019 09:52:12 AM Central Daylight Time	08/02/2019 11:50:43 AM Central Daylight Time	07/30/2019 09:41:12 PM Central Daylight Time			08/06/2019 01:35:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H5253	111	1	2020	Roanoke/Richmond Metro Area	Roanoke	2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	111	2	1	1	1	H5253_111_2	2	1			08/02/2019	2020.01	08/02/2019 09:52:34 AM Central Daylight Time	08/02/2019 11:51:01 AM Central Daylight Time	07/30/2019 09:41:45 PM Central Daylight Time			08/06/2019 01:35:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H5253	111	2	2020	Roanoke/Richmond Metro Area	Richmond	2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	112	1	1	1	1	H5253_112_1	3	1			08/06/2019	2020.01	08/06/2019 12:59:35 PM Central Daylight Time	08/02/2019 11:51:20 AM Central Daylight Time	07/30/2019 09:42:19 PM Central Daylight Time			08/06/2019 01:35:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H5253	112	1	2020	Richmond and Roanoke Metro Area	Roanoke	2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	112	2	1	1	1	H5253_112_2	2	1			08/05/2019	2020.01	08/05/2019 08:30:33 AM Central Daylight Time	08/02/2019 11:51:39 AM Central Daylight Time	07/30/2019 09:42:54 PM Central Daylight Time			08/06/2019 01:35:07 PM Central Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Plan 2 (HMO)	1	1		1			H5253	112	2	2020	Richmond and Roanoke Metro Area	Richmond	2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5253	801	0	1	1	1	H5253_801_0	1	1			05/11/2019	2020.01	05/11/2019 09:32:59 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	801	0	2020	Milwaukee and Green Bay Area Counties		1	72	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	802	0	1	1	1	H5253_802_0	1	1			05/11/2019	2020.01	05/11/2019 09:33:38 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	802	0	2020	Milwaukee and Green Bay Area Counties		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	805	0	1	1	1	H5253_805_0	1	1			05/11/2019	2020.01	05/11/2019 09:35:49 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	805	0	2020	Select Counties in WI		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	810	0	1	1	1	H5253_810_0	1	1			05/11/2019	2020.01	05/11/2019 09:35:00 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	810	0	2020	Arizona		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	811	0	1	1	1	H5253_811_0	1	1			05/11/2019	2020.01	05/11/2019 09:35:38 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	811	0	2020	Arizona		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	812	0	1	1	1	H5253_812_0	1	1			05/11/2019	2020.01	05/11/2019 09:36:36 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	812	0	2020	Arizona		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	813	0	1	1	1	H5253_813_0	1	1			05/11/2019	2020.01	05/11/2019 09:37:20 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	813	0	2020	Select counties in North Carolina		1	4296	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	814	0	1	1	1	H5253_814_0	1	1			05/11/2019	2020.01	05/11/2019 09:37:56 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	814	0	2020	Select counties in North Carolina		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	815	0	1	1	1	H5253_815_0	1	1			05/11/2019	2020.01	05/11/2019 09:38:31 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	815	0	2020	Select counties in North Carolina		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	816	0	2	1	1	H5253_816_0	1	1			05/11/2019	2020.01	05/11/2019 09:39:11 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		2	2		H5253	816	0	2020	Select counties in North Carolina		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	817	0	2	1	1	H5253_817_0	1	1			05/11/2019	2020.01	05/11/2019 09:40:16 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		2	2		H5253	817	0	2020	Select counties in North Carolina		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	818	0	1	1	1	H5253_818_0	1	1			05/11/2019	2020.01	05/11/2019 09:42:01 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	818	0	2020	"Select counties in IA, IL, TN, & VA"		1	3708	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	819	0	1	1	1	H5253_819_0	1	1			05/11/2019	2020.01	05/11/2019 09:42:13 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	819	0	2020	"Select counties in IA, IL, TN, & VA"		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	820	0	1	1	1	H5253_820_0	1	1			05/11/2019	2020.01	05/11/2019 09:42:48 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	820	0	2020	"Select counties in IA, IL, TN, & VA"		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	821	0	1	1	1	H5253_821_0	1	1			05/11/2019	2020.01	05/11/2019 09:43:27 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	821	0	2020	Select counties in Kentucky and Ohio		1	732	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	822	0	1	1	1	H5253_822_0	1	1			05/11/2019	2020.01	05/11/2019 09:44:10 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	822	0	2020	Select counties in Kentucky and Ohio		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5253	823	0	1	1	1	H5253_823_0	1	1			05/11/2019	2020.01	05/11/2019 09:45:37 AM Eastern Daylight Time					06/03/2019 07:39:57 AM Eastern Daylight Time	"UNITEDHEALTHCARE OF WISCONSIN, INC."	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	1	1		1			H5253	823	0	2020	Select counties in Kentucky and Ohio		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;17a;18a;	2		1					1				
H5256	1	0	1	18	6	H5256_001_0	5	2			05/31/2019	2020.01	05/31/2019 11:14:01 AM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthplans.com	Medical Associates SmartPlan (Cost)	6	18		1			H5256	1	0	2020	"Grant, Crawford, Iowa, Lafayette Counties"		2	34700	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H5256	2	0	1	18	6	H5256_002_0	5	2			05/31/2019	2020.01	05/31/2019 01:07:51 PM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthplans.com	Medical Associates Community Plan (Cost)	6	18		1			H5256	2	0	2020	"Grant, Crawford, Iowa, Lafayette Counties"		2	4350	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H5256	4	0	1	18	6	H5256_004_0	5	2			05/31/2019	2020.01	05/31/2019 01:57:45 PM Central Daylight Time					06/03/2019 11:42:29 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthplans.com	Medical Associates Freedom Plan (Cost)	6	18		1			H5256	4	0	2020	"Grant, Crawford, Iowa, Lafayette Counties"		2	5400	2			2									(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2942		(800)735-2942		(800)735-2942		(800)735-2942										2					2					2	2			
H5262	1	0	1	1	1	H5262_001_0	2	1			05/28/2019	2020.01	05/28/2019 10:56:55 AM Central Daylight Time	06/03/2019 09:54:26 PM Central Daylight Time	06/03/2019 09:54:00 PM Central Daylight Time			06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	Gundersen Senior Preferred Elite (w/Rx) (HMO)	1	1		1			H5262	1	0	2020	La Crosse and SW Wisconsin and NE Iowa		2		2			2						https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredgundersen/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	3	0	1	1	1	H5262_003_0	2	1			05/28/2019	2020.01	05/28/2019 10:57:23 AM Central Daylight Time	06/03/2019 09:54:28 PM Central Daylight Time	06/03/2019 09:54:01 PM Central Daylight Time			06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	Gundersen Senior Preferred Value (w/Rx) (HMO)	1	1		1			H5262	3	0	2020	La Crosse and SW Wisconsin and NE Iowa		2		2			2						https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredgundersen/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	4	0	1	1	1	H5262_004_0	2	1			05/23/2019	2020.01	05/23/2019 10:19:16 AM Central Daylight Time	06/03/2019 09:54:28 PM Central Daylight Time				06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	Gundersen Senior Preferred Value (no Rx) (HMO)	1	1		1			H5262	4	0	2020	La Crosse and SW Wisconsin and NE Iowa		2		2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferredgundersen/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5262	5	0	1	1	1	H5262_005_0	2	1			05/23/2019	2020.01	05/23/2019 10:19:28 AM Central Daylight Time	06/03/2019 09:54:30 PM Central Daylight Time				06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	Gundersen Senior Preferred Elite (no Rx) (HMO)	1	1		1			H5262	5	0	2020	La Crosse and SW Wisconsin and NE Iowa		2		2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferredgundersen/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5262	7	0	1	1	1	H5262_007_0	2	1			05/28/2019	2020.01	05/28/2019 11:08:56 AM Central Daylight Time	06/03/2019 09:54:31 PM Central Daylight Time	06/03/2019 09:54:02 PM Central Daylight Time			06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	UW Health Senior Preferred Elite (w/Rx) (HMO)	1	1		1			H5262	7	0	2020	"Columbia, Dane, Iowa, Richland, and Sauk Counties"		2		2			2						https://www.seniorpreferred.org/seniorpreferreduw/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferreduw/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferreduw/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	8	0	1	1	1	H5262_008_0	2	1			05/28/2019	2020.01	05/28/2019 11:09:32 AM Central Daylight Time	06/03/2019 09:54:31 PM Central Daylight Time	06/03/2019 09:54:03 PM Central Daylight Time			06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	UW Health Senior Preferred Value (w/Rx) (HMO)	1	1		1			H5262	8	0	2020	"Columbia, Dane, Iowa, Richland, and Sauk Counties"		2		2			2						https://www.seniorpreferred.org/seniorpreferreduw/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferreduw/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferreduw/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	9	0	1	1	1	H5262_009_0	3	1			05/23/2019	2020.01	05/23/2019 10:29:44 AM Central Daylight Time	06/04/2019 02:28:02 PM Central Daylight Time				06/05/2019 04:03:41 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	UW Health Senior Preferred Value (no Rx) (HMO)	1	1		1			H5262	9	0	2020	"Columbia, Dane, Iowa, Richland, and Sauk Counties"		2		2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferreduw/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5262	10	0	1	1	1	H5262_010_0	2	1			05/23/2019	2020.01	05/23/2019 10:30:47 AM Central Daylight Time	06/03/2019 09:54:33 PM Central Daylight Time				06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	UW Health Senior Preferred Elite (no Rx) (HMO)	1	1		1			H5262	10	0	2020	"Columbia, Dane, Iowa, Richland, and Sauk Counties"		2		2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferreduw/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5262	11	0	1	1	1	H5262_011_0	2	1			05/28/2019	2020.01	05/28/2019 12:00:33 PM Central Daylight Time	06/03/2019 09:54:34 PM Central Daylight Time	06/03/2019 09:54:04 PM Central Daylight Time			06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	ProHealth Senior Preferred Elite (w/Rx) (HMO)	1	1		1			H5262	11	0	2020	Waukesha County		2		2			2						https://www.seniorpreferred.org/seniorpreferredprohealth/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferredprohealth/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredprohealth/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	12	0	1	1	1	H5262_012_0	3	1			08/06/2019	2020.01	08/06/2019 09:57:53 AM Central Daylight Time	08/06/2019 03:57:42 PM Central Daylight Time	08/06/2019 03:57:43 PM Central Daylight Time			08/06/2019 04:06:55 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	ProHealth Senior Preferred Value (w/Rx) (HMO)	1	1		1			H5262	12	0	2020	Waukesha County		2		2			2						https://www.seniorpreferred.org/seniorpreferredprohealth/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferredprohealth/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredprohealth/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	13	0	1	1	1	H5262_013_0	2	1			05/23/2019	2020.01	05/23/2019 10:24:51 AM Central Daylight Time	06/03/2019 09:54:37 PM Central Daylight Time				06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	ProHealth Senior Preferred Elite (no Rx) (HMO)	1	1		1			H5262	13	0	2020	Waukesha County		2		2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferredprohealth/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5262	18	0	1	1	1	H5262_018_0	2	1			05/28/2019	2020.01	05/28/2019 11:10:50 AM Central Daylight Time	06/03/2019 09:54:36 PM Central Daylight Time	06/03/2019 09:54:06 PM Central Daylight Time			06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	seniorpreferred.org/seniorpreferredswedishamerican	SwedishAmerican Senior Preferred Elite (w/Rx) (HMO)	1	1		1			H5262	18	0	2020	Winnebago County		2		2			2						https://www.seniorpreferred.org/seniorpreferredswedishamerican/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferredswedishamerican/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredswedishamerican/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	19	0	1	1	1	H5262_019_0	3	1			08/06/2019	2020.01	08/06/2019 09:58:14 AM Central Daylight Time	08/06/2019 03:57:42 PM Central Daylight Time	08/06/2019 03:57:43 PM Central Daylight Time			08/06/2019 04:06:55 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	seniorpreferred.org/seniorpreferredswedishamerican	SwedishAmerican Senior Preferred Value (w/Rx) (HMO)	1	1		1			H5262	19	0	2020	Winnebago County		2		2			2						https://www.seniorpreferred.org/seniorpreferredswedishamerican/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferredswedishamerican/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredswedishamerican/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	20	0	1	1	1	H5262_020_0	2	1			05/23/2019	2020.01	05/23/2019 10:25:13 AM Central Daylight Time	06/03/2019 09:54:40 PM Central Daylight Time				06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	seniorpreferred.org/seniorpreferredswedishamerican	SwedishAmerican Senior Preferred Elite (no Rx) (HMO)	1	1		1			H5262	20	0	2020	Winnebago County		2		2			2						https://www.seniorpreferred.org/seniorpreferredswedishamerican/DrugCoverage/FindAPharmacy	https://www.seniorpreferred.org/seniorpreferredswedishamerican/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredswedishamerican/FindADoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H5262	21	0	1	1	1	H5262_021_0	3	1			08/06/2019	2020.01	08/06/2019 10:36:04 AM Central Daylight Time	08/06/2019 03:57:42 PM Central Daylight Time	08/06/2019 03:57:43 PM Central Daylight Time			08/06/2019 04:06:55 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	Gundersen Senior Preferred Core (w/Rx) (HMO)	1	1		1			H5262	21	0	2020	La Crosse and SW Wisconsin and NE Iowa		2		2			2						https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/PartDDrugFormulary	http://www.seniorpreferred.org/	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	23	0	1	1	1	H5262_023_0	3	1			08/06/2019	2020.01	08/06/2019 10:36:13 AM Central Daylight Time	08/06/2019 03:57:43 PM Central Daylight Time	08/06/2019 03:57:43 PM Central Daylight Time			08/06/2019 04:06:55 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	UW Health Senior Preferred Core (w/Rx) (HMO)	1	1		1			H5262	23	0	2020	"Columbia, Dane, Iowa, Richland, and Sauk Counties"		2		2			2						https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/PartDDrugFormulary	http://www.seniorpreferred.org/	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H5262	801	0	1	1	1	H5262_801_0	2	1			05/31/2019	2020.01	05/31/2019 03:21:33 PM Central Daylight Time					06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	Employer Group Senior Preferred (w/ Rx) (HMO)	1	1		1			H5262	801	0	2020	"Southern and Western WI, Winnebago County, IL"		1	1200	2			2						https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/PartDDrugFormulary	http://www.seniorpreferred.org/	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		1	1	2;5;6;7c;7d;11a;11b;15;	2		1					1				
H5262	802	0	1	1	1	H5262_802_0	2	1			05/31/2019	2020.01	05/31/2019 03:23:20 PM Central Daylight Time					06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN CORPORATION	Senior Preferred	www.seniorpreferred.org	Employer Group Senior Preferred (no Rx) (HMO)	1	1		1			H5262	802	0	2020	"Southern and Western WI, Winnebago County, IL"		1	1200	2			2						https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/PartDDrugFormulary	http://www.seniorpreferred.org/	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										1	1	2;5;6;7c;7d;11a;11b;	2		1					1				
H5264	2	0	1	18	6	H5264_002_0	5	2			06/03/2019	2020.01	06/03/2019 10:44:19 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Health Plan, Inc."	deancare.com/medicare	DeanCare Gold Enhanced (Cost)	6	18		1			H5264	2	0	2020	South Central Wisconsin		2	160238	2			2								www.deancare.com/find-a-doctor	(888)422-3326		(608)827-4372		(888)422-3326		(608)827-4372										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5264	3	0	1	18	6	H5264_003_0	5	2			06/03/2019	2020.01	06/03/2019 10:44:42 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Health Plan, Inc."	deancare.com/medicare	DeanCare Gold Basic (Cost)	6	18		1			H5264	3	0	2020	South Central Wisconsin		2	870	2			2								www.deancare.com/find-a-doctor	(888)422-3326		(608)827-4372		(888)422-3326		(608)827-4372										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5264	5	0	1	18	6	H5264_005_0	5	2			06/03/2019	2020.01	06/03/2019 10:45:07 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Health Plan, Inc."	deancare.com/medicare	DeanCare Gold Shared Value (Cost)	6	18		1			H5264	5	0	2020	South Central Wisconsin		2	37108	2			2								www.deancare.com/drugformulary	(888)422-3326		(608)827-4372		(888)422-3326		(608)827-4372										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5273	1	0	1	1	1	H5273_001_0	6	1			08/05/2019	2020.01	08/05/2019 03:39:13 PM Eastern Daylight Time	08/02/2019 12:55:02 PM Eastern Daylight Time	07/31/2019 02:27:52 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	"CAREPARTNERS OF CONNECTICUT, INC."	CarePartners of Connecticut	www.carepartnersct.com	CarePartners of CT CareAdvantage Preferred (HMO)	1	1		1			H5273	1	0	2020	Most of Connecticut		2		2			2						https://tuftsweb.healthsparq.com/healthsparq/public/#/one/insurerCode=TUFTS_I&brandCode=THPMPCPCT&pr	www.carepartnersct.com/drug-search	https://tuftsweb.healthsparq.com/healthsparq/public/#/one/insurerCode=TUFTS_I&brandCode=THPMPCPCT&pr	(888)341-1507		(888)341-1507		(833)270-2728		(833)270-2728		(888)341-1507		(888)341-1507		(833)270-2728		(833)270-2728		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5273	2	0	1	1	1	H5273_002_0	5	1			08/05/2019	2020.01	08/05/2019 01:49:41 PM Eastern Daylight Time	08/02/2019 12:56:08 PM Eastern Daylight Time	07/31/2019 02:27:22 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	"CAREPARTNERS OF CONNECTICUT, INC."	CarePartners of Connecticut	www.carepartnersct.com	CarePartners of CT CareAdvantage Prime (HMO)	1	1		1			H5273	2	0	2020	Most of Connecticut		2		2			2						https://tuftsweb.healthsparq.com/healthsparq/public/#/one/insurerCode=TUFTS_I&brandCode=THPMPCPCT&pr	www.carepartnersct.com/drug-search	https://tuftsweb.healthsparq.com/healthsparq/public/#/one/insurerCode=TUFTS_I&brandCode=THPMPCPCT&pr	(888)341-1507		(888)341-1507		(833)270-2728		(833)270-2728		(888)341-1507		(888)341-1507		(833)270-2728		(833)270-2728		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5273	3	0	1	1	1	H5273_003_0	5	1			08/05/2019	2020.01	08/05/2019 01:49:46 PM Eastern Daylight Time	08/02/2019 12:57:34 PM Eastern Daylight Time	07/31/2019 02:28:34 PM Eastern Daylight Time			08/06/2019 02:32:05 PM Eastern Daylight Time	"CAREPARTNERS OF CONNECTICUT, INC."	CarePartners of Connecticut	www.carepartnersct.com	CarePartners of CT CareAdvantage Premier (HMO)	1	1		1			H5273	3	0	2020	Most of Connecticut		2		2			2						https://tuftsweb.healthsparq.com/healthsparq/public/#/one/insurerCode=TUFTS_I&brandCode=THPMPCPCT&pr	www.carepartnersct.com/drug-search	https://tuftsweb.healthsparq.com/healthsparq/public/#/one/insurerCode=TUFTS_I&brandCode=THPMPCPCT&pr	(888)341-1507		(888)341-1507		(833)270-2728		(833)270-2728		(888)341-1507		(888)341-1507		(833)270-2728		(833)270-2728		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5280	1	0	1	48	5	H5280_001_0	8	1			08/22/2019	2020.01	08/22/2019 05:45:07 PM Pacific Daylight Time					08/22/2019 05:47:57 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF OHIO, INC."	Molina Healthcare of Ohio	www.molinahealthcare.com/duals	Molina Dual Options  MyCareOhio (Medicare-Medicaid Plan)	5	48		1			H5280	1	0	2020	Select Counties in Ohio		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)665-4623		(855)665-4623		(866)856-8295		(866)856-8295		(855)665-4623		(855)665-4623		(866)856-8295		(866)856-8295		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H5294	2	2	1	1	1	H5294_002_2	4	1	2	1	07/17/2019	2020.01	07/17/2019 10:11:33 AM Eastern Daylight Time	07/19/2019 11:30:49 AM Pacific Daylight Time	07/15/2019 04:58:59 PM Pacific Daylight Time			07/19/2019 11:53:28 AM Pacific Daylight Time	"SUPERIOR HEALTH PLAN, INC."	Allwell	allwell.superiorhealthplan.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H5294	2	2	2020	"16 counties in No., Central, So. and West Texas"	"Cameron, Hidalgo and Starr Counties"	2		2			1	3		1		1	allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	2	3	1	1	1	H5294_002_3	4	1	2	1	05/24/2019	2020.01	07/15/2019 04:44:47 PM Pacific Daylight Time	08/05/2019 04:19:40 PM Central Daylight Time	08/05/2019 03:24:44 PM Central Daylight Time			08/06/2019 12:43:33 PM Central Daylight Time	"SUPERIOR HEALTH PLAN, INC."	Allwell	allwell.superiorhealthplan.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H5294	2	3	2020	"16 counties in No., Central, So. and West Texas"	"Colin, Rockwall, Dallas, Tarrant, Denton"	2		2			1	3		1		1	allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	2	4	1	1	1	H5294_002_4	3	1	2	1	07/17/2019	2020.01	07/17/2019 10:24:37 AM Eastern Daylight Time	07/19/2019 11:30:45 AM Pacific Daylight Time	07/15/2019 04:59:04 PM Pacific Daylight Time			07/19/2019 11:53:28 AM Pacific Daylight Time	"SUPERIOR HEALTH PLAN, INC."	Allwell	allwell.superiorhealthplan.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H5294	2	4	2020	"16 counties in No., Central, So. and West Texas"	"San Antonio, El Paso, and Corpus Christi Areas"	2		2			1	3		1		1	allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	7	0	1	1	1	H5294_007_0	3	1	2	1	05/24/2019	2020.01	05/24/2019 01:06:56 PM Pacific Daylight Time	08/05/2019 04:19:32 PM Central Daylight Time	08/05/2019 03:24:47 PM Central Daylight Time			08/06/2019 12:43:33 PM Central Daylight Time	"SUPERIOR HEALTH PLAN, INC."	Allwell	allwell.superiorhealthplan.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H5294	7	0	2020	Fort Bend and Montgomery Counties		2		2			1	3		1		1	allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5294	9	0	1	1	1	H5294_009_0	3	1	2	1	05/24/2019	2020.01	05/24/2019 01:08:18 PM Pacific Daylight Time	08/05/2019 04:19:36 PM Central Daylight Time	08/05/2019 03:24:41 PM Central Daylight Time			08/06/2019 12:43:33 PM Central Daylight Time	"SUPERIOR HEALTH PLAN, INC."	Allwell	allwell.superiorhealthplan.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H5294	9	0	2020	Lubbock County		2		2			1	3		1		1	allwell.superiorhealthplan.com/findadoctor	allwell.superiorhealthplan.com/formulary	allwell.superiorhealthplan.com/findadoctor	(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(877)935-8023		(877)935-8023		(877)826-5520		(877)826-5520		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5302	11	0	1	1	1	H5302_011_0	4	1			07/03/2019	2020.01	07/03/2019 01:52:26 PM Eastern Daylight Time	08/02/2019 12:26:46 AM Eastern Daylight Time	07/31/2019 01:26:53 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Platinum Plan (HMO)	1	1		1			H5302	11	0	2020	Select Counties in Atlanta Market		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5302	12	0	1	1	1	H5302_012_0	4	1	2	1	07/10/2019	2020.01	07/10/2019 04:35:00 PM Eastern Daylight Time	08/02/2019 12:28:52 AM Eastern Daylight Time	07/31/2019 01:28:04 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	1	1		1			H5302	12	0	2020	Atlanta Metro		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5302	13	0	1	1	1	H5302_013_0	4	1	2	1	07/10/2019	2020.01	07/10/2019 04:35:25 PM Eastern Daylight Time	08/02/2019 12:30:00 AM Eastern Daylight Time	07/31/2019 01:29:16 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Preferred Plan (HMO D-SNP)	1	1		1			H5302	13	0	2020	Cobb County		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5302	809	0	1	1	1	H5302_809_0	1	1			05/24/2019	2020.01	05/24/2019 09:50:11 AM Eastern Daylight Time					05/30/2019 06:54:08 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H5302	809	0	2020	Georgia		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5302	810	0	1	1	1	H5302_810_0	1	1			05/24/2019	2020.01	05/24/2019 09:50:20 AM Eastern Daylight Time					05/30/2019 06:54:08 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare w/Rx Plan (HMO)	1	1		1			H5302	810	0	2020	Georgia		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5302	812	0	1	1	1	H5302_812_0	1	1			05/24/2019	2020.01	05/24/2019 09:50:29 AM Eastern Daylight Time					05/30/2019 06:54:08 PM Eastern Daylight Time	AETNA HEALTH INC. (GA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H5302	812	0	2020	Georgia		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5322	1	0	1	2	1	H5322_001_0	2	1		1	05/22/2019	2020.01	05/22/2019 08:25:42 AM Central Daylight Time	08/02/2019 11:00:31 AM Central Daylight Time	07/30/2019 09:43:29 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)	1	2		1			H5322	1	0	2020	"Select Counties in OH, SC and VA"		2		2			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	2			
H5322	3	0	1	1	1	H5322_003_0	2	1		1	05/14/2019	2020.01	05/14/2019 01:07:07 PM Central Daylight Time	08/02/2019 11:00:52 AM Central Daylight Time	07/30/2019 09:44:06 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO I-SNP)	1	1		1			H5322	3	0	2020	Select Counties in FL and NJ		2		2			1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)818-4270		(866)818-4270		(888)834-3721		(888)834-3721		(866)818-4270		(866)818-4270		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	4	0	1	2	1	H5322_004_0	2	1		1	05/28/2019	2020.01	05/28/2019 06:18:38 PM Central Daylight Time	08/02/2019 11:01:13 AM Central Daylight Time	07/30/2019 09:44:42 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS I-SNP)	1	2		1			H5322	4	0	2020	Atlanta and Augusta Metro areas		2		2			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	2			
H5322	24	0	1	1	1	H5322_024_0	6	1			08/02/2019	2020.01	08/02/2019 09:53:40 AM Central Daylight Time	08/02/2019 11:01:34 AM Central Daylight Time	07/30/2019 09:45:18 PM Central Daylight Time			08/06/2019 01:26:14 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO)	1	1		1			H5322	24	0	2020	"Grafton, Hillsborough, and Rockingham Counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	25	0	1	1	1	H5322_025_0	3	1	2	1	07/12/2019	2020.01	07/12/2019 11:51:21 AM Central Daylight Time	08/02/2019 11:01:56 AM Central Daylight Time	07/30/2019 09:45:53 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H5322	25	0	2020	Select Counties in Texas		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-4983		(866)944-4983		(888)834-3721		(888)834-3721		(866)944-4983		(866)944-4983		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	26	0	1	1	1	H5322_026_0	3	1	2	1	08/06/2019	2020.01	08/06/2019 09:06:56 AM Central Daylight Time	08/02/2019 11:02:17 AM Central Daylight Time	07/31/2019 09:34:43 AM Central Daylight Time			08/06/2019 09:21:24 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H5322	26	0	2020	"Cameron, Hidalgo, and Willacy Counties"		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	28	0	1	2	1	H5322_028_0	4	1	2	1	07/11/2019	2020.01	07/11/2019 09:58:29 AM Central Daylight Time	08/02/2019 11:02:39 AM Central Daylight Time	07/30/2019 09:47:05 PM Central Daylight Time			08/06/2019 03:47:42 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	1	2		1			H5322	28	0	2020	Select Counties in Ohio		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-3488		(866)944-3488		(888)834-3721		(888)834-3721		(866)944-3488		(866)944-3488		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	29	0	1	2	1	H5322_029_0	4	1	2	1	07/11/2019	2020.01	07/11/2019 09:58:59 AM Central Daylight Time	08/02/2019 11:03:00 AM Central Daylight Time	07/30/2019 09:47:41 PM Central Daylight Time			08/06/2019 03:47:42 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO-POS D-SNP)	1	2		1			H5322	29	0	2020	Select Counties in Kansas		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)262-9947		(866)262-9947		(888)834-3721		(888)834-3721		(866)262-9947		(866)262-9947		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	30	0	1	2	1	H5322_030_0	3	1	2	1	05/25/2019	2020.01	05/25/2019 06:31:29 PM Central Daylight Time	08/02/2019 11:03:22 AM Central Daylight Time	07/30/2019 09:48:18 PM Central Daylight Time			08/06/2019 03:47:42 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO-POS D-SNP)	1	2		1			H5322	30	0	2020	Select Counties in Georgia		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(866)480-1086		(866)480-1086		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5322	31	0	1	1	1	H5322_031_0	5	1	2	1	07/24/2019	2020.01	07/24/2019 09:47:41 AM Central Daylight Time	08/02/2019 11:03:44 AM Central Daylight Time	07/30/2019 09:48:55 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO D-SNP)	1	1		1			H5322	31	0	2020	Select Counites in OK		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-7150		(844)368-7150		(888)834-3721		(888)834-3721		(844)368-7150		(844)368-7150		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	1	0	1	1	1	H5325_001_0	4	1	2	1	05/28/2019	2020.01	05/28/2019 02:16:52 PM Central Daylight Time	08/02/2019 12:27:29 PM Central Daylight Time	07/31/2019 12:30:26 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	"COVENTRY HEALTH CARE OF KANSAS, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	1	1		1			H5325	1	0	2020	Eastern Kansas		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	2	0	1	1	1	H5325_002_0	3	1	2	1	05/28/2019	2020.01	05/28/2019 02:33:01 PM Central Daylight Time	08/02/2019 12:28:06 PM Central Daylight Time	07/31/2019 12:31:36 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	"COVENTRY HEALTH CARE OF KANSAS, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	1	1		1			H5325	2	0	2020	Central Kansas		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	3	0	1	1	1	H5325_003_0	3	1	2	1	05/28/2019	2020.01	05/28/2019 02:46:19 PM Central Daylight Time	08/02/2019 12:28:42 PM Central Daylight Time	07/31/2019 12:32:47 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	"COVENTRY HEALTH CARE OF KANSAS, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	1	1		1			H5325	3	0	2020	Kansas City Metro		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	4	0	1	1	1	H5325_004_0	3	1	2	1	05/28/2019	2020.01	05/28/2019 02:50:19 PM Central Daylight Time	08/02/2019 12:29:19 PM Central Daylight Time	07/31/2019 12:33:58 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	"COVENTRY HEALTH CARE OF KANSAS, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	1	1		1			H5325	4	0	2020	Southwest Missouri		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5325	5	0	1	1	1	H5325_005_0	3	1	2	1	05/28/2019	2020.01	05/28/2019 02:53:56 PM Central Daylight Time	08/02/2019 07:36:37 AM Central Daylight Time	07/31/2019 12:35:09 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	"COVENTRY HEALTH CARE OF KANSAS, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Gold Prime (HMO D-SNP)	1	1		1			H5325	5	0	2020	Missouri		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5337	1	0	1	1	1	H5337_001_0	5	1	2	1	07/10/2019	2020.01	07/10/2019 04:30:18 PM Eastern Daylight Time	08/02/2019 10:48:15 AM Eastern Daylight Time	07/31/2019 01:36:20 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	"AETNA BETTER HEALTH, INC. (OH)"	Aetna Better Health of Ohio (HMO SNP)	www.aetnamedicare.com	Aetna Medicare Assure (HMO D-SNP)	1	1		1			H5337	1	0	2020	Select counties in OH		2		2			1	3		2		2	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5355	1	0	1	48	5	H5355_001_0	2	1			08/21/2019	2020.01	08/21/2019 05:26:00 PM Pacific Daylight Time					08/21/2019 05:26:11 PM Pacific Daylight Time	IEHP HEALTH ACCESS	IEHP DualChoice	www.iehp.org	IEHP DualChoice (Medicare-Medicaid Plan)	5	48		1			H5355	1	0	2020	Riverside and San Bernardino Counties		2	343088	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																
H5377	1	0	1	1	1	H5377_001_0	2	1			08/01/2019	2020.01	08/01/2019 07:08:10 PM Eastern Daylight Time	08/04/2019 04:56:00 PM Eastern Daylight Time	08/02/2019 01:18:36 PM Eastern Daylight Time			08/05/2019 11:08:39 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5377-001 (HMO)	1	1		1			H5377	1	0	2020	Roanoke Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5386	3	0	1	1	1	H5386_003_0	5	1			08/01/2019	2020.01	08/01/2019 09:17:12 AM Pacific Daylight Time	08/01/2019 01:34:43 PM Pacific Daylight Time	07/30/2019 01:43:06 PM Pacific Daylight Time			08/02/2019 10:49:29 AM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Gold Card (HMO)	1	1		1			H5386	3	0	2020	Sharp Direct Advantage Gold San Diego County		2	10034	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)222-3183		(855)222-3183		(855)562-8853		(858)499-8050		(711)-		(711)-		(711)-		(711)-		(800)231-4403		(800)231-4403		(711)-		(711)-		2					2					2	2			
H5386	4	0	1	1	1	H5386_004_0	5	1			08/01/2019	2020.01	08/01/2019 09:17:31 AM Pacific Daylight Time	08/01/2019 01:42:32 PM Pacific Daylight Time	07/30/2019 01:44:01 PM Pacific Daylight Time			08/02/2019 10:49:29 AM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Platinum Card (HMO)	1	1		1			H5386	4	0	2020	Sharp Direct Advantage Platinum San Diego County		2	4300	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)222-3183		(855)222-3183		(855)562-8853		(858)499-8050		(711)-		(711)-		(711)-		(711)-		(800)231-4403		(800)231-4403		(711)-		(711)-		2					2					2	2			
H5386	801	0	1	1	1	H5386_801_0	1	1			05/30/2019	2020.01	05/30/2019 10:47:52 AM Pacific Daylight Time					05/31/2019 02:41:55 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Calendar Year (HMO)	1	1		1			H5386	801	0	2020	Sharp Direct Advantage San Diego County		1	5100	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)222-3183		(855)222-3183		(855)562-8853		(858)499-8050		(711)-		(711)-		(711)-		(711)-		(800)231-4403		(800)231-4403		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;18a;	1	1a;2;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;18a;	1					1				
H5386	802	0	1	1	1	H5386_802_0	1	1			05/30/2019	2020.01	05/30/2019 10:51:59 AM Pacific Daylight Time					05/31/2019 02:41:55 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage Non-Calendar Year (HMO)	1	1		1			H5386	802	0	2020	Sharp Direct Advantage San Diego County		1	4800	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050		(855)222-3183		(855)222-3183		(855)562-8853		(858)499-8050		(711)-		(711)-		(711)-		(711)-		(800)231-4403		(800)231-4403		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;18a;	1	1a;2;3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;18a;	1					1				
H5386	803	0	1	1	1	H5386_803_0	1	1			04/15/2019	2020.01	04/15/2019 05:05:56 PM Pacific Daylight Time					05/31/2019 02:41:55 PM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan	sharpmedicareadvantage.com	Sharp Direct Advantage MA Only (HMO)	1	1		1			H5386	803	0	2020	Sharp Direct Advantage San Diego County		1	0	2			2						sharpmedicareadvantage.com	sharpmedicareadvantage.com	sharpmedicareadvantage.com	(855)562-8853		(858)499-8050		(855)562-8853		(858)499-8050										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;9b;15;	1	3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7i;8a;8b1;8b2;8b3;9a1;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;16b;17a;18a;	1					1				
H5398	1	0	1	1	1	H5398_001_0	4	1			08/01/2019	2020.01	08/01/2019 10:00:48 AM US Mountain Standard Time	08/05/2019 04:20:12 PM Central Daylight Time	08/05/2019 03:25:37 PM Central Daylight Time			08/06/2019 10:05:57 AM Central Daylight Time	CENTENE VENTURE COMPANY KANSAS	Ascension Complete	kansas.ascensioncomplete.com	Ascension Complete Via Christi Reward (HMO)	1	1		1			H5398	1	0	2020	"Butler, Harvey and Sedgwick Counties"		2		2			2						kansas.ascensioncomplete.com	kansas.ascensioncomplete.com	kansas.ascensioncomplete.com	(833)816-6623		(833)816-6623		(877)831-9439		(877)831-9439		(833)816-6623		(833)816-6623		(877)831-9439		(877)831-9439		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5398	2	0	1	1	1	H5398_002_0	3	1			08/01/2019	2020.01	08/01/2019 10:01:32 AM US Mountain Standard Time	08/05/2019 04:20:08 PM Central Daylight Time	08/05/2019 03:25:33 PM Central Daylight Time			08/06/2019 10:05:57 AM Central Daylight Time	CENTENE VENTURE COMPANY KANSAS	Ascension Complete	kansas.ascensioncomplete.com	Ascension Complete Via Christi Secure (HMO)	1	1		1			H5398	2	0	2020	"Butler, Harvey and Sedgwick Counties"		2		2			2						kansas.ascensioncomplete.com	kansas.ascensioncomplete.com	kansas.ascensioncomplete.com	(833)816-6623		(833)816-6623		(877)831-9439		(877)831-9439		(833)816-6623		(833)816-6623		(877)831-9439		(877)831-9439		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5403	1	0	1	20	8	H5403_001_0	1	1			05/23/2019	2020.01	05/23/2019 11:39:53 AM Pacific Daylight Time		05/23/2019 11:23:38 AM Pacific Daylight Time			05/23/2019 11:44:16 AM Pacific Daylight Time	ON LOK SENIOR HEALTH SERVICES	On Lok Lifeways	www.onloklifeways.org	On Lok Lifeways (Dual Eligibles) (PACE)	8	20		1			H5403	1	0	2020	"San Francisco, Alameda and Santa Clara counties"		2		2			2						www.onloklifeways.org	N/A										(888)996-6565		(415)292-8895		(888)886-6565		(888)886-6565												(711)-				(711)-																
H5403	2	0	1	20	8	H5403_002_0	1	1			05/23/2019	2020.01	05/23/2019 11:40:54 AM Pacific Daylight Time		05/23/2019 11:23:24 AM Pacific Daylight Time			05/23/2019 11:44:16 AM Pacific Daylight Time	ON LOK SENIOR HEALTH SERVICES	On Lok Lifeways	www.onloklifeways.org	On Lok Lifeways (Medicare Only) (PACE)	8	20		1			H5403	2	0	2020	"San Francisco, Alameda and Santa Clara counties"		2		2			2						www.onloklifeways.org	N/A										(888)996-6565		(415)292-8895		(888)886-6565		(888)886-6565												(711)-				(711)-																
H5405	1	0	1	20	8	H5405_001_0	1	1			05/28/2019	2020.01	05/28/2019 04:19:24 PM Pacific Daylight Time		05/28/2019 03:51:38 PM Pacific Daylight Time			05/28/2019 04:22:09 PM Pacific Daylight Time	CENTER FOR ELDERS INDEPENDENCE	Center For Elders' Independence	www.cei.elders.org	Center for Elders' Independence - Part D (PACE)	8	20		1			H5405	1	0	2020	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	2	0	1	20	8	H5405_002_0	1	1			05/28/2019	2020.01	05/28/2019 04:20:17 PM Pacific Daylight Time		05/28/2019 03:58:36 PM Pacific Daylight Time			05/28/2019 04:22:09 PM Pacific Daylight Time	CENTER FOR ELDERS INDEPENDENCE	Center For Elders' Independence	www.cei.elders.org	Center for Elders' Independence (PACE)	8	20		1			H5405	2	0	2020	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	1	0	1	20	8	H5406_001_0	1	1			05/20/2019	2020.01	05/20/2019 03:01:05 PM Pacific Daylight Time		05/20/2019 02:22:45 PM Pacific Daylight Time			05/20/2019 03:03:13 PM Pacific Daylight Time	SUTTER VALLEY HOSPITALS	Sutter SeniorCare PACE	www.sutterseniorcare.org	Sutter SeniorCare (PACE)	8	20		1			H5406	1	0	2020	Sacramento Counties		2		2			2						N/A	N/A	N/A									(833)560-7223		(833)560-7223	63415	(833)560-7223		(833)560-7223	63415									(916)393-1112		(916)393-1112		(916)393-1112		(916)393-1112																
H5406	2	0	1	20	8	H5406_002_0	1	1			05/20/2019	2020.01	05/20/2019 03:01:44 PM Pacific Daylight Time		05/20/2019 02:24:08 PM Pacific Daylight Time			05/20/2019 03:03:13 PM Pacific Daylight Time	SUTTER VALLEY HOSPITALS	Sutter SeniorCare PACE	www.sutterseniorcare.org	Sutter SeniorCare (PACE)	8	20		1			H5406	2	0	2020	Yolo Counties		2		2			2						N/A	N/A	N/A									(833)560-7223		(833)560-7223	63415	(833)560-7223		(833)560-7223	63415									(916)393-1112		(916)393-1112		(916)393-1112		(916)393-1112																
H5410	1	0	1	1	1	H5410_001_0	7	1			07/08/2019	2020.01	07/08/2019 04:26:35 PM Central Daylight Time	07/31/2019 02:06:24 PM Central Daylight Time	07/30/2019 04:23:18 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.lmchealthplans.com	Leon Medical Centers Health Plans - Leon Cares (HMO)	1	1		1			H5410	1	0	2020	Miami-Dade county		2	0	2			2						www.cignahealthspring.com	www.lmchealthplans.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	2			
H5410	4	0	1	1	1	H5410_004_0	4	1			07/08/2019	2020.01	07/08/2019 04:04:16 PM Central Daylight Time	06/27/2019 08:45:04 AM Central Daylight Time				07/12/2019 01:35:34 PM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	1	1		1			H5410	4	0	2020	Northern Florida		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5410	13	0	1	1	1	H5410_013_0	4	1	2	1	07/08/2019	2020.01	07/08/2019 04:05:00 PM Central Daylight Time	07/31/2019 06:10:35 PM Central Daylight Time	07/30/2019 04:23:33 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H5410	13	0	2020	Northern Florida		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	18	0	1	1	1	H5410_018_0	4	1			07/08/2019	2020.01	07/08/2019 04:06:38 PM Central Daylight Time	07/31/2019 06:10:56 PM Central Daylight Time	07/30/2019 04:23:46 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H5410	18	0	2020	Northern Florida		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(800)668-3813		(800)668-3813		(855)980-3032		(855)980-3032		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	24	0	1	1	1	H5410_024_0	4	1			07/08/2019	2020.01	07/08/2019 04:07:29 PM Central Daylight Time	07/31/2019 06:11:17 PM Central Daylight Time	07/30/2019 04:24:00 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H5410	24	0	2020	Orlando Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	25	0	1	1	1	H5410_025_0	4	1	2	1	07/08/2019	2020.01	07/08/2019 04:09:01 PM Central Daylight Time	07/31/2019 06:18:44 PM Central Daylight Time	07/30/2019 04:24:14 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H5410	25	0	2020	Orlando Area		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	26	0	1	1	1	H5410_026_0	4	1			07/08/2019	2020.01	07/08/2019 04:09:54 PM Central Daylight Time	07/31/2019 06:19:05 PM Central Daylight Time	07/30/2019 04:24:28 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring Preferred Part B Savings (HMO)	1	1		1			H5410	26	0	2020	Orlando Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	27	0	1	1	1	H5410_027_0	4	1			07/08/2019	2020.01	07/08/2019 04:10:41 PM Central Daylight Time	07/31/2019 06:19:25 PM Central Daylight Time	07/30/2019 04:24:41 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H5410	27	0	2020	Daytona Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	28	0	1	1	1	H5410_028_0	4	1			07/08/2019	2020.01	07/08/2019 04:11:31 PM Central Daylight Time	07/31/2019 06:19:46 PM Central Daylight Time	07/30/2019 04:24:55 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring Preferred Part B Savings (HMO)	1	1		1			H5410	28	0	2020	Daytona Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	29	0	1	1	1	H5410_029_0	4	1			07/08/2019	2020.01	07/08/2019 04:12:16 PM Central Daylight Time	07/31/2019 06:20:07 PM Central Daylight Time	07/30/2019 04:25:09 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H5410	29	0	2020	Tampa Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	30	0	1	1	1	H5410_030_0	4	1			07/08/2019	2020.01	07/08/2019 04:13:04 PM Central Daylight Time	07/31/2019 06:20:28 PM Central Daylight Time	07/30/2019 04:25:23 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring Preferred Part B Savings (HMO)	1	1		1			H5410	30	0	2020	Tampa Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	31	0	1	1	1	H5410_031_0	4	1	2	1	07/08/2019	2020.01	07/08/2019 04:13:52 PM Central Daylight Time	07/31/2019 06:21:35 PM Central Daylight Time	07/30/2019 04:25:38 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H5410	31	0	2020	Daytona Area		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	32	0	1	1	1	H5410_032_0	4	1	2	1	07/08/2019	2020.01	07/08/2019 04:14:34 PM Central Daylight Time	07/31/2019 06:21:56 PM Central Daylight Time	07/30/2019 04:25:53 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H5410	32	0	2020	Tampa Area		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	33	0	1	1	1	H5410_033_0	4	1			07/08/2019	2020.01	07/08/2019 04:15:19 PM Central Daylight Time	07/31/2019 06:22:17 PM Central Daylight Time	07/30/2019 04:26:07 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring Primary (HMO)	1	1		1			H5410	33	0	2020	Orlando Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	34	0	1	1	1	H5410_034_0	4	1			07/08/2019	2020.01	07/08/2019 04:16:03 PM Central Daylight Time	07/31/2019 06:22:37 PM Central Daylight Time	07/30/2019 04:26:22 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring Primary (HMO)	1	1		1			H5410	34	0	2020	Daytona Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	35	0	1	1	1	H5410_035_0	4	1			07/08/2019	2020.01	07/08/2019 04:16:50 PM Central Daylight Time	07/31/2019 06:22:58 PM Central Daylight Time	07/30/2019 04:26:36 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring Primary (HMO)	1	1		1			H5410	35	0	2020	Tampa Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(800)668-3813		(800)668-3813		(855)980-3041		(855)980-3041		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5410	807	0	1	1	1	H5410_807_0	2	1			04/18/2019	2020.01	04/18/2019 12:27:28 PM Central Daylight Time					05/30/2019 10:06:14 PM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Leon Medical Centers Health Plans - Leon Cares (HMO)	1	1		1			H5410	807	0	2020	Florida		1	1224	2			2						www.cignahealthspring.com	www.cignahealthspring.com		(888)281-7867		(888)281-7867		(888)821-2508		(888)821-2508		(888)281-7867		(888)281-7867		(888)821-2508		(888)821-2508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7e;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;12;14a;14d;15;17a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7d;7e;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;16b;17a;17b;	1					1				
H5410	808	0	1	1	1	H5410_808_0	2	1			04/18/2019	2020.01	04/18/2019 12:28:35 PM Central Daylight Time					05/30/2019 05:54:32 PM Central Daylight Time	HEALTHSPRING OF FLORIDA	"HealthSpring of Florida, Inc."	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	1	1		1			H5410	808	0	2020	Northern Florida		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5420	1	0	1	1	1	H5420_001_0	3	1			08/02/2019	2020.01	08/02/2019 12:33:51 PM Central Daylight Time	08/02/2019 11:04:05 AM Central Daylight Time	07/30/2019 09:49:30 PM Central Daylight Time			08/06/2019 03:06:27 PM Central Daylight Time	"MEDICA HEALTHCARE PLANS, INC."	UnitedHealthcare	www.Medicaplans.com	Medica HealthCare Plans MedicareMax (HMO)	1	1		1			H5420	1	0	2020	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5420	3	0	1	1	1	H5420_003_0	3	1			08/02/2019	2020.01	08/02/2019 12:34:18 PM Central Daylight Time	08/02/2019 11:04:26 AM Central Daylight Time	07/30/2019 09:50:03 PM Central Daylight Time			08/06/2019 03:06:27 PM Central Daylight Time	"MEDICA HEALTHCARE PLANS, INC."	UnitedHealthcare	www.Medicaplans.com	Medica HealthCare Plans MedicareMax (HMO)	1	1		1			H5420	3	0	2020	Broward 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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5420	6	0	1	1	1	H5420_006_0	3	1	2	1	08/05/2019	2020.01	08/05/2019 04:04:24 PM Central Daylight Time	08/02/2019 11:04:47 AM Central Daylight Time	07/30/2019 09:50:38 PM Central Daylight Time			08/06/2019 03:06:27 PM Central Daylight Time	"MEDICA HEALTHCARE PLANS, INC."	UnitedHealthcare	www.Medicaplans.com	Medica HealthCare Plans MedicareMax Plus (HMO D-SNP)	1	1		1			H5420	6	0	2020	Miami-Dade and Broward County		2		2			1	3		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	7	0	1	1	1	H5422_007_0	6	1	2	1	08/02/2019	2020.01	08/02/2019 09:02:03 AM Eastern Daylight Time	08/05/2019 10:04:32 AM Eastern Daylight Time	07/30/2019 07:09:28 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H5422	7	0	2020	Select Counties in Georgia		2		2			1	3		1		1	https://shop.bcbsga.com/medicare	https://shop.bcbsga.com/medicare	www.anthem.com/medicare	(844)887-6355		(844)887-6355		(844)227-8228		(844)227-8228		(844)887-6355		(844)887-6355		(844)227-8229		(844)227-8229		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	8	0	1	1	1	H5422_008_0	6	1			06/25/2019	2020.01	06/25/2019 05:42:50 PM Eastern Daylight Time	08/05/2019 10:04:32 AM Eastern Daylight Time	07/30/2019 07:10:06 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Essential (HMO)	1	1		1			H5422	8	0	2020	Select Counties in Georgia		2		2			2						https://shop.bcbsga.com/medicare	https://shop.bcbsga.com/medicare	www.anthem.com/medicare	(855)690-7797		(855)690-7797		(800)797-1769		(800)797-1769		(855)690-7797		(855)690-7797		(844)364-2117		(844)364-2117		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	11	0	1	1	1	H5422_011_0	7	1			08/01/2019	2020.01	08/01/2019 01:28:13 PM Eastern Daylight Time	08/05/2019 10:04:32 AM Eastern Daylight Time	07/30/2019 07:10:42 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Plus (HMO)	1	1		1			H5422	11	0	2020	Select Counties in Georgia		2		2			2						https://shop.bcbsga.com/medicare	https://shop.bcbsga.com/medicare	www.anthem.com/medicare	(855)690-7797		(855)690-7797		(800)797-1769		(800)797-1769		(855)690-7797		(855)690-7797		(844)364-2117		(844)364-2117		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	13	0	1	1	1	H5422_013_0	6	1			07/16/2019	2020.01	07/16/2019 06:04:38 PM Eastern Daylight Time	08/05/2019 10:04:33 AM Eastern Daylight Time	07/30/2019 07:11:21 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Extra (HMO)	1	1		1			H5422	13	0	2020	Select counties in Georgia		2		2			2						www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)690-7797		(855)690-7797		(800)797-1769		(800)797-1769		(855)690-7797		(855)690-7797		(844)364-2117		(844)364-2117		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5422	803	0	1	1	1	H5422_803_0	3	1			05/22/2019	2020.01	05/22/2019 01:11:48 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.bcbsga.com/medicare	BlueValue (HMO)	1	1		1			H5422	803	0	2020	Georgia Select Counties		1	600	2			2						www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	804	0	1	1	1	H5422_804_0	3	1			05/22/2019	2020.01	05/22/2019 01:11:17 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.bcbsga.com/medicare	BlueValue (HMO)	1	1		1			H5422	804	0	2020	Georgia - Select Counties		1	600	2			2						www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	806	0	2	1	1	H5422_806_0	3	1			05/22/2019	2020.01	05/22/2019 01:23:25 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.bcbsga.com/medicare	BlueValue (HMO)	1	1		2	1		H5422	806	0	2020	Georgia - Select counties		1	600	2			2						www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	807	0	2	1	1	H5422_807_0	3	1			05/30/2019	2020.01	05/30/2019 07:26:47 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.anthem.com/ga/medicare	BlueValue (HMO)	1	1		2	1		H5422	807	0	2020	Select Georgia Counties		1	600	2			2						www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	808	0	1	1	1	H5422_808_0	3	1			05/22/2019	2020.01	05/22/2019 01:25:42 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.anthem.com/ga/medicare	BlueValue (HMO)	1	1		1			H5422	808	0	2020	Select Georgia Counties		1	600	2			2						www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	809	0	1	1	1	H5422_809_0	3	1			05/22/2019	2020.01	05/22/2019 01:26:05 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.anthem.com/ga/medicare	BlueValue (HMO)	1	1		1			H5422	809	0	2020	Select Georgia Counties		1	600	2			2						www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	810	0	2	1	1	H5422_810_0	3	1			05/30/2019	2020.01	05/30/2019 07:27:00 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.anthem.com/ga/medicare	BlueValue (HMO)	1	1		2	1		H5422	810	0	2020	Select Georgia Counties		1	600	2			2						www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5422	811	0	2	1	1	H5422_811_0	3	1			05/30/2019	2020.01	05/30/2019 07:27:06 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Anthem Blue Cross and Blue Shield	www.anthem.com/ga/medicare	Blue Value (HMO)	1	1		2	1		H5422	811	0	2020	Select Georgia Counties		1	600	2			2						www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	www.anthem.com/ga/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5425	1	0	1	1	1	H5425_001_0	7	1			08/01/2019	2020.01	08/01/2019 11:13:40 AM Pacific Daylight Time	08/05/2019 02:13:13 PM Pacific Daylight Time	08/02/2019 04:19:42 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	1	1		1			H5425	1	0	2020	Ventura County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	4	0	1	1	1	H5425_004_0	8	1			07/02/2019	2020.01	07/02/2019 03:50:47 PM Pacific Daylight Time	08/05/2019 02:16:58 PM Pacific Daylight Time	08/02/2019 04:19:46 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Signature offered by SCAN Health Plan (HMO)	1	1		1			H5425	4	0	2020	San Diego County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	5	0	1	1	1	H5425_005_0	7	1			07/02/2019	2020.01	07/02/2019 04:12:43 PM Pacific Daylight Time	08/05/2019 02:19:58 PM Pacific Daylight Time	08/02/2019 04:19:49 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Classic offered by SCAN Health Plan (HMO)	1	1		1			H5425	5	0	2020	San Diego County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	6	0	1	1	1	H5425_006_0	9	1			07/02/2019	2020.01	07/02/2019 04:16:08 PM Pacific Daylight Time	08/05/2019 02:28:05 PM Pacific Daylight Time	08/02/2019 04:18:12 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	1	1		1			H5425	6	0	2020	Los Angeles County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	7	0	1	1	1	H5425_007_0	7	1			07/02/2019	2020.01	07/02/2019 03:12:21 PM Pacific Daylight Time	08/05/2019 02:30:46 PM Pacific Daylight Time	08/02/2019 04:18:15 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	1	1		1			H5425	7	0	2020	Orange County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	8	0	1	1	1	H5425_008_0	7	1			07/02/2019	2020.01	07/02/2019 03:12:30 PM Pacific Daylight Time	08/05/2019 02:33:53 PM Pacific Daylight Time	08/02/2019 04:18:17 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	1	1		1			H5425	8	0	2020	Riverside County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	9	0	1	1	1	H5425_009_0	7	1			07/02/2019	2020.01	07/02/2019 03:12:26 PM Pacific Daylight Time	08/05/2019 02:36:40 PM Pacific Daylight Time	08/02/2019 04:18:20 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	1	1		1			H5425	9	0	2020	San Bernardino County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	10	0	1	1	1	H5425_010_0	9	1	2	1	08/01/2019	2020.01	08/01/2019 11:07:38 AM Pacific Daylight Time	08/02/2019 08:46:16 AM Pacific Daylight Time	08/12/2019 09:54:41 AM Pacific Daylight Time			08/12/2019 10:03:41 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections (HMO D-SNP)	1	1		1			H5425	10	0	2020	"Los Angeles, Riverside and San Bernardino Counties"		2		2			1	3		1		1	www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(888)315-7226		(888)315-7226		(866)722-6725		(866)722-6725		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	19	0	1	1	1	H5425_019_0	7	1			07/02/2019	2020.01	07/02/2019 04:13:00 PM Pacific Daylight Time	08/05/2019 02:39:35 PM Pacific Daylight Time	08/02/2019 04:18:25 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	1	1		1			H5425	19	0	2020	San Francisco County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	20	0	1	1	1	H5425_020_0	7	1			07/02/2019	2020.01	07/02/2019 04:13:15 PM Pacific Daylight Time	08/05/2019 02:42:14 PM Pacific Daylight Time	08/02/2019 04:18:28 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	1	1		1			H5425	20	0	2020	Santa Clara County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	28	0	1	1	1	H5425_028_0	8	1		1	07/02/2019	2020.01	07/02/2019 03:12:37 PM Pacific Daylight Time	08/05/2019 02:54:52 PM Pacific Daylight Time	08/02/2019 04:18:31 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Heart First (HMO C-SNP)	1	1		1			H5425	28	0	2020	Orange County		2		2			1	4			10000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	29	0	1	1	1	H5425_029_0	7	1	2	1	08/01/2019	2020.01	08/01/2019 11:08:16 AM Pacific Daylight Time	08/01/2019 09:48:33 AM Pacific Daylight Time	08/02/2019 04:18:33 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections at Home (HMO D-SNP)	1	1		1			H5425	29	0	2020	Los Angeles County		2		2			1	3		1		1	www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(888)315-7226		(888)315-7226		(866)722-6725		(866)722-6725		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	30	0	1	1	1	H5425_030_0	7	1	2	1	07/02/2019	2020.01	07/02/2019 02:35:22 PM Pacific Daylight Time	08/05/2019 02:50:01 PM Pacific Daylight Time	08/02/2019 04:18:36 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections at Home (HMO D-SNP)	1	1		1			H5425	30	0	2020	Riverside County		2		2			1	3		1		1	www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(888)315-7226		(888)315-7226		(866)722-6725		(866)722-6725		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	31	0	1	1	1	H5425_031_0	7	1	2	1	07/02/2019	2020.01	07/02/2019 02:36:02 PM Pacific Daylight Time	08/05/2019 02:47:23 PM Pacific Daylight Time	08/02/2019 04:18:38 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections at Home (HMO D-SNP)	1	1		1			H5425	31	0	2020	San Bernardino County		2		2			1	3		1		1	www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(888)315-7226		(888)315-7226		(866)722-6725		(866)722-6725		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	33	0	1	1	1	H5425_033_0	8	1		1	07/02/2019	2020.01	07/02/2019 03:12:42 PM Pacific Daylight Time	08/05/2019 02:57:20 PM Pacific Daylight Time	08/02/2019 04:18:41 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Heart First (HMO C-SNP)	1	1		1			H5425	33	0	2020	Riverside and San Bernardino Counties		2		2			1	4			10000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	34	0	1	1	1	H5425_034_0	7	1		1	07/02/2019	2020.01	07/02/2019 03:12:47 PM Pacific Daylight Time	08/05/2019 02:57:28 PM Pacific Daylight Time	08/02/2019 04:18:43 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	1	1		1			H5425	34	0	2020	Los Angeles and Orange Counties		2		2			1	4			1E+13		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	40	0	1	1	1	H5425_040_0	7	1			08/01/2019	2020.01	08/01/2019 11:10:54 AM Pacific Daylight Time	08/01/2019 10:47:16 AM Pacific Daylight Time	08/02/2019 04:18:46 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Plus offered by SCAN Health Plan (HMO)	1	1		1			H5425	40	0	2020	San Diego County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	45	0	1	1	1	H5425_045_0	7	1			08/01/2019	2020.01	08/01/2019 11:13:32 AM Pacific Daylight Time	08/01/2019 10:54:19 AM Pacific Daylight Time	08/02/2019 04:18:49 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Plus (HMO)	1	1		1			H5425	45	0	2020	Selected Southern and Northern CA Counties		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	52	0	1	1	1	H5425_052_0	7	1			07/02/2019	2020.01	07/02/2019 04:15:55 PM Pacific Daylight Time	08/05/2019 06:48:27 PM Pacific Daylight Time	08/02/2019 04:18:51 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	1	1		1			H5425	52	0	2020	Napa and Sonoma Counties		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	53	0	1	1	1	H5425_053_0	7	1		1	07/02/2019	2020.01	07/02/2019 04:13:49 PM Pacific Daylight Time	08/05/2019 02:52:14 PM Pacific Daylight Time	08/02/2019 04:18:54 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Heart First (HMO C-SNP)	1	1		1			H5425	53	0	2020	Napa and Sonoma Counties		2		2			1	4			10000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	54	0	1	1	1	H5425_054_0	7	1		1	07/02/2019	2020.01	07/02/2019 04:14:01 PM Pacific Daylight Time	08/05/2019 02:49:39 PM Pacific Daylight Time	08/02/2019 04:18:57 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	1	1		1			H5425	54	0	2020	Napa and Sonoma Counties		2		2			1	4			1E+13		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	55	0	1	1	1	H5425_055_0	7	1		1	07/02/2019	2020.01	07/02/2019 02:51:18 PM Pacific Daylight Time	08/05/2019 02:46:50 PM Pacific Daylight Time	08/02/2019 04:18:59 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Heart First offered by SCAN Health Plan (HMO C-SNP)	1	1		1			H5425	55	0	2020	San Diego County		2		2			1	4			10000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	64	0	1	1	1	H5425_064_0	7	1			07/02/2019	2020.01	07/02/2019 02:03:52 PM Pacific Daylight Time	08/05/2019 02:43:59 PM Pacific Daylight Time	08/02/2019 04:19:02 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic II (HMO)	1	1		1			H5425	64	0	2020	Los Angeles County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	65	0	1	1	1	H5425_065_0	8	1			07/02/2019	2020.01	07/02/2019 03:13:19 PM Pacific Daylight Time	08/05/2019 02:38:46 PM Pacific Daylight Time	08/02/2019 04:19:04 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	1	1		1			H5425	65	0	2020	Los Angeles County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	66	0	1	1	1	H5425_066_0	8	1			07/02/2019	2020.01	07/02/2019 03:13:23 PM Pacific Daylight Time	08/05/2019 02:36:25 PM Pacific Daylight Time	08/02/2019 04:19:07 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	1	1		1			H5425	66	0	2020	Orange County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	67	0	1	1	1	H5425_067_0	8	1			07/02/2019	2020.01	07/02/2019 03:13:32 PM Pacific Daylight Time	08/05/2019 02:34:10 PM Pacific Daylight Time	08/02/2019 04:19:09 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	1	1		1			H5425	67	0	2020	Riverside County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	68	0	1	1	1	H5425_068_0	9	1			07/02/2019	2020.01	07/02/2019 03:13:38 PM Pacific Daylight Time	08/05/2019 02:31:25 PM Pacific Daylight Time	08/02/2019 04:19:12 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Prime (HMO)	1	1		1			H5425	68	0	2020	San Bernardino County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	69	0	1	1	1	H5425_069_0	8	1			07/02/2019	2020.01	07/02/2019 03:13:29 PM Pacific Daylight Time	08/05/2019 02:28:43 PM Pacific Daylight Time	08/02/2019 04:19:16 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	1	1		1			H5425	69	0	2020	Stanislaus County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	70	0	1	1	1	H5425_070_0	8	1		1	07/02/2019	2020.01	07/02/2019 03:13:44 PM Pacific Daylight Time	08/05/2019 02:25:14 PM Pacific Daylight Time	08/02/2019 04:19:18 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO C-SNP)	1	1		1			H5425	70	0	2020	Stanislaus County		2		2			1	4			1E+13		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	71	0	1	1	1	H5425_071_0	8	1			08/01/2019	2020.01	08/01/2019 11:12:42 AM Pacific Daylight Time	08/01/2019 10:58:30 AM Pacific Daylight Time	08/02/2019 04:19:22 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Plus (HMO)	1	1		1			H5425	71	0	2020	Stanislaus County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	72	0	1	1	1	H5425_072_0	8	1			08/01/2019	2020.01	08/01/2019 11:13:24 AM Pacific Daylight Time	08/01/2019 11:00:37 AM Pacific Daylight Time	08/02/2019 04:19:25 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Plus (HMO)	1	1		1			H5425	72	0	2020	Santa Clara County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	73	0	1	1	1	H5425_073_0	8	1			07/02/2019	2020.01	07/02/2019 03:13:53 PM Pacific Daylight Time	08/05/2019 06:51:54 PM Pacific Daylight Time	08/02/2019 04:19:28 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Options (HMO)	1	1		1			H5425	73	0	2020	Santa Clara County		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	74	0	1	1	1	H5425_074_0	8	1			07/02/2019	2020.01	07/02/2019 03:13:49 PM Pacific Daylight Time	08/05/2019 06:54:35 PM Pacific Daylight Time	08/02/2019 04:19:30 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Compass (HMO)	1	1		1			H5425	74	0	2020	Napa and Sonoma Counties		2		2			2						www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	803	0	1	1	1	H5425_803_0	4	1			05/24/2019	2020.01	05/24/2019 02:02:16 PM Pacific Daylight Time					06/03/2019 05:03:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	1	1		1			H5425	803	0	2020	Southern and Northern California Counties		1	34813	2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5425	804	0	1	1	1	H5425_804_0	4	1			05/24/2019	2020.01	05/24/2019 02:02:40 PM Pacific Daylight Time					06/03/2019 05:03:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Retiree Group (HMO)	1	1		1			H5425	804	0	2020	Southern and Northern California Counties		1	12895	2			2						https://www.scanhealthplan.com/	https://www.scanhealthplan.com/	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	52	0	1	1	1	H5427_052_0	5	1			07/23/2019	2020.01	07/23/2019 10:27:17 AM Eastern Daylight Time	06/02/2019 04:39:20 PM Eastern Daylight Time				07/23/2019 11:07:57 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	www.FreedomHealth.com	Freedom Savings Plan (HMO)	1	1		1			H5427	52	0	2020	Select Counties in Florida		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://www.FreedomHealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5427	59	0	1	1	1	H5427_059_0	9	1			07/23/2019	2020.01	07/23/2019 10:27:33 AM Eastern Daylight Time	08/05/2019 12:18:23 PM Eastern Daylight Time	08/05/2019 05:49:54 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	www.FreedomHealth.com	Freedom Medicare Plan Rx (HMO)	1	1		1			H5427	59	0	2020	Select Counties in Florida		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	60	0	1	1	1	H5427_060_0	9	1			07/23/2019	2020.01	07/23/2019 10:27:47 AM Eastern Daylight Time	08/05/2019 12:19:53 PM Eastern Daylight Time	08/05/2019 05:50:33 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	www.FreedomHealth.com	Freedom Medicare Plan Rx (HMO)	1	1		1			H5427	60	0	2020	Select Counties in Florida		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	70	0	1	1	1	H5427_070_0	10	1		1	07/23/2019	2020.01	07/23/2019 10:28:00 AM Eastern Daylight Time	08/05/2019 12:21:23 PM Eastern Daylight Time	08/05/2019 05:51:12 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	www.FreedomHealth.com	Freedom VIP Care (HMO C-SNP)	1	1		1			H5427	70	0	2020	Select Counties in Florida		2	0	2			1	4			10		www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	72	0	1	1	1	H5427_072_0	9	1		1	07/23/2019	2020.01	07/23/2019 10:28:14 AM Eastern Daylight Time	08/05/2019 12:23:18 PM Eastern Daylight Time	08/05/2019 05:51:51 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	www.FreedomHealth.com	Freedom VIP Savings (HMO C-SNP)	1	1		1			H5427	72	0	2020	Select Counties in Florida		2	0	2			1	4			10		www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	77	0	1	1	1	H5427_077_0	10	1		1	07/23/2019	2020.01	07/23/2019 10:28:29 AM Eastern Daylight Time	08/05/2019 12:24:41 PM Eastern Daylight Time	08/05/2019 05:52:29 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	www.FreedomHealth.com	Freedom VIP Savings COPD (HMO C-SNP)	1	1		1			H5427	77	0	2020	Select Counties in Florida		2	0	2			1	4			100000000		www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	78	0	1	1	1	H5427_078_0	9	1	2	1	07/23/2019	2020.01	07/23/2019 10:28:44 AM Eastern Daylight Time	08/05/2019 12:26:01 PM Eastern Daylight Time	08/05/2019 06:17:53 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	www.FreedomHealth.com	Freedom Medi-Medi Partial (HMO D-SNP)	1	1		1			H5427	78	0	2020	Select Counties in Florida		2	0	2			1	3		2		2	www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	82	0	1	1	1	H5427_082_0	9	1		1	07/23/2019	2020.01	07/23/2019 10:28:58 AM Eastern Daylight Time	08/05/2019 12:27:19 PM Eastern Daylight Time	08/05/2019 05:54:43 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	www.FreedomHealth.com	Freedom VIP Savings (HMO C-SNP)	1	1		1			H5427	82	0	2020	Select Counties in Florida		2	0	2			1	4			10		www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	83	0	1	1	1	H5427_083_0	10	1		1	07/23/2019	2020.01	07/23/2019 10:29:12 AM Eastern Daylight Time	08/05/2019 12:28:40 PM Eastern Daylight Time	08/05/2019 12:52:41 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	www.FreedomHealth.com	Freedom VIP Savings COPD (HMO C-SNP)	1	1		1			H5427	83	0	2020	Select Counties in Florida		2	0	2			1	4			100000000		www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	87	0	1	1	1	H5427_087_0	9	1	2	1	07/23/2019	2020.01	07/23/2019 10:29:27 AM Eastern Daylight Time	08/05/2019 12:29:59 PM Eastern Daylight Time	08/05/2019 05:56:06 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	www.FreedomHealth.com	Freedom Medi-Medi Full (HMO D-SNP)	1	1		1			H5427	87	0	2020	Select Counties in Florida		2	0	2			1	3		1		1	www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	88	0	1	1	1	H5427_088_0	10	1			07/23/2019	2020.01	07/23/2019 10:29:41 AM Eastern Daylight Time	08/05/2019 12:31:19 PM Eastern Daylight Time	08/05/2019 05:56:49 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	1	1		1			H5427	88	0	2020	select counties in Florida		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	89	0	1	1	1	H5427_089_0	9	1			07/23/2019	2020.01	07/23/2019 10:29:54 AM Eastern Daylight Time	08/05/2019 12:41:05 PM Eastern Daylight Time	08/05/2019 05:57:31 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	1	1		1			H5427	89	0	2020	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	91	0	1	1	1	H5427_091_0	10	1			07/23/2019	2020.01	07/23/2019 10:30:06 AM Eastern Daylight Time	08/05/2019 12:42:23 PM Eastern Daylight Time	08/05/2019 12:55:35 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	1	1		1			H5427	91	0	2020	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	92	0	1	1	1	H5427_092_0	10	1			07/23/2019	2020.01	07/23/2019 10:30:22 AM Eastern Daylight Time	08/05/2019 12:44:39 PM Eastern Daylight Time	08/05/2019 12:56:18 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	1	1		1			H5427	92	0	2020	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	93	0	1	1	1	H5427_093_0	10	1			07/23/2019	2020.01	07/23/2019 10:30:34 AM Eastern Daylight Time	08/05/2019 12:46:13 PM Eastern Daylight Time	08/05/2019 12:56:59 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	1	1		1			H5427	93	0	2020	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	94	0	1	1	1	H5427_094_0	9	1			07/23/2019	2020.01	07/23/2019 10:30:47 AM Eastern Daylight Time	08/05/2019 12:51:42 PM Eastern Daylight Time	08/05/2019 06:00:20 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	1	1		1			H5427	94	0	2020	Select Counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	96	0	1	1	1	H5427_096_0	11	1			07/23/2019	2020.01	07/23/2019 10:31:02 AM Eastern Daylight Time	08/05/2019 12:53:16 PM Eastern Daylight Time	08/05/2019 12:58:24 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	http://www.FreedomHealth.com	Freedom Platinum Rewards Plan Rx (HMO)	1	1		1			H5427	96	0	2020	Select Counties in Florida		2		2			2						www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	98	0	1	1	1	H5427_098_0	11	1			07/23/2019	2020.01	07/23/2019 10:31:16 AM Eastern Daylight Time	08/05/2019 12:54:34 PM Eastern Daylight Time	08/05/2019 12:59:06 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	1	1		1			H5427	98	0	2020	select counties in FL		2	0	2			2						www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5427	99	0	1	1	1	H5427_099_0	11	1		1	07/23/2019	2020.01	07/23/2019 10:31:29 AM Eastern Daylight Time	08/05/2019 12:55:58 PM Eastern Daylight Time	08/05/2019 12:59:50 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"FREEDOM HEALTH, INC."	"Freedom Health, Inc."	www.FreedomHealth.com	Freedom VIP Rewards (HMO C-SNP)	1	1		1			H5427	99	0	2020	select counties in FL		2	0	2			1	4			10		www.freedomhealth.com	www.freedomhealth.com	http://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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5430	1	0	1	1	1	H5430_001_0	5	1	2	1	07/12/2019	2020.01	07/12/2019 04:24:17 PM Eastern Daylight Time	08/02/2019 07:30:21 AM Eastern Daylight Time	07/30/2019 10:49:34 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	ONECARE BY CARE1ST HEALTH PLAN ARIZONA INC.	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H5430	1	0	2020	Select Counties in Arizona		2	45818	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5431	1	0	1	1	1	H5431_001_0	6	1			08/01/2019	2020.01	08/01/2019 06:17:58 AM Eastern Daylight Time	08/05/2019 10:04:33 AM Eastern Daylight Time	07/30/2019 07:11:58 PM Eastern Daylight Time			08/05/2019 04:07:36 PM Eastern Daylight Time	"HEALTHSUN HEALTH PLANS, INC."	"HealthSun Health Plans, Inc."	www.HealthSun.com	HealthSun SunPlus Advantage Plan (HMO)	1	1		1			H5431	1	0	2020	Miami-Dade		2		2			2						www.HealthSun.com	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		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		2					2					2	2			
H5431	6	0	1	1	1	H5431_006_0	7	1			08/01/2019	2020.01	08/01/2019 10:58:26 AM Eastern Daylight Time	08/05/2019 10:04:33 AM Eastern Daylight Time	07/30/2019 07:12:37 PM Eastern Daylight Time			08/05/2019 04:07:36 PM Eastern Daylight Time	"HEALTHSUN HEALTH PLANS, INC."	"HealthSun Health Plans, Inc."	www.HealthSun.com	HealthSun MediMax (HMO)	1	1		1			H5431	6	0	2020	Broward and Miami-Dade		2		2			2						www.HealthSun.com	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		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		2					2					2	2			
H5431	12	0	1	1	1	H5431_012_0	6	1			08/01/2019	2020.01	08/01/2019 06:18:22 AM Eastern Daylight Time	08/05/2019 10:04:34 AM Eastern Daylight Time	07/30/2019 07:13:22 PM Eastern Daylight Time			08/05/2019 04:07:36 PM Eastern Daylight Time	"HEALTHSUN HEALTH PLANS, INC."	"HealthSun Health Plans, Inc."	www.HealthSun.com	HealthSun HealthAdvantage Plan (HMO)	1	1		1			H5431	12	0	2020	Broward County		2		2			2						www.HealthSun.com	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		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		2					2					2	2			
H5431	13	0	1	1	1	H5431_013_0	6	1			08/01/2019	2020.01	08/01/2019 06:18:51 AM Eastern Daylight Time	08/05/2019 10:04:34 AM Eastern Daylight Time	07/30/2019 07:14:11 PM Eastern Daylight Time			08/05/2019 04:07:36 PM Eastern Daylight Time	"HEALTHSUN HEALTH PLANS, INC."	"HealthSun Health Plans, Inc."	www.HealthSun.com	HealthSun HealthAdvantage Plan (HMO)	1	1		1			H5431	13	0	2020	Palm Beach		2		2			2						www.HealthSun.com	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		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		2					2					2	2			
H5431	14	0	1	1	1	H5431_014_0	6	1			08/01/2019	2020.01	08/01/2019 10:58:40 AM Eastern Daylight Time	08/05/2019 10:04:34 AM Eastern Daylight Time	07/30/2019 07:14:50 PM Eastern Daylight Time			08/05/2019 04:07:36 PM Eastern Daylight Time	"HEALTHSUN HEALTH PLANS, INC."	"HealthSun Health Plans, Inc."	www.HealthSun.com	HealthSun MediMax (HMO)	1	1		1			H5431	14	0	2020	Palm Beach		2		2			2						www.HealthSun.com	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		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		(877)206-0500		2					2					2	2			
H5433	1	0	1	1	1	H5433_001_0	4	1	2	1	08/06/2019	2020.01	08/06/2019 11:06:29 AM Pacific Daylight Time	07/31/2019 01:47:12 PM Pacific Daylight Time	07/31/2019 01:58:10 PM Pacific Daylight Time			08/06/2019 11:12:35 AM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	OneCare	www.caloptima.org/onecare	OneCare (HMO D-SNP)	1	1		1			H5433	1	0	2020	"Orange County, California"		2	18250	2			1	3		1		1	www.caloptima.org/onecare	https://www.caloptima.org/en/Members/OneCare/MedicarePartD.aspx	www.caloptima.org/onecare	(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	2			
H5434	2	0	1	4	1	H5434_002_0	11	1			07/17/2019	2020.01	07/17/2019 02:59:11 PM Eastern Daylight Time	08/01/2019 02:39:21 PM Eastern Daylight Time	07/30/2019 05:29:31 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Select (PPO)	1	4		1			H5434	2	0	2020	"Select counties in S.FL/ W.FL/C.FL,N.C. FL/N.W FL"		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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			
H5434	23	0	1	4	1	H5434_023_0	7	1			06/03/2019	2020.01	06/03/2019 01:54:58 PM Eastern Daylight Time	08/01/2019 02:40:28 PM Eastern Daylight Time	07/30/2019 05:30:24 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/Medicare	BlueMedicare Value (PPO)	1	4		1			H5434	23	0	2020	Pinellas County		2	4000	2			2						FloridaBlue.com/Medicare	MyPrime.com	FloridaBlue.com/Medicare	(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						1	1	7a;7d;	
H5434	24	0	1	4	1	H5434_024_0	7	1			06/03/2019	2020.01	06/03/2019 01:55:35 PM Eastern Daylight Time	08/01/2019 02:41:36 PM Eastern Daylight Time	07/30/2019 05:31:17 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	1	4		1			H5434	24	0	2020	Manatee & Sarasota Counties		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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			
H5434	25	0	1	4	1	H5434_025_0	7	1			06/03/2019	2020.01	06/03/2019 01:56:03 PM Eastern Daylight Time	08/01/2019 02:42:43 PM Eastern Daylight Time	07/30/2019 05:32:10 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	1	4		1			H5434	25	0	2020	Escambia & Santa Rosa Counties		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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			
H5434	26	0	1	4	1	H5434_026_0	7	1			06/03/2019	2020.01	06/03/2019 01:57:02 PM Eastern Daylight Time	08/01/2019 02:43:50 PM Eastern Daylight Time	07/30/2019 05:33:02 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	1	4		1			H5434	26	0	2020	"Broward, Palm Beach & St. Lucie Counties"		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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						1	1	7a;7d;	
H5434	30	0	1	4	1	H5434_030_0	7	1			06/03/2019	2020.01	06/03/2019 01:57:52 PM Eastern Daylight Time	08/01/2019 02:44:56 PM Eastern Daylight Time	07/30/2019 05:33:56 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	1	4		1			H5434	30	0	2020	Collier & Lee Counties		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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			
H5434	31	0	1	4	1	H5434_031_0	7	1			06/03/2019	2020.01	06/03/2019 01:58:19 PM Eastern Daylight Time	08/01/2019 02:46:03 PM Eastern Daylight Time	07/30/2019 05:34:48 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	1	4		1			H5434	31	0	2020	Duval County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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						1	1	7a;7d;	
H5434	32	0	1	4	1	H5434_032_0	7	1			06/03/2019	2020.01	06/03/2019 01:58:49 PM Eastern Daylight Time	08/01/2019 02:47:08 PM Eastern Daylight Time	07/30/2019 05:35:42 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	1	4		1			H5434	32	0	2020	Miami-Dade County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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						1	1	7a;7d;	
H5434	33	0	1	4	1	H5434_033_0	7	1			06/03/2019	2020.01	06/03/2019 01:59:41 PM Eastern Daylight Time	08/01/2019 02:48:15 PM Eastern Daylight Time	07/30/2019 05:36:36 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	1	4		1			H5434	33	0	2020	Orange County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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						1	1	7a;7d;	
H5434	34	0	1	4	1	H5434_034_0	7	1			06/03/2019	2020.01	06/03/2019 02:00:19 PM Eastern Daylight Time	08/01/2019 02:49:22 PM Eastern Daylight Time	07/30/2019 05:37:30 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	1	4		1			H5434	34	0	2020	Polk County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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						1	1	7a;7d;	
H5434	35	0	1	4	1	H5434_035_0	8	1			06/03/2019	2020.01	06/03/2019 02:00:52 PM Eastern Daylight Time	08/01/2019 02:50:28 PM Eastern Daylight Time	07/30/2019 05:38:25 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Value (PPO)	1	4		1			H5434	35	0	2020	Pasco County		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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			
H5434	801	0	1	4	1	H5434_801_0	2	1			06/03/2019	2020.01	06/03/2019 08:39:58 AM Eastern Daylight Time					06/03/2019 08:45:44 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Group PPO (PPO)	1	4		1			H5434	801	0	2020	State of Florida with National Coverage		1	42286	2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	1a;2;5;6;7c;7e;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	1	1a;18a;	1									
H5434	802	0	1	4	1	H5434_802_0	2	1			06/03/2019	2020.01	06/03/2019 08:40:19 AM Eastern Daylight Time					06/03/2019 08:45:44 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Group PPO (PPO)	1	4		1			H5434	802	0	2020	State of Florida with National Coverage		1	5126	2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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	1a;1b;2;5;6;7c;7e;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;15;16b;	1	1a;1b;	1									
H5435	1	0	1	9	4	H5435_001_0	1	1			05/31/2019	2020.01	05/31/2019 06:04:25 PM Central Daylight Time	05/31/2019 11:41:38 AM Central Daylight Time				06/02/2019 11:58:00 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareDirect Essential (PFFS)	4	9	2	1			H5435	1	0	2020	Select counties nationwide		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)579-8774		(866)579-8774		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2										2	2			
H5435	24	0	1	9	4	H5435_024_0	3	1			08/02/2019	2020.01	08/02/2019 12:59:07 PM Central Daylight Time	08/02/2019 11:00:43 AM Central Daylight Time	07/30/2019 09:51:08 PM Central Daylight Time			08/06/2019 09:33:36 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareDirect Rx (PFFS)	4	9	2	1			H5435	24	0	2020	Select counties nationwide		2		2			2						www.UHCMedicareSolutions.com	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	2			
H5439	10	0	1	4	1	H5439_010_0	3	1			07/08/2019	2020.01	07/08/2019 10:12:44 AM US Mountain Standard Time	07/19/2019 12:54:47 PM Pacific Daylight Time				07/19/2019 01:06:05 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Aqua (PPO)	1	4		1			H5439	10	0	2020	Northern Counties		2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5439	11	0	1	4	1	H5439_011_0	5	1			08/01/2019	2020.01	08/01/2019 10:02:33 AM US Mountain Standard Time	08/05/2019 04:01:31 PM Central Daylight Time	08/05/2019 03:27:10 PM Central Daylight Time			08/06/2019 10:21:55 AM Central Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 1 (PPO)	1	4		1			H5439	11	0	2020	Northern Counties		2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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						2			
H5439	13	0	1	4	1	H5439_013_0	5	1			08/01/2019	2020.01	08/01/2019 10:03:03 AM US Mountain Standard Time	08/05/2019 04:01:35 PM Central Daylight Time	08/05/2019 03:27:13 PM Central Daylight Time			08/06/2019 10:21:55 AM Central Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 1 (PPO)	1	4		1			H5439	13	0	2020	"Douglas, Jackson, Josephine"		2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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						2			
H5439	14	1	1	4	1	H5439_014_1	5	1			08/01/2019	2020.01	08/01/2019 10:03:31 AM US Mountain Standard Time	08/05/2019 04:01:39 PM Central Daylight Time	08/05/2019 03:27:15 PM Central Daylight Time			08/06/2019 10:21:55 AM Central Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 2 (PPO)	1	4		1			H5439	14	1	2020	10 Northern Counties	"Clackamas, Lane, Multnomah and Washington"	2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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						2			
H5439	14	2	1	4	1	H5439_014_2	5	1			08/01/2019	2020.01	08/01/2019 10:03:58 AM US Mountain Standard Time	08/05/2019 04:01:01 PM Central Daylight Time	08/05/2019 03:27:18 PM Central Daylight Time			08/06/2019 10:21:55 AM Central Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 2 (PPO)	1	4		1			H5439	14	2	2020	10 Northern Counties	"Benton, Linn and Yamhill Counties"	2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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						2			
H5439	14	3	1	4	1	H5439_014_3	5	1			08/01/2019	2020.01	08/01/2019 10:04:27 AM US Mountain Standard Time	08/05/2019 04:01:05 PM Central Daylight Time	08/05/2019 03:27:21 PM Central Daylight Time			08/06/2019 10:21:55 AM Central Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 2 (PPO)	1	4		1			H5439	14	3	2020	10 Northern Counties	Marion and Polk Counties	2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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						2			
H5439	14	4	1	4	1	H5439_014_4	5	1			08/01/2019	2020.01	08/01/2019 04:53:06 PM US Mountain Standard Time	08/05/2019 04:01:10 PM Central Daylight Time	08/05/2019 03:27:23 PM Central Daylight Time			08/06/2019 10:21:55 AM Central Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 2 (PPO)	1	4		1			H5439	14	4	2020	10 Northern Counties	"Clark, WA County"	2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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						2			
H5439	15	0	1	4	1	H5439_015_0	5	1			08/01/2019	2020.01	08/01/2019 10:05:10 AM US Mountain Standard Time	08/05/2019 04:01:14 PM Central Daylight Time	08/05/2019 03:26:57 PM Central Daylight Time			08/06/2019 10:21:55 AM Central Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 3 (PPO)	1	4		1			H5439	15	0	2020	"Douglas, Josephine"		2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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						2			
H5439	16	1	1	4	1	H5439_016_1	5	1			08/01/2019	2020.01	08/01/2019 10:06:47 AM US Mountain Standard Time	08/05/2019 04:01:19 PM Central Daylight Time	08/05/2019 03:27:00 PM Central Daylight Time			08/06/2019 10:21:55 AM Central Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 2 (PPO)	1	4		1			H5439	16	1	2020	"Jackson, Josephine, Douglas"	Jackson County	2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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						2			
H5439	16	2	1	4	1	H5439_016_2	5	1			08/01/2019	2020.01	08/01/2019 10:07:19 AM US Mountain Standard Time	08/05/2019 04:01:23 PM Central Daylight Time	08/05/2019 03:27:03 PM Central Daylight Time			08/06/2019 10:21:55 AM Central Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 2 (PPO)	1	4		1			H5439	16	2	2020	"Jackson, Josephine, Douglas"	Josephine and Douglas Counties	2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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						2			
H5439	17	0	1	4	1	H5439_017_0	5	1			08/07/2019	2020.01	08/07/2019 10:53:22 AM US Mountain Standard Time	08/05/2019 04:01:27 PM Central Daylight Time	08/05/2019 03:27:06 PM Central Daylight Time			08/07/2019 03:13:10 PM Central Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Violet 4 (PPO)	1	4		1			H5439	17	0	2020	Lane County		2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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						2			
H5439	801	0	1	4	1	H5439_801_0	2	1			05/13/2019	2020.01	05/13/2019 02:16:27 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Medicare Advantage Employer (PPO)	1	4		1			H5439	801	0	2020	48 States - All Counties		1	6000	2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(800)960-4638		(800)960-4638		(800)949-6192		(800)949-6192		(800)960-4638		(800)960-4638		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5439	802	0	1	4	1	H5439_802_0	2	1			05/10/2019	2020.01	05/10/2019 10:56:29 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Medicare Advantage Employer (PPO)	1	4		1			H5439	802	0	2020	48 States - All Counties		1	54326	2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(800)960-4638		(800)960-4638		(800)949-6192		(800)949-6192										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5439	803	0	1	4	1	H5439_803_0	2	1			05/10/2019	2020.01	05/10/2019 10:56:40 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	or.healthnetadvantage.com	Health Net Medicare Advantage Employer (PPO)	1	4		1			H5439	803	0	2020	48 States - All Counties		1	20253	2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(800)960-4638		(800)960-4638		(800)949-6192		(800)949-6192		(800)960-4638		(800)960-4638		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5454	1	0	1	1	1	H5454_001_0	6	1			07/03/2019	2020.01	07/03/2019 11:16:41 AM Central Daylight Time	08/06/2019 02:11:20 PM Central Daylight Time	08/06/2019 02:11:24 PM Central Daylight Time			08/06/2019 02:39:04 PM Central Daylight Time	"CLEAR SPRING HEALTH OF ILLINOIS, INC."	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (HMO)	1	1		1			H5454	1	0	2020	"Rockford, Metro St Louis"		2	13115	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)384-1241		(877)384-1241		(877)384-1241		(877)384-1241		(833)478-6372		(833)478-6372		(877)384-1241		(877)384-1241		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5454	2	0	1	1	1	H5454_002_0	7	1			07/03/2019	2020.01	07/03/2019 11:17:12 AM Central Daylight Time	08/06/2019 02:11:20 PM Central Daylight Time	08/06/2019 02:11:26 PM Central Daylight Time			08/06/2019 02:39:04 PM Central Daylight Time	"CLEAR SPRING HEALTH OF ILLINOIS, INC."	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (HMO)	1	1		1			H5454	2	0	2020	Metro Chicago		2	14922	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)384-1241		(877)384-1241		(877)384-1241		(877)384-1241		(833)478-6372		(833)478-6372		(877)384-1241		(877)384-1241		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5454	3	0	1	1	1	H5454_003_0	5	1			06/02/2019	2020.01	06/02/2019 11:14:01 AM Central Daylight Time	08/06/2019 02:11:20 PM Central Daylight Time	08/06/2019 02:11:27 PM Central Daylight Time			08/06/2019 02:39:04 PM Central Daylight Time	"CLEAR SPRING HEALTH OF ILLINOIS, INC."	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential Plus (HMO)	1	1		1			H5454	3	0	2020	"Rockford, Metro St. Louis"		2	2405	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)384-1241		(877)384-1241		(877)384-1241		(877)384-1241		(833)478-6372		(833)478-6372		(877)384-1241		(877)384-1241		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5454	4	0	1	1	1	H5454_004_0	5	1			06/02/2019	2020.01	06/02/2019 11:16:46 AM Central Daylight Time	08/06/2019 02:11:21 PM Central Daylight Time	08/06/2019 02:11:29 PM Central Daylight Time			08/06/2019 02:39:04 PM Central Daylight Time	"CLEAR SPRING HEALTH OF ILLINOIS, INC."	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential Plus (HMO)	1	1		1			H5454	4	0	2020	Metro Chicago		2	2405	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)384-1241		(877)384-1241		(877)384-1241		(877)384-1241		(833)478-6372		(833)478-6372		(877)384-1241		(877)384-1241		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	64	0	1	1	1	H5471_064_0	7	1	2	1	08/01/2019	2020.01	08/01/2019 10:59:00 AM Eastern Daylight Time	08/05/2019 10:04:35 AM Eastern Daylight Time	07/30/2019 07:16:20 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Complete (HMO D-SNP)	1	1		1			H5471	64	0	2020	Miami-Dade		2		2			1	3		2		1	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	65	0	1	1	1	H5471_065_0	7	1			08/02/2019	2020.01	08/02/2019 04:22:22 PM Eastern Daylight Time	08/05/2019 10:04:35 AM Eastern Daylight Time	07/30/2019 07:17:49 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply More (HMO)	1	1		1			H5471	65	0	2020	Miami-Dade		2		2			2						www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	66	0	1	1	1	H5471_066_0	7	1	2	1	08/01/2019	2020.01	08/01/2019 06:09:45 AM Eastern Daylight Time	08/05/2019 10:04:35 AM Eastern Daylight Time	07/30/2019 07:19:17 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Complete (HMO D-SNP)	1	1		1			H5471	66	0	2020	Polk		2		2			1	3		2		1	www.simplyhealthcareplans.com/medicare/prescription-drug-benefits	www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	67	0	1	1	1	H5471_067_0	7	1		1	07/31/2019	2020.01	07/31/2019 09:21:54 PM Eastern Daylight Time	08/05/2019 10:04:36 AM Eastern Daylight Time	07/30/2019 07:20:46 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Care (HMO I-SNP)	1	1		1			H5471	67	0	2020	Miami-Dade		2		2			1	1	1				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	68	0	1	1	1	H5471_068_0	8	1		1	08/01/2019	2020.01	08/01/2019 05:55:21 AM Eastern Daylight Time	08/05/2019 10:04:36 AM Eastern Daylight Time	07/30/2019 07:22:11 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Comfort (HMO I-SNP)	1	1		1			H5471	68	0	2020	Miami-Dade		2		2			1	1	2				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	69	0	1	1	1	H5471_069_0	7	1		1	08/01/2019	2020.01	08/01/2019 05:54:55 AM Eastern Daylight Time	08/05/2019 10:04:36 AM Eastern Daylight Time	07/30/2019 07:22:50 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Level (HMO C-SNP)	1	1		1			H5471	69	0	2020	Miami-Dade		2		2			1	4			10		http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	70	0	1	1	1	H5471_070_0	7	1		1	08/01/2019	2020.01	08/01/2019 04:54:30 PM Eastern Daylight Time	08/05/2019 10:04:36 AM Eastern Daylight Time	07/30/2019 07:23:28 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Level (HMO C-SNP)	1	1		1			H5471	70	0	2020	Polk		2		2			1	4			10		http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	71	0	1	1	1	H5471_071_0	7	1			07/31/2019	2020.01	07/31/2019 09:22:35 PM Eastern Daylight Time	08/05/2019 10:04:37 AM Eastern Daylight Time	07/30/2019 07:24:06 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply More (HMO)	1	1		1			H5471	71	0	2020	Polk		2		2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	72	0	1	1	1	H5471_072_0	7	1	2	1	08/01/2019	2020.01	08/01/2019 06:11:03 AM Eastern Daylight Time	08/05/2019 10:04:37 AM Eastern Daylight Time	07/30/2019 07:24:43 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Complete (HMO D-SNP)	1	1		1			H5471	72	0	2020	"Orange, Osceola, Seminole"		2		2			1	3		1		1	http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	73	0	1	1	1	H5471_073_0	7	1		1	08/01/2019	2020.01	08/01/2019 06:13:00 AM Eastern Daylight Time	08/05/2019 10:04:37 AM Eastern Daylight Time	07/30/2019 07:25:21 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Level (HMO C-SNP)	1	1		1			H5471	73	0	2020	"Orange, Osceola, Seminole"		2		2			1	4			10		http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	74	0	1	1	1	H5471_074_0	7	1			08/01/2019	2020.01	08/01/2019 06:11:31 AM Eastern Daylight Time	08/05/2019 10:04:38 AM Eastern Daylight Time	07/30/2019 07:25:58 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply More (HMO)	1	1		1			H5471	74	0	2020	"Orange, Osceola, Seminole"		2		2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	75	0	1	1	1	H5471_075_0	9	1		1	08/01/2019	2020.01	08/01/2019 06:16:13 AM Eastern Daylight Time	08/05/2019 10:04:38 AM Eastern Daylight Time	07/30/2019 07:26:35 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Level (HMO C-SNP)	1	1		1			H5471	75	0	2020	"Hernando, Hillsborough, Pasco, Pinellas"		2		2			1	4			10		http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	76	0	1	1	1	H5471_076_0	7	1	2	1	07/16/2019	2020.01	07/16/2019 01:26:42 PM Eastern Daylight Time	08/05/2019 10:04:38 AM Eastern Daylight Time	07/30/2019 07:27:16 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Complete (HMO D-SNP)	1	1		1			H5471	76	0	2020	Broward		2		2			1	3		1		1	http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	77	0	1	1	1	H5471_077_0	7	1			08/01/2019	2020.01	08/01/2019 05:55:54 AM Eastern Daylight Time	08/05/2019 10:04:39 AM Eastern Daylight Time	07/30/2019 07:27:55 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply More (HMO)	1	1		1			H5471	77	0	2020	Broward		2		2			2						www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	78	0	1	1	1	H5471_078_0	7	1			08/01/2019	2020.01	08/01/2019 06:14:54 AM Eastern Daylight Time	08/05/2019 10:04:39 AM Eastern Daylight Time	07/30/2019 07:28:33 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply More (HMO)	1	1		1			H5471	78	0	2020	"Hernando, Hillsborough, Pasco, Pinellas"		2		2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	79	0	1	1	1	H5471_079_0	7	1		1	08/05/2019	2020.01	08/05/2019 05:02:25 AM Eastern Daylight Time	08/05/2019 10:04:40 AM Eastern Daylight Time	07/30/2019 07:29:10 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Care (HMO I-SNP)	1	1		1			H5471	79	0	2020	Broward		2		2			1	1	1				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	80	0	1	1	1	H5471_080_0	7	1		1	08/01/2019	2020.01	08/01/2019 05:57:17 AM Eastern Daylight Time	08/05/2019 10:04:40 AM Eastern Daylight Time	07/30/2019 07:29:47 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Level (HMO C-SNP)	1	1		1			H5471	80	0	2020	Broward		2		2			1	4			10		http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	81	0	1	1	1	H5471_081_0	7	1		1	08/01/2019	2020.01	08/01/2019 05:59:36 AM Eastern Daylight Time	08/05/2019 10:04:41 AM Eastern Daylight Time	07/30/2019 07:30:25 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Comfort (HMO I-SNP)	1	1		1			H5471	81	0	2020	Broward		2		2			1	1	2				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	82	0	1	1	1	H5471_082_0	7	1	2	1	07/16/2019	2020.01	07/16/2019 01:27:27 PM Eastern Daylight Time	08/05/2019 10:04:41 AM Eastern Daylight Time	07/30/2019 07:31:03 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Complete (HMO D-SNP)	1	1		1			H5471	82	0	2020	"Hernando, Hillsborough, Pasco, Pinellas"		2		2			1	3		1		1	http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	83	0	1	1	1	H5471_083_0	7	1			08/01/2019	2020.01	08/01/2019 06:02:37 AM Eastern Daylight Time	08/05/2019 10:04:41 AM Eastern Daylight Time	07/30/2019 07:31:40 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply More (HMO)	1	1		1			H5471	83	0	2020	Palm Beach		2		2			2						www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	84	0	1	1	1	H5471_084_0	7	1	2	1	08/01/2019	2020.01	08/01/2019 06:00:05 AM Eastern Daylight Time	08/05/2019 10:04:42 AM Eastern Daylight Time	07/30/2019 07:32:18 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Complete (HMO D-SNP)	1	1		1			H5471	84	0	2020	Palm Beach		2		2			1	3		1		1	http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	85	0	1	1	1	H5471_085_0	7	1		1	08/01/2019	2020.01	08/01/2019 06:03:53 AM Eastern Daylight Time	08/05/2019 10:04:42 AM Eastern Daylight Time	07/30/2019 07:32:57 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Level (HMO C-SNP)	1	1		1			H5471	85	0	2020	Palm Beach		2		2			1	4			10		http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	90	0	1	1	1	H5471_090_0	7	1		1	08/05/2019	2020.01	08/05/2019 05:10:35 AM Eastern Daylight Time	08/05/2019 10:04:42 AM Eastern Daylight Time	07/30/2019 07:33:34 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Care (HMO I-SNP)	1	1		1			H5471	90	0	2020	Polk		2		2			1	1	1				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	91	0	1	1	1	H5471_091_0	7	1		1	07/16/2019	2020.01	07/16/2019 01:27:45 PM Eastern Daylight Time	08/05/2019 10:04:29 AM Eastern Daylight Time	07/30/2019 07:34:12 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Comfort (HMO I-SNP)	1	1		1			H5471	91	0	2020	Polk		2		2			1	1	2				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	92	0	1	1	1	H5471_092_0	7	1		1	08/05/2019	2020.01	08/05/2019 05:12:52 AM Eastern Daylight Time	08/05/2019 10:04:29 AM Eastern Daylight Time	07/30/2019 07:34:50 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Care (HMO I-SNP)	1	1		1			H5471	92	0	2020	"Orange, Osceola, Seminole"		2		2			1	1	1				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	93	0	1	1	1	H5471_093_0	7	1		1	08/01/2019	2020.01	08/01/2019 06:14:20 AM Eastern Daylight Time	08/05/2019 10:04:30 AM Eastern Daylight Time	07/30/2019 07:35:28 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Comfort (HMO I-SNP)	1	1		1			H5471	93	0	2020	"Orange, Osceola, Seminole"		2		2			1	1	2				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	94	0	1	1	1	H5471_094_0	7	1		1	08/05/2019	2020.01	08/05/2019 05:15:00 AM Eastern Daylight Time	08/05/2019 10:04:30 AM Eastern Daylight Time	07/30/2019 07:36:05 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Care (HMO I-SNP)	1	1		1			H5471	94	0	2020	"Hernando, Hillsborough, Pasco, Pinellas"		2		2			1	1	1				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	95	0	1	1	1	H5471_095_0	7	1		1	08/01/2019	2020.01	08/01/2019 06:17:32 AM Eastern Daylight Time	08/05/2019 10:04:30 AM Eastern Daylight Time	07/30/2019 07:36:45 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Comfort (HMO I-SNP)	1	1		1			H5471	95	0	2020	"Hernando, Hillsborough, Pasco, Pinellas"		2		2			1	1	2				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	96	0	1	1	1	H5471_096_0	7	1		1	08/01/2019	2020.01	08/01/2019 06:04:43 AM Eastern Daylight Time	08/05/2019 10:07:27 AM Eastern Daylight Time	07/30/2019 07:37:22 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Care (HMO I-SNP)	1	1		1			H5471	96	0	2020	Palm Beach		2		2			1	1	1				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	97	0	1	1	1	H5471_097_0	7	1		1	08/01/2019	2020.01	08/01/2019 06:05:09 AM Eastern Daylight Time	08/05/2019 10:07:28 AM Eastern Daylight Time	07/30/2019 07:37:59 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Comfort (HMO I-SNP)	1	1		1			H5471	97	0	2020	Palm Beach		2		2			1	1	2				http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	98	0	1	1	1	H5471_098_0	7	1			08/01/2019	2020.01	08/01/2019 06:12:26 AM Eastern Daylight Time	08/05/2019 10:07:28 AM Eastern Daylight Time	07/30/2019 07:38:36 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Select (HMO)	1	1		1			H5471	98	0	2020	"Orange, Osceola, Seminole"		2		2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	99	0	1	1	1	H5471_099_0	7	1			08/01/2019	2020.01	08/01/2019 06:15:40 AM Eastern Daylight Time	08/05/2019 10:07:28 AM Eastern Daylight Time	07/30/2019 07:39:13 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Select (HMO)	1	1		1			H5471	99	0	2020	"Hernando, Hillsborough, Pasco, Pinellas"		2		2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	100	0	1	1	1	H5471_100_0	7	1			06/25/2019	2020.01	06/25/2019 08:54:43 PM Eastern Daylight Time	08/05/2019 10:07:29 AM Eastern Daylight Time	07/30/2019 07:39:52 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Select (HMO)	1	1		1			H5471	100	0	2020	Broward		2		2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	101	0	1	1	1	H5471_101_0	7	1			06/25/2019	2020.01	06/25/2019 08:54:28 PM Eastern Daylight Time	08/05/2019 10:07:29 AM Eastern Daylight Time	07/30/2019 07:40:29 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Select (HMO)	1	1		1			H5471	101	0	2020	Palm Beach		2		2			2						http://www.simplyhealthcareplans.com/medicare/pharmacy/pharmacy-locator/index.html	http://www.simplyhealthcareplans.com/medicare/pharmacy/formulary/index.html	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	103	0	1	1	1	H5471_103_0	7	1			08/01/2019	2020.01	08/01/2019 05:54:22 AM Eastern Daylight Time	08/05/2019 10:07:30 AM Eastern Daylight Time	07/30/2019 07:41:07 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Extra (HMO)	1	1		1			H5471	103	0	2020	Miami-Dade		2		2			2						www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	104	0	1	1	1	H5471_104_0	7	1			08/01/2019	2020.01	08/01/2019 05:56:45 AM Eastern Daylight Time	08/05/2019 10:07:30 AM Eastern Daylight Time	07/30/2019 07:41:45 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Extra (HMO)	1	1		1			H5471	104	0	2020	Broward		2		2			2						www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5471	105	0	1	1	1	H5471_105_0	7	1			08/01/2019	2020.01	08/01/2019 06:03:21 AM Eastern Daylight Time	08/05/2019 10:07:30 AM Eastern Daylight Time	07/30/2019 07:42:22 PM Eastern Daylight Time			08/05/2019 04:24:44 PM Eastern Daylight Time	"SIMPLY HEALTHCARE PLANS, INC."	"Simply Healthcare Plans, Inc."	www.mysimplymedicare.com	Simply Extra (HMO)	1	1		1			H5471	105	0	2020	Palm Beach		2		2			2						www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	www.mysimplymedicare.com	(877)577-0115		(877)577-0115		(888)870-7138		(888)870-7138		(877)577-0115		(877)577-0115		(800)215-7968		(800)215-7968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	1	0	1	2	1	H5475_001_0	5	1	2	1	07/11/2019	2020.01	07/11/2019 05:01:18 PM Eastern Daylight Time	08/02/2019 07:31:56 AM Eastern Daylight Time	07/30/2019 10:50:10 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Extra Plus (HMO-POS D-SNP)	1	2		1			H5475	1	0	2020	Select counties in Michigan		2	84706	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	3	0	1	2	1	H5475_003_0	5	1			05/30/2019	2020.01	05/30/2019 02:32:15 PM Eastern Daylight Time	08/02/2019 07:33:31 AM Eastern Daylight Time	07/30/2019 10:50:45 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO-POS)	1	2		1			H5475	3	0	2020	Select counties in MI		2	28647	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	4	0	1	2	1	H5475_004_0	5	1	2	1	07/11/2019	2020.01	07/11/2019 05:09:17 PM Eastern Daylight Time	08/02/2019 07:35:06 AM Eastern Daylight Time	07/30/2019 10:51:21 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Extra Plus (HMO-POS D-SNP)	1	2		1			H5475	4	0	2020	Select counties in MI		2	29308	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	5	0	1	2	1	H5475_005_0	5	1			05/30/2019	2020.01	05/30/2019 02:36:22 PM Eastern Daylight Time	08/02/2019 07:36:41 AM Eastern Daylight Time	07/30/2019 10:51:58 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H5475	5	0	2020	Select counties in MI		2	21009	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	6	0	1	2	1	H5475_006_0	5	1			05/30/2019	2020.01	05/30/2019 02:36:40 PM Eastern Daylight Time	08/02/2019 07:38:17 AM Eastern Daylight Time	07/30/2019 10:52:34 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H5475	6	0	2020	Select counties in MI/IL		2	46973	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	8	0	1	2	1	H5475_008_0	5	1	2	1	07/11/2019	2020.01	07/11/2019 05:13:27 PM Eastern Daylight Time	08/02/2019 07:39:51 AM Eastern Daylight Time	07/30/2019 10:53:10 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Extra Plus (HMO-POS D-SNP)	1	2		1			H5475	8	0	2020	Select counties in MI		2	9061	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	9	0	1	2	1	H5475_009_0	5	1			05/30/2019	2020.01	05/30/2019 02:45:40 PM Eastern Daylight Time	08/02/2019 07:41:25 AM Eastern Daylight Time	07/30/2019 10:53:46 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H5475	9	0	2020	Select counties in MI		2	5143	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	10	0	1	2	1	H5475_010_0	6	1	2	1	07/11/2019	2020.01	07/11/2019 05:19:39 PM Eastern Daylight Time	08/02/2019 07:43:00 AM Eastern Daylight Time	07/30/2019 10:54:22 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Extra Plus (HMO-POS D-SNP)	1	2		1			H5475	10	0	2020	Select counties in OH		2	2611	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	11	0	1	2	1	H5475_011_0	6	1			05/29/2019	2020.01	05/29/2019 09:24:56 AM Eastern Daylight Time	08/02/2019 07:44:36 AM Eastern Daylight Time	07/30/2019 10:54:58 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H5475	11	0	2020	Select counties in OH		2	2435	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	12	0	1	2	1	H5475_012_0	5	1	2	1	07/11/2019	2020.01	07/11/2019 05:14:40 PM Eastern Daylight Time	08/02/2019 07:46:10 AM Eastern Daylight Time	07/30/2019 10:55:34 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Extra Plus (HMO-POS D-SNP)	1	2		1			H5475	12	0	2020	Select counties in OH		2	946	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	13	0	1	2	1	H5475_013_0	5	1			05/29/2019	2020.01	05/29/2019 09:28:56 AM Eastern Daylight Time	08/02/2019 07:47:44 AM Eastern Daylight Time	07/30/2019 10:56:10 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H5475	13	0	2020	Select counties in OH		2	2218	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	15	0	1	2	1	H5475_015_0	6	1	2	1	07/11/2019	2020.01	07/11/2019 05:15:43 PM Eastern Daylight Time	08/02/2019 04:54:49 PM Eastern Daylight Time	07/30/2019 10:56:46 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Extra Plus (HMO-POS D-SNP)	1	2		1			H5475	15	0	2020	Select counties in OH		2	1054	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(877)902-6784		(877)902-6784		(866)527-0056		(866)527-0056		(877)902-6784		(877)902-6784		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5475	16	0	1	2	1	H5475_016_0	5	1			05/30/2019	2020.01	05/30/2019 03:07:34 PM Eastern Daylight Time	08/02/2019 07:51:05 AM Eastern Daylight Time	07/30/2019 10:57:22 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H5475	16	0	2020	Select counties in OH		2	728	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	19	0	1	2	1	H5475_019_0	5	1			05/29/2019	2020.01	05/29/2019 09:36:48 AM Eastern Daylight Time	08/02/2019 07:52:42 AM Eastern Daylight Time	07/30/2019 10:57:58 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H5475	19	0	2020	Select counties in IN		2	886	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	20	0	1	2	1	H5475_020_0	4	1			07/11/2019	2020.01	07/11/2019 05:10:14 PM Eastern Daylight Time	08/02/2019 07:54:17 AM Eastern Daylight Time	07/30/2019 10:58:34 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Edge (HMO-POS)	1	2		1			H5475	20	0	2020	Select counties in IN		2	21	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	21	0	1	2	1	H5475_021_0	4	1	2	1	07/11/2019	2020.01	07/11/2019 05:11:06 PM Eastern Daylight Time	08/02/2019 07:55:53 AM Eastern Daylight Time	07/30/2019 10:59:10 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Extra Plus (HMO-POS D-SNP)	1	2		1			H5475	21	0	2020	Select counties in OH		2	3140	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	22	0	1	2	1	H5475_022_0	4	1			05/29/2019	2020.01	05/29/2019 09:42:00 AM Eastern Daylight Time	08/02/2019 07:57:29 AM Eastern Daylight Time	07/30/2019 10:59:46 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H5475	22	0	2020	Select counties in OH		2	2129	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	23	0	1	2	1	H5475_023_0	5	1	2	1	07/11/2019	2020.01	07/11/2019 05:12:06 PM Eastern Daylight Time	08/04/2019 07:03:04 PM Eastern Daylight Time	07/30/2019 11:00:22 PM Eastern Daylight Time			08/05/2019 04:22:20 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Extra Smile (HMO-POS D-SNP)	1	2		1			H5475	23	0	2020	Select counties in MI		2	8041	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	24	0	1	2	1	H5475_024_0	4	1			07/12/2019	2020.01	07/12/2019 04:15:33 PM Eastern Daylight Time	08/02/2019 08:00:41 AM Eastern Daylight Time	07/30/2019 11:00:58 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Elite Smile (HMO-POS)	1	2		1			H5475	24	0	2020	Select counties in MI		2	9105	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	26	0	1	2	1	H5475_026_0	4	1			05/29/2019	2020.01	05/29/2019 09:48:29 AM Eastern Daylight Time	08/02/2019 08:02:18 AM Eastern Daylight Time	07/30/2019 11:01:34 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Explore (HMO-POS)	1	2		1			H5475	26	0	2020	Select counties in MI/IL		2	8239	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	27	0	1	2	1	H5475_027_0	4	1	2	1	05/31/2019	2020.01	05/31/2019 09:45:42 AM Eastern Daylight Time	08/02/2019 08:03:54 AM Eastern Daylight Time	07/30/2019 11:02:10 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Extra Smile (HMO-POS D-SNP)	1	2		1			H5475	27	0	2020	Select counties in OH		2	1851	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	28	0	1	2	1	H5475_028_0	4	1			05/30/2019	2020.01	05/30/2019 03:02:40 PM Eastern Daylight Time	08/02/2019 08:05:31 AM Eastern Daylight Time	07/30/2019 11:02:45 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential Smile (HMO-POS)	1	2		1			H5475	28	0	2020	Select counties in OH		2	523	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	29	0	1	2	1	H5475_029_0	4	1		1	05/30/2019	2020.01	05/30/2019 03:48:29 PM Eastern Daylight Time	08/02/2019 08:07:10 AM Eastern Daylight Time	07/30/2019 11:03:21 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Guardian (HMO-POS C-SNP)	1	2		1			H5475	29	0	2020	Select counties in MI		2	286	2			1	4			1E+13		www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	30	0	1	2	1	H5475_030_0	4	1	2	1	05/29/2019	2020.01	05/29/2019 06:48:23 PM Eastern Daylight Time	08/02/2019 08:08:48 AM Eastern Daylight Time	07/30/2019 11:03:56 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Extra Plus (HMO-POS D-SNP)	1	2		1			H5475	30	0	2020	Select counties in IN		2	1055	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	31	0	1	1	1	H5475_031_0	4	1			07/11/2019	2020.01	07/11/2019 05:06:00 PM Eastern Daylight Time	08/02/2019 08:10:30 AM Eastern Daylight Time	07/30/2019 11:04:33 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Plus (HMO)	1	1		1			H5475	31	0	2020	Select counties in MI		2	859	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5475	32	0	1	1	1	H5475_032_0	4	1			07/11/2019	2020.01	07/11/2019 05:04:58 PM Eastern Daylight Time	08/02/2019 08:12:13 AM Eastern Daylight Time	07/30/2019 11:05:09 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF MICHIGAN, INC."	WellCare	www.wellcare.com/medicare	WellCare Plus (HMO)	1	1		1			H5475	32	0	2020	Select counties in OH		2	40	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5493	1	0	1	20	8	H5493_001_0	1	1			06/01/2019	2020.01	06/01/2019 02:43:44 PM Eastern Daylight Time		06/01/2019 02:35:53 PM Eastern Daylight Time			06/01/2019 02:50:15 PM Eastern Daylight Time	"LIFE AT ST. FRANCIS HEALTHCARE, INC."	Saint Francis LIFE	http://stfrancishealthcare.org/life/	"LIFE at St. Francis Healthcare, Inc (PACE)"	8	20		1			H5493	1	0	2020	"New Castle County, Delaware"		2		2			2						www.stfrancishealthcare.org	www.stfrancishealthcare.org												(302)660-3355		(800)000-0000		(302)660-3351												(800)232-5460		(800)676-3777		(000)000-0000																
H5493	2	0	1	20	8	H5493_002_0	1	1			06/01/2019	2020.01	06/01/2019 02:42:07 PM Eastern Daylight Time		06/01/2019 02:36:47 PM Eastern Daylight Time			06/01/2019 02:50:15 PM Eastern Daylight Time	"LIFE AT ST. FRANCIS HEALTHCARE, INC."	Saint Francis LIFE	http://stfrancishealthcare.org/life/	"LIFE at St. Francis Healthcare, Inc (PACE)"	8	20		1			H5493	2	0	2020	"LIFE at St. Francis Healthcare, Inc"		2		2			2						www.stfrancishealthcare.org	www.stfrancishealthcare.org												(302)660-3355				(302)660-3351												(800)232-5460				(800)232-5460																
H5496	5	0	1	1	1	H5496_005_0	5	1		1	08/02/2019	2020.01	08/02/2019 04:19:16 PM Eastern Daylight Time	08/02/2019 02:50:23 PM Eastern Daylight Time	08/02/2019 02:21:20 PM Eastern Daylight Time			08/04/2019 04:30:34 PM Eastern Daylight Time	"IMPERIAL HEALTH PLAN OF CALIFORNIA, INC."	"Imperial Health Plan of California, Inc."	www.imperialhealthplan.com	Imperial Senior Value (HMO C-SNP)	1	1		1			H5496	5	0	2020	"Northern, Central and Southern California"		2	6000	2			1	4			10		www.imperialhealthplan.com	www.imperialhealthplan.com	www.imperialhealthplan.com	(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333		(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333	201	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5496	7	0	1	1	1	H5496_007_0	5	1			05/31/2019	2020.01	05/31/2019 09:16:34 PM Eastern Daylight Time	08/02/2019 02:54:18 PM Eastern Daylight Time	08/02/2019 02:23:47 PM Eastern Daylight Time			08/04/2019 04:30:34 PM Eastern Daylight Time	"IMPERIAL HEALTH PLAN OF CALIFORNIA, INC."	"Imperial Health Plan of California, Inc."	www.imperialhealthplan.com	Imperial Traditional (HMO) (HMO)	1	1		1			H5496	7	0	2020	"Northern, Central and Southern California"		2	12000	2			2						www.imperialhealthplan.com	www.imperialhealthplan.com	www.imperialhealthplan.com	(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333		(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5496	9	0	1	1	1	H5496_009_0	5	1			08/02/2019	2020.01	08/02/2019 04:19:42 PM Eastern Daylight Time	08/02/2019 02:56:11 PM Eastern Daylight Time	08/02/2019 02:24:48 PM Eastern Daylight Time			08/04/2019 04:30:34 PM Eastern Daylight Time	"IMPERIAL HEALTH PLAN OF CALIFORNIA, INC."	"Imperial Health Plan of California, Inc."	www.imperialhealthplan.com	Imperial Traditional Plus (HMO) (HMO)	1	1		1			H5496	9	0	2020	"Northern, Central and Southern California"		2	6000	2			2						www.imperialhealthplan.com	www.imperialhealthplan.com	www.imperialhealthplan.com	(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333		(800)838-8271		(626)708-0333		(800)838-5914		(626)708-0333		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5521	12	0	1	4	1	H5521_012_0	5	1			07/08/2019	2020.01	07/08/2019 01:46:32 PM Eastern Daylight Time	08/02/2019 01:43:42 PM Eastern Daylight Time	07/31/2019 01:37:32 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H5521	12	0	2020	Central and NE PA		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	13	0	1	4	1	H5521_013_0	5	1			07/03/2019	2020.01	07/03/2019 05:32:13 PM Eastern Daylight Time	08/02/2019 09:45:14 AM Eastern Daylight Time	07/31/2019 01:38:42 AM Eastern Daylight Time			08/02/2019 07:36:58 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier Plan (PPO)	1	4		1			H5521	13	0	2020	Connecticut		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	15	0	1	4	1	H5521_015_0	4	1			07/03/2019	2020.01	07/03/2019 05:53:42 PM Eastern Daylight Time	08/02/2019 10:14:24 AM Eastern Daylight Time	07/31/2019 01:39:52 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	15	0	2020	District of Columbia		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	16	0	1	4	1	H5521_016_0	6	1			07/08/2019	2020.01	07/08/2019 01:14:41 PM Eastern Daylight Time	08/02/2019 11:25:41 AM Eastern Daylight Time	07/31/2019 01:41:01 AM Eastern Daylight Time			08/02/2019 07:36:58 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H5521	16	0	2020	Chicagoland		2	21048	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	20	0	1	4	1	H5521_020_0	4	1			07/03/2019	2020.01	07/03/2019 05:54:08 PM Eastern Daylight Time	08/02/2019 10:48:58 AM Eastern Daylight Time	07/31/2019 01:42:12 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier 2 (PPO)	1	4		1			H5521	20	0	2020	Ohio and Northern Kentucky		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	22	0	1	4	1	H5521_022_0	3	1			07/03/2019	2020.01	07/03/2019 02:38:42 PM Eastern Daylight Time	08/02/2019 10:10:26 AM Eastern Daylight Time	07/31/2019 01:43:22 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	1	4		1			H5521	22	0	2020	"CLA, CAR, DOU, CHU, NYE, STO, WAS"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	27	0	1	4	1	H5521_027_0	4	1			07/03/2019	2020.01	07/03/2019 05:54:57 PM Eastern Daylight Time	08/02/2019 10:16:26 AM Eastern Daylight Time	07/31/2019 01:44:32 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H5521	27	0	2020	Fairfax County and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	33	0	1	4	1	H5521_033_0	3	1			08/01/2019	2020.01	08/01/2019 02:12:47 PM Eastern Daylight Time	08/02/2019 01:15:40 PM Eastern Daylight Time	07/31/2019 01:45:50 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	1	4		1			H5521	33	0	2020	"North, Central, West, NW, SW, TC, South FL"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	37	0	1	4	1	H5521_037_0	3	1			07/03/2019	2020.01	07/03/2019 07:47:59 PM Eastern Daylight Time	08/01/2019 06:05:42 PM Eastern Daylight Time	07/31/2019 01:47:00 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier (PPO)	1	4		1			H5521	37	0	2020	Northern New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	40	0	1	4	1	H5521_040_0	3	1			07/03/2019	2020.01	07/03/2019 07:48:04 PM Eastern Daylight Time	08/02/2019 10:48:21 AM Eastern Daylight Time	07/31/2019 01:48:10 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	40	0	2020	"Metro (NYC, Queens, Brooklyn, SI, Nassau)"		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	53	0	1	4	1	H5521_053_0	3	1			07/31/2019	2020.01	07/31/2019 09:01:01 AM Eastern Daylight Time	08/01/2019 12:31:45 PM Pacific Daylight Time	07/30/2019 10:49:20 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H5521	53	0	2020	San Diego County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	55	0	1	4	1	H5521_055_0	3	1			08/01/2019	2020.01	08/01/2019 01:54:04 PM Eastern Daylight Time	08/02/2019 10:01:21 AM Eastern Daylight Time	07/31/2019 01:50:30 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H5521	55	0	2020	"CLA, CAR, DOU, CHU, NYE, STO, WAS"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	56	0	1	4	1	H5521_056_0	3	1			07/03/2019	2020.01	07/03/2019 03:08:28 PM Eastern Daylight Time	08/01/2019 09:38:46 AM Pacific Daylight Time	07/30/2019 10:51:39 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H5521	56	0	2020	Orange County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	57	0	1	4	1	H5521_057_0	4	1			07/03/2019	2020.01	07/03/2019 05:05:34 PM Central Daylight Time	08/01/2019 03:47:57 PM Central Daylight Time	07/31/2019 12:52:50 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (PPO)	1	4		1			H5521	57	0	2020	Denver Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	76	0	1	4	1	H5521_076_0	4	1			07/08/2019	2020.01	07/08/2019 04:59:37 PM Eastern Daylight Time	08/02/2019 10:50:40 AM Eastern Daylight Time	07/31/2019 01:54:00 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	76	0	2020	Greater Rochester		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	77	0	1	4	1	H5521_077_0	3	1			08/01/2019	2020.01	08/01/2019 09:14:11 AM Eastern Daylight Time	08/02/2019 10:52:31 AM Eastern Daylight Time	07/31/2019 01:55:11 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	77	0	2020	Northern Central Upstate NY		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	81	0	1	4	1	H5521_081_0	3	1			08/01/2019	2020.01	08/01/2019 10:18:24 AM Eastern Daylight Time	08/01/2019 11:37:49 AM Eastern Daylight Time	07/31/2019 01:56:20 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	81	0	2020	North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	82	0	1	4	1	H5521_082_0	4	1			07/03/2019	2020.01	07/03/2019 05:55:13 PM Eastern Daylight Time	08/02/2019 10:18:24 AM Eastern Daylight Time	07/31/2019 01:57:30 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	1	4		1			H5521	82	0	2020	Richmond and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	83	0	1	4	1	H5521_083_0	4	1			07/03/2019	2020.01	07/03/2019 05:55:29 PM Eastern Daylight Time	08/02/2019 10:20:24 AM Eastern Daylight Time	07/31/2019 01:58:39 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	1	4		1			H5521	83	0	2020	Danville City and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	84	0	1	4	1	H5521_084_0	4	1			07/03/2019	2020.01	07/03/2019 05:55:44 PM Eastern Daylight Time	08/02/2019 10:22:24 AM Eastern Daylight Time	07/31/2019 01:59:49 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	1	4		1			H5521	84	0	2020	Newport News and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	85	0	1	4	1	H5521_085_0	4	1			08/01/2019	2020.01	08/01/2019 02:27:20 PM Eastern Daylight Time	08/02/2019 10:49:39 AM Eastern Daylight Time	07/31/2019 02:00:58 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	85	0	2020	Northern KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	86	0	1	4	1	H5521_086_0	4	1			07/31/2019	2020.01	07/31/2019 02:30:02 PM Eastern Daylight Time	08/02/2019 11:26:20 AM Eastern Daylight Time	07/31/2019 02:02:08 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	86	0	2020	Chicagoland		2	123264	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	87	0	1	4	1	H5521_087_0	4	1			08/01/2019	2020.01	08/01/2019 02:28:12 PM Eastern Daylight Time	08/02/2019 10:50:18 AM Eastern Daylight Time	07/31/2019 02:03:18 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	87	0	2020	Cincinnati OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	88	0	1	4	1	H5521_088_0	4	1			08/01/2019	2020.01	08/01/2019 02:29:10 PM Eastern Daylight Time	08/02/2019 10:51:00 AM Eastern Daylight Time	07/31/2019 02:04:28 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	88	0	2020	Toledo and Akron OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	89	0	1	4	1	H5521_089_0	4	1			08/01/2019	2020.01	08/01/2019 02:29:45 PM Eastern Daylight Time	08/02/2019 10:51:42 AM Eastern Daylight Time	07/31/2019 02:05:37 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	89	0	2020	Central OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	90	0	1	4	1	H5521_090_0	4	1			07/31/2019	2020.01	07/31/2019 09:03:40 PM Eastern Daylight Time	08/02/2019 10:52:19 AM Eastern Daylight Time	07/31/2019 02:06:47 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	90	0	2020	Dayton OH Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	91	0	1	4	1	H5521_091_0	3	1			08/01/2019	2020.01	08/01/2019 05:43:53 PM Eastern Daylight Time	08/01/2019 06:12:34 PM Eastern Daylight Time	07/31/2019 02:07:58 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	1	4		1			H5521	91	0	2020	Atlanta GA and SE AL Markets		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	95	0	1	4	1	H5521_095_0	4	1			07/03/2019	2020.01	07/03/2019 06:36:32 PM Eastern Daylight Time	08/02/2019 01:44:19 PM Eastern Daylight Time	07/31/2019 02:09:07 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H5521	95	0	2020	"New Castle, Kent and Sussex Counties"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	99	0	1	4	1	H5521_099_0	4	1			07/31/2019	2020.01	07/31/2019 02:30:39 PM Eastern Daylight Time	08/02/2019 11:26:59 AM Eastern Daylight Time	07/31/2019 02:10:18 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	99	0	2020	Northeast Indiana		2	38964	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	100	0	1	4	1	H5521_100_0	3	1			07/31/2019	2020.01	07/31/2019 05:00:47 PM Eastern Daylight Time	08/02/2019 07:09:40 AM Pacific Daylight Time	07/30/2019 11:11:26 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	100	0	2020	"Maricopa, Pima and Pinal Counties"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	101	0	1	4	1	H5521_101_0	3	1			07/03/2019	2020.01	07/03/2019 02:39:08 PM Eastern Daylight Time	08/01/2019 03:56:07 PM Eastern Daylight Time	07/31/2019 02:12:36 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H5521	101	0	2020	Salt Lake and Utah counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	102	0	1	4	1	H5521_102_0	4	1			07/03/2019	2020.01	07/03/2019 05:57:43 PM Eastern Daylight Time	08/02/2019 10:24:25 AM Eastern Daylight Time	07/31/2019 02:13:46 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	1	4		1			H5521	102	0	2020	Roanoke and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	110	0	1	4	1	H5521_110_0	3	1			07/03/2019	2020.01	07/03/2019 07:48:25 PM Eastern Daylight Time	08/02/2019 10:55:43 AM Eastern Daylight Time	07/31/2019 02:14:56 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	110	0	2020	Capital Region and Hudson Valley		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	116	0	1	4	1	H5521_116_0	3	1			08/01/2019	2020.01	08/01/2019 05:46:01 PM Eastern Daylight Time	08/01/2019 06:13:08 PM Eastern Daylight Time	07/31/2019 02:16:06 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	116	0	2020	Southwest Alabama		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	117	0	1	4	1	H5521_117_0	3	1			07/03/2019	2020.01	07/03/2019 07:48:32 PM Eastern Daylight Time	08/02/2019 10:57:37 AM Eastern Daylight Time	07/31/2019 02:17:16 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	117	0	2020	Suffolk County		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	118	0	1	4	1	H5521_118_0	4	1			07/31/2019	2020.01	07/31/2019 03:26:50 PM Eastern Daylight Time	08/02/2019 10:59:20 AM Eastern Daylight Time	07/31/2019 02:18:27 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	1	4		1			H5521	118	0	2020	Greater Rochester		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	119	0	1	4	1	H5521_119_0	3	1			07/03/2019	2020.01	07/03/2019 07:48:46 PM Eastern Daylight Time	08/02/2019 11:00:55 AM Eastern Daylight Time	07/31/2019 02:19:36 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	1	4		1			H5521	119	0	2020	Capital Region and Hudson Valley		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	120	0	1	4	1	H5521_120_0	4	1			07/31/2019	2020.01	07/31/2019 03:26:36 PM Eastern Daylight Time	08/02/2019 11:02:22 AM Eastern Daylight Time	07/31/2019 02:20:46 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	1	4		1			H5521	120	0	2020	"Metro (LI, 5 Boroughs, Westchester/Rockland)"		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	121	0	1	4	1	H5521_121_0	4	1			07/08/2019	2020.01	07/08/2019 01:37:35 PM Eastern Daylight Time	08/02/2019 11:05:26 AM Eastern Daylight Time	07/31/2019 02:21:58 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	121	0	2020	"Westchester, Rockland, Bronx"		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	122	0	1	4	1	H5521_122_0	3	1			07/03/2019	2020.01	07/03/2019 06:37:30 PM Eastern Daylight Time	08/02/2019 01:45:01 PM Eastern Daylight Time	07/31/2019 02:23:08 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Gold Plan (PPO)	1	4		1			H5521	122	0	2020	Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	123	0	1	4	1	H5521_123_0	3	1			07/03/2019	2020.01	07/03/2019 07:49:09 PM Eastern Daylight Time	08/01/2019 06:08:33 PM Eastern Daylight Time	07/31/2019 02:24:18 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare SNJ Prime Elite (PPO)	1	4		1			H5521	123	0	2020	"Counties: Burlington, Camden, Gloucester, Mercer"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	124	0	1	4	1	H5521_124_0	3	1			07/03/2019	2020.01	07/03/2019 07:49:20 PM Eastern Daylight Time	08/01/2019 06:12:08 PM Eastern Daylight Time	07/31/2019 02:25:28 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier 2 (PPO)	1	4		1			H5521	124	0	2020	"Counties: ATL, BUR, CAM, CPM, CUM, GLO, SLM"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	125	0	1	4	1	H5521_125_0	3	1			07/03/2019	2020.01	07/03/2019 03:08:48 PM Eastern Daylight Time	08/01/2019 08:09:24 AM Pacific Daylight Time	07/30/2019 11:26:38 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H5521	125	0	2020	Los Angeles County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	127	0	1	4	1	H5521_127_0	3	1			07/03/2019	2020.01	07/03/2019 02:39:17 PM Eastern Daylight Time	08/01/2019 05:28:49 PM Eastern Daylight Time	07/31/2019 02:27:47 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H5521	127	0	2020	Puget Sound		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	128	0	1	4	1	H5521_128_0	3	1			07/03/2019	2020.01	07/03/2019 02:39:36 PM Eastern Daylight Time	08/01/2019 05:30:27 PM Eastern Daylight Time	07/31/2019 02:28:58 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	1	4		1			H5521	128	0	2020	Puget Sound		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	134	0	1	4	1	H5521_134_0	4	1			07/03/2019	2020.01	07/03/2019 05:58:06 PM Eastern Daylight Time	08/02/2019 10:53:34 AM Eastern Daylight Time	07/31/2019 02:30:08 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier 1 (PPO)	1	4		1			H5521	134	0	2020	Select Counties in Ohio		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	139	0	1	4	1	H5521_139_0	3	1			07/03/2019	2020.01	07/03/2019 03:51:16 PM Eastern Daylight Time	08/01/2019 11:38:40 AM Eastern Daylight Time	07/31/2019 02:31:17 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	139	0	2020	North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	140	0	1	4	1	H5521_140_0	3	1			08/01/2019	2020.01	08/01/2019 10:18:57 AM Eastern Daylight Time	08/01/2019 11:39:24 AM Eastern Daylight Time	07/31/2019 02:32:28 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	140	0	2020	Greenville/Spartanburg SC and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	141	0	1	4	1	H5521_141_0	3	1			08/01/2019	2020.01	08/01/2019 10:19:18 AM Eastern Daylight Time	08/01/2019 11:40:06 AM Eastern Daylight Time	07/31/2019 02:33:37 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	141	0	2020	Nashville TN and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	142	0	1	4	1	H5521_142_0	5	1			07/03/2019	2020.01	07/03/2019 05:33:16 PM Eastern Daylight Time	08/02/2019 09:48:11 AM Eastern Daylight Time	07/31/2019 02:34:47 AM Eastern Daylight Time			08/02/2019 07:36:58 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	1	4		1			H5521	142	0	2020	Southern Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	143	0	1	4	1	H5521_143_0	5	1			07/03/2019	2020.01	07/03/2019 05:33:57 PM Eastern Daylight Time	08/02/2019 09:50:06 AM Eastern Daylight Time	07/31/2019 02:35:58 AM Eastern Daylight Time			08/02/2019 07:36:58 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	1	4		1			H5521	143	0	2020	Mid Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	144	0	1	4	1	H5521_144_0	5	1			07/03/2019	2020.01	07/03/2019 05:34:15 PM Eastern Daylight Time	08/02/2019 09:51:37 AM Eastern Daylight Time	07/31/2019 02:37:08 AM Eastern Daylight Time			08/02/2019 07:36:58 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	1	4		1			H5521	144	0	2020	Northern and Additional Maine		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	150	0	1	4	1	H5521_150_0	5	1			07/31/2019	2020.01	07/31/2019 02:31:26 PM Eastern Daylight Time	08/02/2019 11:27:37 AM Eastern Daylight Time	07/31/2019 02:38:19 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	1	4		1			H5521	150	0	2020	Milwaukee Metropolitan Area		2	14688	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	154	0	1	4	1	H5521_154_0	3	1			08/01/2019	2020.01	08/01/2019 10:19:43 AM Eastern Daylight Time	08/01/2019 11:40:44 AM Eastern Daylight Time	07/31/2019 02:39:28 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	154	0	2020	Memphis TN and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	156	0	1	4	1	H5521_156_0	4	1			07/03/2019	2020.01	07/03/2019 05:58:24 PM Eastern Daylight Time	08/02/2019 10:54:14 AM Eastern Daylight Time	07/31/2019 02:40:38 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	156	0	2020	Lexington KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	157	0	1	4	1	H5521_157_0	4	1			08/01/2019	2020.01	08/01/2019 05:25:24 PM Eastern Daylight Time	08/02/2019 09:53:33 AM Eastern Daylight Time	07/31/2019 02:41:49 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	1	4		1			H5521	157	0	2020	Connecticut		2	3369	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	159	0	1	4	1	H5521_159_0	4	1			08/01/2019	2020.01	08/01/2019 05:25:42 PM Eastern Daylight Time	08/02/2019 09:55:52 AM Eastern Daylight Time	07/31/2019 02:43:03 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	1	4		1			H5521	159	0	2020	Eastern MA		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	160	0	1	4	1	H5521_160_0	4	1			08/01/2019	2020.01	08/01/2019 03:12:36 PM Eastern Daylight Time	08/02/2019 09:59:41 AM Eastern Daylight Time	07/31/2019 02:44:13 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	1	4		1			H5521	160	0	2020	Central MA		2	3369	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	168	0	1	4	1	H5521_168_0	3	1			08/01/2019	2020.01	08/01/2019 10:16:08 AM Eastern Daylight Time	08/01/2019 11:41:24 AM Eastern Daylight Time	07/31/2019 02:45:33 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	1	4		1			H5521	168	0	2020	"Wake, Durham Counties NC"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	169	0	1	4	1	H5521_169_0	3	1			07/03/2019	2020.01	07/03/2019 03:59:05 PM Eastern Daylight Time	08/01/2019 11:42:05 AM Eastern Daylight Time	07/31/2019 02:46:43 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	169	0	2020	Sandhills and Southeastern NC		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	170	0	1	4	1	H5521_170_0	3	1			08/01/2019	2020.01	08/01/2019 10:20:20 AM Eastern Daylight Time	08/01/2019 11:42:48 AM Eastern Daylight Time	07/31/2019 02:47:53 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus Plan (PPO)	1	4		1			H5521	170	0	2020	"Greensboro, Winston-Salem NC and Surrounding Area"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	171	0	1	4	1	H5521_171_0	3	1			08/01/2019	2020.01	08/01/2019 05:44:53 PM Eastern Daylight Time	08/01/2019 06:13:42 PM Eastern Daylight Time	07/31/2019 02:49:03 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	171	0	2020	Central Alabama		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	177	0	1	4	1	H5521_177_0	3	1			07/03/2019	2020.01	07/03/2019 02:28:48 PM Eastern Daylight Time	08/01/2019 06:14:16 PM Eastern Daylight Time	07/31/2019 02:50:13 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	177	0	2020	Cherokee County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	178	0	1	4	1	H5521_178_0	3	1			08/01/2019	2020.01	08/01/2019 05:45:38 PM Eastern Daylight Time	08/01/2019 06:14:51 PM Eastern Daylight Time	07/31/2019 02:51:24 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	178	0	2020	Select Louisiana Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	183	0	1	4	1	H5521_183_0	3	1			07/03/2019	2020.01	07/03/2019 03:58:42 PM Eastern Daylight Time	08/01/2019 11:43:28 AM Eastern Daylight Time	07/31/2019 02:52:35 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	183	0	2020	"Wake, Durham Counties NC"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	184	0	1	4	1	H5521_184_0	3	1			07/03/2019	2020.01	07/03/2019 03:08:58 PM Eastern Daylight Time	08/02/2019 07:51:27 AM Pacific Daylight Time	07/30/2019 11:53:45 PM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (PPO)	1	4		1			H5521	184	0	2020	"Maricopa, Pima and Pinal Counties"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	187	0	1	4	1	H5521_187_0	4	1			07/03/2019	2020.01	07/03/2019 05:05:43 PM Central Daylight Time	08/01/2019 03:48:34 PM Central Daylight Time	07/31/2019 01:54:56 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	1	4		1			H5521	187	0	2020	Denver Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	190	0	1	4	1	H5521_190_0	4	1			07/31/2019	2020.01	07/31/2019 02:32:28 PM Eastern Daylight Time	08/02/2019 11:28:18 AM Eastern Daylight Time	07/31/2019 02:56:06 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	1	4		1			H5521	190	0	2020	Northeast Indiana		2	612	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	194	0	1	4	1	H5521_194_0	4	1			08/02/2019	2020.01	08/02/2019 07:40:07 AM Eastern Daylight Time	08/02/2019 11:28:55 AM Eastern Daylight Time	07/31/2019 02:57:17 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	1	4		1			H5521	194	0	2020	Southwest Michigan		2	3756	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	195	0	1	4	1	H5521_195_0	4	1			07/31/2019	2020.01	07/31/2019 02:33:39 PM Eastern Daylight Time	08/02/2019 11:29:34 AM Eastern Daylight Time	07/31/2019 02:58:28 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	195	0	2020	Milwaukee Metropolitan Area		2	11652	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	196	0	1	4	1	H5521_196_0	3	1			07/03/2019	2020.01	07/03/2019 02:39:57 PM Eastern Daylight Time	08/01/2019 03:56:49 PM Eastern Daylight Time	07/31/2019 02:59:40 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H5521	196	0	2020	Southern Utah		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	197	0	1	4	1	H5521_197_0	3	1			07/03/2019	2020.01	07/03/2019 02:40:08 PM Eastern Daylight Time	08/01/2019 03:57:33 PM Eastern Daylight Time	07/31/2019 03:00:51 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	197	0	2020	Northern Utah		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	200	0	1	4	1	H5521_200_0	3	1			07/03/2019	2020.01	07/03/2019 03:09:30 PM Eastern Daylight Time	08/02/2019 07:52:17 AM Pacific Daylight Time	07/31/2019 12:02:03 AM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Platinum Plan (PPO)	1	4		1			H5521	200	0	2020	"CHS, CNO, GLA, GHM, MHV, SCZ, YVP and YMA"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	205	0	1	4	1	H5521_205_0	3	1			07/03/2019	2020.01	07/03/2019 03:09:21 PM Eastern Daylight Time	08/01/2019 08:10:43 AM Pacific Daylight Time	07/31/2019 12:03:14 AM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H5521	205	0	2020	Kern County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	206	0	1	4	1	H5521_206_0	3	1			07/03/2019	2020.01	07/03/2019 03:09:09 PM Eastern Daylight Time	08/01/2019 08:14:10 AM Pacific Daylight Time	07/31/2019 12:04:26 AM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H5521	206	0	2020	Fresno County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	207	0	1	4	1	H5521_207_0	4	1			08/01/2019	2020.01	08/01/2019 11:42:40 AM Central Daylight Time	08/01/2019 03:49:10 PM Central Daylight Time	07/31/2019 02:05:36 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (PPO)	1	4		1			H5521	207	0	2020	Southern Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	208	0	1	4	1	H5521_208_0	4	1			07/03/2019	2020.01	07/03/2019 05:06:03 PM Central Daylight Time	08/01/2019 03:49:47 PM Central Daylight Time	07/31/2019 02:06:48 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (PPO)	1	4		1			H5521	208	0	2020	Northern Colorado		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	211	0	1	4	1	H5521_211_0	4	1			07/31/2019	2020.01	07/31/2019 02:35:25 PM Eastern Daylight Time	08/02/2019 11:30:12 AM Eastern Daylight Time	07/31/2019 03:07:59 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	211	0	2020	Southwest Indiana		2	300	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	212	0	1	4	1	H5521_212_0	3	1			07/03/2019	2020.01	07/03/2019 07:49:29 PM Eastern Daylight Time	08/02/2019 11:07:00 AM Eastern Daylight Time	07/31/2019 03:09:10 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	1	4		1			H5521	212	0	2020	Western NY		2	0	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	214	0	1	4	1	H5521_214_0	4	1			07/31/2019	2020.01	07/31/2019 02:35:50 PM Eastern Daylight Time	08/02/2019 11:30:51 AM Eastern Daylight Time	07/31/2019 03:10:22 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	214	0	2020	Southeast Michigan		2	540	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	215	0	1	4	1	H5521_215_0	3	1			07/03/2019	2020.01	07/03/2019 07:49:37 PM Eastern Daylight Time	08/02/2019 11:08:32 AM Eastern Daylight Time	07/31/2019 03:11:34 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	215	0	2020	Western NY		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	216	0	1	4	1	H5521_216_0	3	1			08/01/2019	2020.01	08/01/2019 05:46:45 PM Eastern Daylight Time	08/01/2019 06:15:25 PM Eastern Daylight Time	07/31/2019 03:12:45 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	216	0	2020	Tuscaloosa and Surrounding Counties		2	300	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	217	0	1	4	1	H5521_217_0	5	1			07/03/2019	2020.01	07/03/2019 05:36:55 PM Eastern Daylight Time	08/02/2019 11:31:30 AM Eastern Daylight Time	07/31/2019 03:13:57 AM Eastern Daylight Time			08/02/2019 07:36:58 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H5521	217	0	2020	Southeast Michigan		2	456	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	218	0	1	4	1	H5521_218_0	3	1			08/01/2019	2020.01	08/01/2019 05:47:38 PM Eastern Daylight Time	08/01/2019 06:15:59 PM Eastern Daylight Time	07/31/2019 03:15:08 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	218	0	2020	Northern Mississippi		2	300	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	219	0	1	4	1	H5521_219_0	4	1			07/31/2019	2020.01	07/31/2019 01:10:54 PM Eastern Daylight Time	08/02/2019 11:32:09 AM Eastern Daylight Time	07/31/2019 03:16:19 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	219	0	2020	Southwest Michigan		2	276	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	220	0	1	4	1	H5521_220_0	3	1			08/01/2019	2020.01	08/01/2019 05:48:22 PM Eastern Daylight Time	08/01/2019 06:16:33 PM Eastern Daylight Time	07/31/2019 03:17:30 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	220	0	2020	Southern Mississippi		2	300	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	221	0	1	4	1	H5521_221_0	5	1			07/03/2019	2020.01	07/03/2019 05:37:42 PM Eastern Daylight Time	08/02/2019 10:06:00 AM Eastern Daylight Time	07/31/2019 03:18:41 AM Eastern Daylight Time			08/02/2019 07:36:58 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier Plan (PPO)	1	4		1			H5521	221	0	2020	Massachusetts		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	222	0	1	4	1	H5521_222_0	3	1			08/01/2019	2020.01	08/01/2019 05:48:59 PM Eastern Daylight Time	08/01/2019 06:17:07 PM Eastern Daylight Time	07/31/2019 03:19:52 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	222	0	2020	Southeast Alabama		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	223	0	1	4	1	H5521_223_0	4	1			07/31/2019	2020.01	07/31/2019 01:12:53 PM Eastern Daylight Time	08/02/2019 11:32:47 AM Eastern Daylight Time	07/31/2019 03:21:04 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	223	0	2020	NWIN		2	1464	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	224	0	1	4	1	H5521_224_0	3	1			08/01/2019	2020.01	08/01/2019 05:49:50 PM Eastern Daylight Time	08/01/2019 06:17:41 PM Eastern Daylight Time	07/31/2019 03:22:16 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	224	0	2020	Montgomery and Surrounding Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	226	0	1	4	1	H5521_226_0	5	1			07/03/2019	2020.01	07/03/2019 05:38:57 PM Eastern Daylight Time	08/02/2019 11:33:27 AM Eastern Daylight Time	07/31/2019 03:23:28 AM Eastern Daylight Time			08/02/2019 07:36:58 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	1	4		1			H5521	226	0	2020	NWIN		2	1524	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	227	0	1	4	1	H5521_227_0	3	1			08/01/2019	2020.01	08/01/2019 05:50:39 PM Eastern Daylight Time	08/01/2019 06:18:15 PM Eastern Daylight Time	07/31/2019 03:24:39 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	227	0	2020	Northern Alabama		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	228	0	1	4	1	H5521_228_0	4	1			07/31/2019	2020.01	07/31/2019 01:14:26 PM Eastern Daylight Time	08/02/2019 11:34:07 AM Eastern Daylight Time	07/31/2019 03:25:51 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Value (PPO)	1	4		1			H5521	228	0	2020	Northern/Northwestern Illinois		2	1740	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	229	0	1	4	1	H5521_229_0	2	1			07/03/2019	2020.01	07/03/2019 03:58:29 PM Eastern Daylight Time	05/30/2019 01:28:36 AM Eastern Daylight Time				07/03/2019 07:11:03 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basics Plan (PPO)	1	4		1			H5521	229	0	2020	Select Alabama Counties		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	230	0	1	4	1	H5521_230_0	3	1			08/01/2019	2020.01	08/01/2019 05:51:32 PM Eastern Daylight Time	08/01/2019 06:18:49 PM Eastern Daylight Time	07/31/2019 03:27:03 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	230	0	2020	Monroe Metro and Surrounding Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	231	0	1	4	1	H5521_231_0	4	1			07/31/2019	2020.01	07/31/2019 01:14:56 PM Eastern Daylight Time	08/02/2019 11:34:48 AM Eastern Daylight Time	07/31/2019 03:28:15 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	231	0	2020	Central Indiana		2	1668	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	232	0	1	4	1	H5521_232_0	3	1			08/01/2019	2020.01	08/01/2019 05:52:08 PM Eastern Daylight Time	08/01/2019 06:19:23 PM Eastern Daylight Time	07/31/2019 03:29:26 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	232	0	2020	Alexandria Metro and Surrounding Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	233	0	1	4	1	H5521_233_0	3	1			08/01/2019	2020.01	08/01/2019 05:52:41 PM Eastern Daylight Time	08/01/2019 06:19:57 PM Eastern Daylight Time	07/31/2019 03:30:38 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	233	0	2020	Lake Charles Metro and Surrounding Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	234	0	1	4	1	H5521_234_0	3	1			08/01/2019	2020.01	08/01/2019 05:53:06 PM Eastern Daylight Time	08/01/2019 06:20:31 PM Eastern Daylight Time	07/31/2019 03:31:48 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Freedom Plan (PPO)	1	4		1			H5521	234	0	2020	Lafayette Metro and Surrounding Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	235	0	1	4	1	H5521_235_0	2	1			07/03/2019	2020.01	07/03/2019 03:58:15 PM Eastern Daylight Time	05/30/2019 01:31:23 AM Eastern Daylight Time				07/03/2019 07:11:03 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basics Plan (PPO)	1	4		1			H5521	235	0	2020	Select Louisiana Parishes		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	236	0	1	4	1	H5521_236_0	3	1			08/01/2019	2020.01	08/01/2019 10:21:13 AM Eastern Daylight Time	08/01/2019 11:44:07 AM Eastern Daylight Time	07/31/2019 03:32:59 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	236	0	2020	Western North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	237	0	1	4	1	H5521_237_0	3	1			07/03/2019	2020.01	07/03/2019 02:40:19 PM Eastern Daylight Time	08/01/2019 05:31:41 PM Eastern Daylight Time	07/31/2019 03:34:09 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H5521	237	0	2020	Clark county		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	239	0	1	4	1	H5521_239_0	3	1			07/03/2019	2020.01	07/03/2019 03:52:54 PM Eastern Daylight Time	08/01/2019 11:44:45 AM Eastern Daylight Time	07/31/2019 03:35:20 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	239	0	2020	Western North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	241	0	1	4	1	H5521_241_0	2	1			07/03/2019	2020.01	07/03/2019 03:52:42 PM Eastern Daylight Time	05/29/2019 10:13:25 PM Eastern Daylight Time				07/03/2019 07:11:03 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Core Plan (PPO)	1	4		1			H5521	241	0	2020	North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	243	0	1	4	1	H5521_243_0	3	1			07/03/2019	2020.01	07/03/2019 02:32:27 PM Eastern Daylight Time	08/01/2019 11:45:24 AM Eastern Daylight Time	07/31/2019 03:36:31 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	243	0	2020	Rocky Mount North Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	244	0	1	4	1	H5521_244_0	3	1			07/03/2019	2020.01	07/03/2019 02:40:29 PM Eastern Daylight Time	08/01/2019 05:38:32 PM Eastern Daylight Time	07/31/2019 03:37:43 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	1	4		1			H5521	244	0	2020	Clark county		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	245	0	1	4	1	H5521_245_0	3	1			08/01/2019	2020.01	08/01/2019 10:21:48 AM Eastern Daylight Time	08/01/2019 11:46:05 AM Eastern Daylight Time	07/31/2019 03:38:53 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	245	0	2020	Columbia Metro South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	246	0	1	4	1	H5521_246_0	3	1			08/01/2019	2020.01	08/01/2019 12:32:10 PM Eastern Daylight Time	08/01/2019 03:58:15 PM Eastern Daylight Time	07/31/2019 03:40:04 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	1	4		1			H5521	246	0	2020	Greater Salt Lake Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	247	0	1	4	1	H5521_247_0	3	1			08/01/2019	2020.01	08/01/2019 10:22:18 AM Eastern Daylight Time	08/01/2019 11:46:46 AM Eastern Daylight Time	07/31/2019 03:41:15 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	247	0	2020	Charleston and Surrounding Area South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	249	0	1	4	1	H5521_249_0	3	1			08/01/2019	2020.01	08/01/2019 10:22:41 AM Eastern Daylight Time	08/01/2019 11:47:26 AM Eastern Daylight Time	07/31/2019 03:42:27 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	249	0	2020	Pee Dee South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	250	0	1	4	1	H5521_250_0	4	1			08/01/2019	2020.01	08/01/2019 11:42:57 AM Central Daylight Time	08/01/2019 03:50:24 PM Central Daylight Time	07/31/2019 02:43:38 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime 1 (PPO)	1	4		1			H5521	250	0	2020	Denver Metro		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	251	0	1	4	1	H5521_251_0	3	1			07/03/2019	2020.01	07/03/2019 02:18:50 PM Eastern Daylight Time	08/01/2019 11:48:10 AM Eastern Daylight Time	07/31/2019 03:44:49 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	251	0	2020	Midlands South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	252	0	1	4	1	H5521_252_0	3	1			07/03/2019	2020.01	07/03/2019 03:52:17 PM Eastern Daylight Time	08/01/2019 11:48:50 AM Eastern Daylight Time	07/31/2019 03:46:08 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	252	0	2020	"Hilton Head, Augusta and Surrounding Area SC"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	253	0	1	4	1	H5521_253_0	3	1			08/01/2019	2020.01	08/01/2019 10:23:07 AM Eastern Daylight Time	08/01/2019 11:49:29 AM Eastern Daylight Time	07/31/2019 03:47:19 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (PPO)	1	4		1			H5521	253	0	2020	Hilton Head and Surrounding Area South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	254	0	1	4	1	H5521_254_0	3	1			08/01/2019	2020.01	08/01/2019 10:23:38 AM Eastern Daylight Time	08/01/2019 11:50:11 AM Eastern Daylight Time	07/31/2019 03:48:29 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	254	0	2020	Middle Tennessee		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	259	0	1	4	1	H5521_259_0	4	1			07/03/2019	2020.01	07/03/2019 05:58:43 PM Eastern Daylight Time	08/02/2019 10:54:52 AM Eastern Daylight Time	07/31/2019 03:49:41 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	259	0	2020	Louisville KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	260	0	1	4	1	H5521_260_0	4	1			07/03/2019	2020.01	07/03/2019 05:59:11 PM Eastern Daylight Time	08/02/2019 10:55:31 AM Eastern Daylight Time	07/31/2019 03:50:52 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	260	0	2020	Bowling Green/Southwest KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	261	0	1	4	1	H5521_261_0	3	1			08/01/2019	2020.01	08/01/2019 04:36:40 PM Eastern Daylight Time	08/02/2019 01:45:42 PM Eastern Daylight Time	07/31/2019 03:52:04 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	261	0	2020	Western Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	262	0	1	4	1	H5521_262_0	3	1			08/01/2019	2020.01	08/01/2019 04:37:28 PM Eastern Daylight Time	08/02/2019 01:46:21 PM Eastern Daylight Time	07/31/2019 03:53:15 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	262	0	2020	"New Castle, Kent and Sussex Counties"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	263	0	1	4	1	H5521_263_0	3	1			08/01/2019	2020.01	08/01/2019 04:38:01 PM Eastern Daylight Time	08/02/2019 01:47:02 PM Eastern Daylight Time	07/31/2019 03:54:25 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	263	0	2020	Central and Eastern PA		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	266	0	1	4	1	H5521_266_0	4	1			07/03/2019	2020.01	07/03/2019 05:59:36 PM Eastern Daylight Time	08/02/2019 10:56:10 AM Eastern Daylight Time	07/31/2019 03:55:36 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	266	0	2020	Ashland KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	267	0	1	4	1	H5521_267_0	4	1			07/03/2019	2020.01	07/03/2019 06:00:00 PM Eastern Daylight Time	08/02/2019 10:56:49 AM Eastern Daylight Time	07/31/2019 03:56:45 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	267	0	2020	Eastern KY Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	268	0	1	4	1	H5521_268_0	3	1			08/01/2019	2020.01	08/01/2019 12:33:28 PM Eastern Daylight Time	08/02/2019 01:16:25 PM Eastern Daylight Time	07/31/2019 03:57:57 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H5521	268	0	2020	Central FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	269	0	1	4	1	H5521_269_0	3	1			08/01/2019	2020.01	08/01/2019 12:34:55 PM Eastern Daylight Time	08/02/2019 01:17:10 PM Eastern Daylight Time	07/31/2019 03:59:07 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H5521	269	0	2020	North FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	270	0	1	4	1	H5521_270_0	3	1			08/01/2019	2020.01	08/01/2019 12:36:32 PM Eastern Daylight Time	08/02/2019 01:17:55 PM Eastern Daylight Time	07/31/2019 04:00:20 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H5521	270	0	2020	West FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	271	0	1	4	1	H5521_271_0	3	1			08/01/2019	2020.01	08/01/2019 12:38:01 PM Eastern Daylight Time	08/02/2019 01:18:53 PM Eastern Daylight Time	07/31/2019 04:01:30 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H5521	271	0	2020	"Central FL, North FL"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	272	0	1	4	1	H5521_272_0	3	1			08/01/2019	2020.01	08/01/2019 12:39:26 PM Eastern Daylight Time	08/02/2019 01:19:47 PM Eastern Daylight Time	07/31/2019 04:02:40 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H5521	272	0	2020	Southwest FL		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	273	0	1	4	1	H5521_273_0	3	1			08/01/2019	2020.01	08/01/2019 12:40:42 PM Eastern Daylight Time	08/02/2019 01:20:34 PM Eastern Daylight Time	07/31/2019 04:03:51 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus (PPO)	1	4		1			H5521	273	0	2020	"South FL, Treasure Coast FL"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	275	0	1	4	1	H5521_275_0	3	1			07/03/2019	2020.01	07/03/2019 07:50:30 PM Eastern Daylight Time	08/01/2019 06:14:30 PM Eastern Daylight Time	07/31/2019 04:05:02 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Premier (PPO)	1	4		1			H5521	275	0	2020	New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	276	0	1	4	1	H5521_276_0	3	1			07/03/2019	2020.01	07/03/2019 07:50:37 PM Eastern Daylight Time	08/01/2019 06:19:06 PM Eastern Daylight Time	07/31/2019 04:06:13 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Premier Plus (PPO)	1	4		1			H5521	276	0	2020	New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	277	0	1	4	1	H5521_277_0	3	1			07/31/2019	2020.01	07/31/2019 05:46:58 PM Eastern Daylight Time	08/01/2019 06:24:36 PM Eastern Daylight Time	07/31/2019 04:07:24 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Credit Value (PPO)	1	4		1			H5521	277	0	2020	"BER, HUN, MON, MRS, PAS, SOM, SSX, UNN, WRN"		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	278	0	1	4	1	H5521_278_0	3	1			07/03/2019	2020.01	07/03/2019 07:50:52 PM Eastern Daylight Time	08/01/2019 06:26:45 PM Eastern Daylight Time	07/31/2019 04:08:36 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier Plus (PPO)	1	4		1			H5521	278	0	2020	New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	279	0	1	4	1	H5521_279_0	2	1			07/03/2019	2020.01	07/03/2019 03:51:59 PM Eastern Daylight Time	05/29/2019 10:18:45 PM Eastern Daylight Time				07/03/2019 07:11:03 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Core Plan (PPO)	1	4		1			H5521	279	0	2020	South Carolina		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	280	0	1	4	1	H5521_280_0	3	1			08/01/2019	2020.01	08/01/2019 10:24:09 AM Eastern Daylight Time	08/01/2019 11:50:51 AM Eastern Daylight Time	07/31/2019 04:09:47 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	1	4		1			H5521	280	0	2020	Chattanooga TN and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	281	0	1	4	1	H5521_281_0	3	1			07/03/2019	2020.01	07/03/2019 02:41:52 PM Eastern Daylight Time	08/01/2019 11:51:31 AM Eastern Daylight Time	07/31/2019 04:10:58 AM Eastern Daylight Time			08/02/2019 04:04:20 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	1	4		1			H5521	281	0	2020	Chattanooga TN and Surrounding Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	282	0	1	4	1	H5521_282_0	5	1			07/03/2019	2020.01	07/03/2019 05:40:03 PM Eastern Daylight Time	08/02/2019 11:35:26 AM Eastern Daylight Time	07/31/2019 04:12:09 AM Eastern Daylight Time			08/02/2019 07:36:58 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	1	4		1			H5521	282	0	2020	Green Bay Metro		2	14688	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	283	0	1	4	1	H5521_283_0	4	1			07/31/2019	2020.01	07/31/2019 01:16:37 PM Eastern Daylight Time	08/02/2019 11:36:05 AM Eastern Daylight Time	07/31/2019 04:13:20 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	283	0	2020	Green Bay Metro		2	11652	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	284	0	1	4	1	H5521_284_0	4	1			07/31/2019	2020.01	07/31/2019 01:17:26 PM Eastern Daylight Time	08/02/2019 11:36:44 AM Eastern Daylight Time	07/31/2019 04:14:31 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (PPO)	1	4		1			H5521	284	0	2020	Northwest Michigan		2	4452	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	285	0	1	4	1	H5521_285_0	4	1			07/31/2019	2020.01	07/31/2019 01:18:29 PM Eastern Daylight Time	08/02/2019 11:37:24 AM Eastern Daylight Time	07/31/2019 04:15:42 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	285	0	2020	Northwest Michigan		2	276	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	286	0	1	4	1	H5521_286_0	3	1			07/03/2019	2020.01	07/03/2019 05:41:32 PM Eastern Daylight Time	05/30/2019 09:04:59 AM Eastern Daylight Time				07/03/2019 08:00:48 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Core Value (PPO)	1	4		1			H5521	286	0	2020	Milwaukee Metropolitan Area		2	11652	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5521	288	0	1	4	1	H5521_288_0	4	1			07/31/2019	2020.01	07/31/2019 01:19:29 PM Eastern Daylight Time	08/02/2019 11:38:02 AM Eastern Daylight Time	07/31/2019 04:16:53 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	288	0	2020	Midland		2	276	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	289	0	1	4	1	H5521_289_0	4	1			07/31/2019	2020.01	07/31/2019 01:20:15 PM Eastern Daylight Time	08/02/2019 11:38:41 AM Eastern Daylight Time	07/31/2019 04:18:04 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value (PPO)	1	4		1			H5521	289	0	2020	Green and Rock Counties		2	11652	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5521	801	0	1	4	1	H5521_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:50:42 AM Eastern Daylight Time					05/30/2019 06:57:33 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (PPO)	1	4		1			H5521	801	0	2020	National		1	8491350	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	802	0	1	4	1	H5521_802_0	2	1			05/31/2019	2020.01	05/31/2019 11:54:21 AM Eastern Daylight Time					05/31/2019 12:16:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (PPO)	1	4		1			H5521	802	0	2020	National		1	2973180	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	805	0	1	4	1	H5521_805_0	1	1			05/24/2019	2020.01	05/24/2019 09:51:03 AM Eastern Daylight Time					05/30/2019 06:57:33 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Part B Only Plan (PPO)	1	4		1			H5521	805	0	2020	National		1	139500	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	806	0	1	4	1	H5521_806_0	1	1			05/24/2019	2020.01	05/24/2019 09:51:13 AM Eastern Daylight Time					05/30/2019 06:57:33 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Part B Only Plan w/Rx (PPO)	1	4		1			H5521	806	0	2020	National		1	1270	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	809	0	1	4	1	H5521_809_0	1	1			05/24/2019	2020.01	05/24/2019 09:51:28 AM Eastern Daylight Time					05/30/2019 06:57:33 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare $10 Buy-Down Plan (PPO)	1	4		1			H5521	809	0	2020	National		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	810	0	1	4	1	H5521_810_0	1	1			05/30/2019	2020.01	05/30/2019 01:23:40 PM Eastern Daylight Time					05/30/2019 06:57:33 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare $10 Buy-Down Plan w/Rx (PPO)	1	4		1			H5521	810	0	2020	National		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	811	0	1	4	1	H5521_811_0	1	1			05/24/2019	2020.01	05/24/2019 09:51:54 AM Eastern Daylight Time					05/30/2019 06:57:33 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare $10 Buy-Down Plan w/Rx SH (PPO)	1	4		1			H5521	811	0	2020	National		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	812	0	1	4	1	H5521_812_0	2	1			05/31/2019	2020.01	05/31/2019 11:54:47 AM Eastern Daylight Time					05/31/2019 12:16:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (PPO)	1	4		1			H5521	812	0	2020	National		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	813	0	1	4	1	H5521_813_0	1	1			05/24/2019	2020.01	05/24/2019 09:52:06 AM Eastern Daylight Time					05/30/2019 06:57:33 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Part B Only Plan w/Rx SH (PPO)	1	4		1			H5521	813	0	2020	National		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	814	0	1	4	1	H5521_814_0	1	1			05/24/2019	2020.01	05/24/2019 09:52:29 AM Eastern Daylight Time					05/30/2019 06:57:33 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Part B Only $10 Buy-Down Plan (PPO)	1	4		1			H5521	814	0	2020	National		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	815	0	1	4	1	H5521_815_0	1	1			05/24/2019	2020.01	05/24/2019 09:52:42 AM Eastern Daylight Time					05/30/2019 06:57:33 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Part B Only $10 Buy-Down Plan w/Rx (PPO)	1	4		1			H5521	815	0	2020	National		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(771)-		(711)-		(771)-		(711)-		(771)-		(711)-		(771)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5521	816	0	1	4	1	H5521_816_0	1	1			05/24/2019	2020.01	05/24/2019 09:52:53 AM Eastern Daylight Time					05/30/2019 06:57:33 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Part B Only $10 Buy-Down w/Rx SH (PPO)	1	4		1			H5521	816	0	2020	National		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5522	1	0	1	4	1	H5522_001_0	5	1			08/05/2019	2020.01	08/05/2019 12:30:19 PM Eastern Daylight Time	08/02/2019 01:47:40 PM Eastern Daylight Time	07/31/2019 04:19:15 AM Eastern Daylight Time			08/05/2019 12:32:57 PM Eastern Daylight Time	"HEALTHASSURANCE PENNSYLVANIA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier Plus (PPO)	1	4		1			H5522	1	0	2020	Allegheny County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	2	0	1	4	1	H5522_002_0	4	1			07/03/2019	2020.01	07/03/2019 06:30:45 PM Eastern Daylight Time	08/02/2019 01:48:20 PM Eastern Daylight Time	07/31/2019 04:20:26 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	"HEALTHASSURANCE PENNSYLVANIA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier Plus (PPO)	1	4		1			H5522	2	0	2020	Central Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	4	0	1	4	1	H5522_004_0	3	1			08/01/2019	2020.01	08/01/2019 04:39:31 PM Eastern Daylight Time	08/02/2019 01:49:01 PM Eastern Daylight Time	07/31/2019 04:21:37 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	"HEALTHASSURANCE PENNSYLVANIA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (PPO)	1	4		1			H5522	4	0	2020	Central Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	5	0	1	4	1	H5522_005_0	3	1			07/03/2019	2020.01	07/03/2019 06:31:16 PM Eastern Daylight Time	08/02/2019 01:49:41 PM Eastern Daylight Time	07/31/2019 04:22:50 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	"HEALTHASSURANCE PENNSYLVANIA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver (PPO)	1	4		1			H5522	5	0	2020	Western Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	13	0	1	4	1	H5522_013_0	3	1			07/03/2019	2020.01	07/03/2019 06:31:29 PM Eastern Daylight Time	08/02/2019 01:50:20 PM Eastern Daylight Time	07/31/2019 04:24:01 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	"HEALTHASSURANCE PENNSYLVANIA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Silver Plus (PPO)	1	4		1			H5522	13	0	2020	Central Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	14	0	1	4	1	H5522_014_0	3	1			07/03/2019	2020.01	07/03/2019 06:33:01 PM Eastern Daylight Time	08/02/2019 01:50:59 PM Eastern Daylight Time	07/31/2019 04:25:12 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	"HEALTHASSURANCE PENNSYLVANIA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier Plus (PPO)	1	4		1			H5522	14	0	2020	Southeastern PA		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	17	0	1	4	1	H5522_017_0	3	1			07/03/2019	2020.01	07/03/2019 06:33:36 PM Eastern Daylight Time	08/02/2019 01:53:32 PM Eastern Daylight Time	07/31/2019 04:26:24 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	"HEALTHASSURANCE PENNSYLVANIA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Credit Value (PPO)	1	4		1			H5522	17	0	2020	Pennsylvania		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	18	0	1	4	1	H5522_018_0	3	1			07/03/2019	2020.01	07/03/2019 06:35:17 PM Eastern Daylight Time	08/02/2019 01:54:15 PM Eastern Daylight Time	07/31/2019 04:27:35 AM Eastern Daylight Time			08/02/2019 03:37:18 PM Eastern Daylight Time	"HEALTHASSURANCE PENNSYLVANIA, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Advantra Premier (PPO)	1	4		1			H5522	18	0	2020	Allegheny		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5522	802	0	1	4	1	H5522_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:53:10 AM Eastern Daylight Time					05/30/2019 07:00:05 PM Eastern Daylight Time	"HEALTHASSURANCE PENNSYLVANIA, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (PPO)	1	4		1			H5522	802	0	2020	Pennsylvania		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5522	803	0	1	4	1	H5522_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:53:22 AM Eastern Daylight Time					05/30/2019 07:00:05 PM Eastern Daylight Time	"HEALTHASSURANCE PENNSYLVANIA, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (PPO)	1	4		1			H5522	803	0	2020	Pennsylvania		1	2760	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5522	807	0	1	4	1	H5522_807_0	1	1			05/24/2019	2020.01	05/24/2019 09:53:34 AM Eastern Daylight Time					05/30/2019 07:00:05 PM Eastern Daylight Time	"HEALTHASSURANCE PENNSYLVANIA, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (PPO)	1	4		1			H5522	807	0	2020	Pennsylvania		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H5525	4	0	1	4	1	H5525_004_0	3	1			07/15/2019	2020.01	07/15/2019 04:53:02 PM Eastern Daylight Time	08/04/2019 03:02:59 PM Eastern Daylight Time	08/02/2019 01:18:37 PM Eastern Daylight Time			08/05/2019 12:56:58 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-004 (PPO)	1	4		1			H5525	4	0	2020	Peoria Illinois area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	5	0	1	4	1	H5525_005_0	4	1			07/16/2019	2020.01	07/16/2019 02:29:38 PM Eastern Daylight Time	08/04/2019 06:30:34 PM Eastern Daylight Time	08/02/2019 01:18:37 PM Eastern Daylight Time			08/05/2019 11:34:27 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-005 (PPO)	1	4		1			H5525	5	0	2020	Greater Philadelphia Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	6	0	1	4	1	H5525_006_0	4	1			07/16/2019	2020.01	07/16/2019 02:19:13 PM Eastern Daylight Time	08/04/2019 06:19:08 PM Eastern Daylight Time	08/02/2019 01:18:37 PM Eastern Daylight Time			08/05/2019 11:34:27 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-006 (PPO)	1	4		1			H5525	6	0	2020	South Central Pennsylvania area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	7	0	1	4	1	H5525_007_0	5	1			07/23/2019	2020.01	07/23/2019 02:01:18 PM Eastern Daylight Time	08/04/2019 06:09:34 PM Eastern Daylight Time	08/02/2019 01:18:37 PM Eastern Daylight Time			08/05/2019 11:34:27 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-007 (PPO)	1	4		1			H5525	7	0	2020	North Central Pennsylvania area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	8	0	1	4	1	H5525_008_0	3	1			07/15/2019	2020.01	07/15/2019 04:31:22 PM Eastern Daylight Time	08/04/2019 02:50:52 PM Eastern Daylight Time	08/02/2019 01:18:37 PM Eastern Daylight Time			08/05/2019 11:14:55 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-008 (PPO)	1	4		1			H5525	8	0	2020	Select counties in Suburban Indiana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	15	0	1	4	1	H5525_015_0	4	1			07/15/2019	2020.01	07/15/2019 03:51:19 PM Eastern Daylight Time	08/03/2019 11:05:31 AM Eastern Daylight Time	08/02/2019 01:18:37 PM Eastern Daylight Time			08/05/2019 11:43:56 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-015 (PPO)	1	4		1			H5525	15	0	2020	Select Louisiana Parishes		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	17	0	1	4	1	H5525_017_0	4	1			08/02/2019	2020.01	08/02/2019 10:51:07 AM Eastern Daylight Time	08/04/2019 06:41:42 PM Eastern Daylight Time	08/02/2019 01:18:37 PM Eastern Daylight Time			08/05/2019 11:34:27 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-017 (PPO)	1	4		1			H5525	17	0	2020	Western Pennsylvania Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	20	0	1	4	1	H5525_020_0	3	1			07/15/2019	2020.01	07/15/2019 03:41:40 PM Eastern Daylight Time	08/02/2019 05:32:15 PM Eastern Daylight Time	08/02/2019 01:18:37 PM Eastern Daylight Time			08/05/2019 11:17:40 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-020 (PPO)	1	4		1			H5525	20	0	2020	Mobile Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	22	0	1	4	1	H5525_022_0	3	1			07/15/2019	2020.01	07/15/2019 04:38:19 PM Eastern Daylight Time	08/04/2019 06:51:19 PM Eastern Daylight Time	08/02/2019 01:18:38 PM Eastern Daylight Time			08/05/2019 11:58:22 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-022 (PPO)	1	4		1			H5525	22	0	2020	Select counties in Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	23	0	1	4	1	H5525_023_0	3	1			07/15/2019	2020.01	07/15/2019 04:27:11 PM Eastern Daylight Time	08/04/2019 06:49:25 PM Eastern Daylight Time	08/02/2019 01:18:38 PM Eastern Daylight Time			08/05/2019 11:34:27 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-023 (PPO)	1	4		1			H5525	23	0	2020	Select counties in West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	24	0	1	4	1	H5525_024_0	3	1			07/15/2019	2020.01	07/15/2019 04:07:14 PM Eastern Daylight Time	08/04/2019 11:36:29 AM Eastern Daylight Time	08/02/2019 01:18:38 PM Eastern Daylight Time			08/05/2019 11:06:27 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-024 (PPO)	1	4		1			H5525	24	0	2020	Select Counties in Georgia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	25	0	1	4	1	H5525_025_0	3	1			07/15/2019	2020.01	07/15/2019 04:08:30 PM Eastern Daylight Time	08/04/2019 11:53:14 AM Eastern Daylight Time	08/02/2019 01:18:38 PM Eastern Daylight Time			08/05/2019 11:06:27 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-025 (PPO)	1	4		1			H5525	25	0	2020	Select Counties in South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	26	0	1	4	1	H5525_026_0	3	1			07/15/2019	2020.01	07/15/2019 04:14:20 PM Eastern Daylight Time	08/04/2019 04:38:59 PM Eastern Daylight Time	08/02/2019 01:18:38 PM Eastern Daylight Time			08/05/2019 11:13:56 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-026 (PPO)	1	4		1			H5525	26	0	2020	Select Counties in North Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	27	0	1	4	1	H5525_027_0	4	1			07/15/2019	2020.01	07/15/2019 04:00:05 PM Eastern Daylight Time	08/04/2019 03:09:00 PM Eastern Daylight Time	08/02/2019 01:18:38 PM Eastern Daylight Time			08/05/2019 11:23:48 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-027 (PPO)	1	4		1			H5525	27	0	2020	Select Counties in Montana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	30	0	1	4	1	H5525_030_0	3	1			07/16/2019	2020.01	07/16/2019 02:59:44 PM Eastern Daylight Time	08/04/2019 02:51:37 PM Eastern Daylight Time	08/02/2019 01:18:38 PM Eastern Daylight Time			08/05/2019 11:08:28 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-030 (PPO)	1	4		1			H5525	30	0	2020	Select Counties in Ohio and Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	31	0	1	4	1	H5525_031_0	2	1			07/15/2019	2020.01	07/15/2019 04:00:20 PM Eastern Daylight Time	07/16/2019 10:38:47 AM Eastern Daylight Time				07/16/2019 04:25:25 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-031 (PPO)	1	4		1			H5525	31	0	2020	Select Counties in Montana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5525	34	0	1	4	1	H5525_034_0	2	1			06/01/2019	2020.01	06/01/2019 02:09:36 PM Eastern Daylight Time	08/04/2019 04:48:51 PM Eastern Daylight Time	08/02/2019 01:18:38 PM Eastern Daylight Time			08/05/2019 11:22:57 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-034 (PPO)	1	4		1			H5525	34	0	2020	Wilmington Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	35	0	1	4	1	H5525_035_0	3	1			08/01/2019	2020.01	08/01/2019 07:29:17 PM Eastern Daylight Time	08/04/2019 04:53:37 PM Eastern Daylight Time	08/02/2019 01:18:39 PM Eastern Daylight Time			08/05/2019 11:13:56 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-035 (PPO)	1	4		1			H5525	35	0	2020	Select Counties in North Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	36	0	1	4	1	H5525_036_0	2	1	2	1	06/01/2019	2020.01	06/01/2019 02:00:30 PM Eastern Daylight Time	08/04/2019 04:55:12 PM Eastern Daylight Time	08/02/2019 01:18:39 PM Eastern Daylight Time			08/05/2019 11:13:56 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5525-036 (PPO D-SNP)	1	4		1			H5525	36	0	2020	Greater North Carolina Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	37	0	1	4	1	H5525_037_0	3	1			05/31/2019	2020.01	05/31/2019 12:49:59 PM Eastern Daylight Time	08/03/2019 11:49:45 AM Eastern Daylight Time	08/02/2019 01:18:39 PM Eastern Daylight Time			08/05/2019 11:43:56 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Value Plus H5525-037 (PPO)	1	4		1			H5525	37	0	2020	Select Louisiana Parishes		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	38	0	1	4	1	H5525_038_0	4	1			08/01/2019	2020.01	08/01/2019 06:47:19 PM Eastern Daylight Time	08/04/2019 07:22:13 PM Eastern Daylight Time	08/02/2019 01:18:39 PM Eastern Daylight Time			08/05/2019 11:34:27 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-038 (PPO)	1	4		1			H5525	38	0	2020	Pennsylvania		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	39	0	1	4	1	H5525_039_0	2	1			05/30/2019	2020.01	05/30/2019 04:52:53 PM Eastern Daylight Time	08/04/2019 07:24:08 PM Eastern Daylight Time	08/02/2019 01:18:39 PM Eastern Daylight Time			08/05/2019 11:34:27 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Value Plus H5525-039 (PPO)	1	4		1			H5525	39	0	2020	Pennsylvania		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	40	0	1	4	1	H5525_040_0	2	1			07/16/2019	2020.01	07/16/2019 02:05:18 PM Eastern Daylight Time	08/04/2019 07:16:20 PM Eastern Daylight Time	08/02/2019 01:18:39 PM Eastern Daylight Time			08/05/2019 11:58:22 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Value Plus H5525-040 (PPO)	1	4		1			H5525	40	0	2020	Select Counties in Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	41	0	1	4	1	H5525_041_0	2	1			05/30/2019	2020.01	05/30/2019 07:32:45 PM Eastern Daylight Time	08/04/2019 03:12:38 PM Eastern Daylight Time	08/02/2019 01:18:39 PM Eastern Daylight Time			08/05/2019 11:08:28 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Value Plus H5525-041 (PPO)	1	4		1			H5525	41	0	2020	Select counties in Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	42	0	1	4	1	H5525_042_0	5	1			08/01/2019	2020.01	08/01/2019 02:58:59 PM Eastern Daylight Time	08/04/2019 03:08:07 PM Eastern Daylight Time	08/02/2019 01:18:40 PM Eastern Daylight Time			08/05/2019 11:24:16 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-042 (PPO)	1	4		1			H5525	42	0	2020	Select counties in Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	44	0	1	4	1	H5525_044_0	3	1			08/05/2019	2020.01	08/05/2019 11:52:38 AM Eastern Daylight Time	08/04/2019 07:37:43 PM Eastern Daylight Time	08/02/2019 01:18:40 PM Eastern Daylight Time			08/05/2019 11:58:22 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-044 (PPO)	1	4		1			H5525	44	0	2020	Select Counties in Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	45	0	1	4	1	H5525_045_0	2	1	2	1	05/31/2019	2020.01	05/31/2019 12:26:48 PM Eastern Daylight Time	08/04/2019 07:39:38 PM Eastern Daylight Time	08/02/2019 01:18:40 PM Eastern Daylight Time			08/05/2019 11:58:22 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5525-045 (PPO D-SNP)	1	4		1			H5525	45	0	2020	Select Counties in Kentucky		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	46	0	1	4	1	H5525_046_0	3	1	2	1	05/30/2019	2020.01	05/30/2019 05:57:29 PM Eastern Daylight Time	08/04/2019 03:17:54 PM Eastern Daylight Time	08/02/2019 01:18:40 PM Eastern Daylight Time			08/05/2019 11:24:16 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5525-046 (PPO D-SNP)	1	4		1			H5525	46	0	2020	Select counties in Ohio		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	47	0	1	4	1	H5525_047_0	5	1			08/02/2019	2020.01	08/02/2019 04:59:54 PM Eastern Daylight Time	08/04/2019 07:47:14 PM Eastern Daylight Time	08/02/2019 01:18:40 PM Eastern Daylight Time			08/05/2019 11:34:27 AM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	HumanaChoice H5525-047 (PPO)	1	4		1			H5525	47	0	2020	Select Counties in Pennsylvania		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5525	809	0	1	4	1	H5525_809_0	2	1			05/30/2019	2020.01	05/30/2019 11:46:36 AM Eastern Daylight Time					08/27/2019 12:53:30 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5525	809	0	2020	Select Counties in Multi-States		1	236545	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	810	0	1	4	1	H5525_810_0	2	1			05/30/2019	2020.01	05/30/2019 11:47:11 AM Eastern Daylight Time					08/27/2019 12:53:30 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5525	810	0	2020	Select Counties in Multi-States		1	18213	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	812	0	2	4	1	H5525_812_0	2	1			05/30/2019	2020.01	05/30/2019 11:47:47 AM Eastern Daylight Time					08/27/2019 12:53:30 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		2	1		H5525	812	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	813	0	2	4	1	H5525_813_0	2	1			05/30/2019	2020.01	05/30/2019 11:48:24 AM Eastern Daylight Time					08/27/2019 12:53:30 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		2	1		H5525	813	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	816	0	1	4	1	H5525_816_0	2	1			05/30/2019	2020.01	05/30/2019 11:49:11 AM Eastern Daylight Time					08/27/2019 12:53:30 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5525	816	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	817	0	1	4	1	H5525_817_0	2	1			05/30/2019	2020.01	05/30/2019 11:50:15 AM Eastern Daylight Time					08/27/2019 12:53:30 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5525	817	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-	711	(711)-	711	(711)-	711	(711)-	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	818	0	1	4	1	H5525_818_0	2	1			05/30/2019	2020.01	05/30/2019 11:50:51 AM Eastern Daylight Time					08/27/2019 12:53:30 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5525	818	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	819	0	1	4	1	H5525_819_0	2	1			05/30/2019	2020.01	05/30/2019 11:51:28 AM Eastern Daylight Time					08/27/2019 12:53:30 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5525	819	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-	711	(711)-	711	(711)-	711	(711)-	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	820	0	1	4	1	H5525_820_0	2	1			05/30/2019	2020.01	05/30/2019 11:52:11 AM Eastern Daylight Time					08/27/2019 12:53:30 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5525	820	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5525	821	0	1	4	1	H5525_821_0	2	1			05/30/2019	2020.01	05/30/2019 11:52:50 AM Eastern Daylight Time					08/27/2019 12:53:30 PM Eastern Daylight Time	"HUMANA BENEFIT PLAN OF ILLINOIS, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5525	821	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-	711	(711)-	711	(711)-	711	(711)-	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5526	4	0	1	4	1	H5526_004_0	5	1			07/10/2019	2020.01	07/10/2019 10:14:38 AM Eastern Daylight Time	08/06/2019 01:08:36 PM Eastern Daylight Time	08/06/2019 01:09:08 PM Eastern Daylight Time			08/06/2019 02:49:22 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	BlueCross BlueShield Forever Blue 751 (PPO)	1	4		1			H5526	4	0	2020	Western New York		2		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			
H5526	16	0	1	4	1	H5526_016_0	6	1			07/10/2019	2020.01	07/10/2019 10:14:55 AM Eastern Daylight Time	08/06/2019 03:41:43 PM Eastern Daylight Time	08/06/2019 01:09:09 PM Eastern Daylight Time			08/06/2019 03:42:48 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bcbswny.com/medicare	BlueCross BlueShield Forever Blue Value (PPO)	1	4		1			H5526	16	0	2020	Western New York		2		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			
H5526	18	0	1	4	1	H5526_018_0	5	1			07/10/2019	2020.01	07/10/2019 10:15:06 AM Eastern Daylight Time	08/06/2019 01:08:39 PM Eastern Daylight Time	08/06/2019 01:09:11 PM Eastern Daylight Time			08/06/2019 02:49:22 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.bsneny.com/medicare	BlueShield Forever Blue 770 (PPO)	1	4		1			H5526	18	0	2020	Northeastern New York		2		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						2			
H5526	806	0	1	4	1	H5526_806_0	1	1			05/31/2019	2020.01	05/31/2019 11:52:55 AM Eastern Daylight Time					05/31/2019 02:55:28 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	PPO Group (MA Only) CY (PPO)	1	4		1			H5526	806	0	2020	Western and Northeastern New York		1	11242	2			2						www.bcbswny.com	http://www.bcbswny.com/pharmacy	www.nymedicare.com	(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;9a1;9b;9c;11a;11b;11c;15;	2		1									
H5526	808	0	1	4	1	H5526_808_0	1	1			05/31/2019	2020.01	05/31/2019 11:53:40 AM Eastern Daylight Time					05/31/2019 02:55:28 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	PPO Group (MA-PD) CY (PPO)	1	4		1			H5526	808	0	2020	Western and Northeastern New York		1	115081	2			2						www.bcbswny.com	http://www.bcbswny.com/pharmacy	www.nymedicare.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)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;9a1;9b;9c;11a;11b;11c;15;	2		1									
H5528	807	0	1	4	1	H5528_807_0	4	1			06/02/2019	2020.01	06/02/2019 02:00:22 AM US Eastern Daylight Time					06/02/2019 09:28:42 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Group Access Rx (PPO)	1	4		1			H5528	807	0	2020	United States		1	213	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						2			
H5533	3	0	1	4	1	H5533_003_0	12	1			08/02/2019	2020.01	08/02/2019 04:43:46 PM Eastern Daylight Time	08/05/2019 09:35:46 AM Eastern Daylight Time	07/31/2019 01:35:42 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH NETWORK, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO High Deductible with Rx (PPO)	1	4		1			H5533	3	0	2020	Western Pennsylvania		2	60730	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	11	7b;	7b1;
H5533	5	0	1	4	1	H5533_005_0	12	1			08/02/2019	2020.01	08/02/2019 06:04:14 PM Eastern Daylight Time	08/05/2019 09:14:46 AM Eastern Daylight Time	07/31/2019 01:37:26 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH NETWORK, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO Rx Enhanced (PPO)	1	4		1			H5533	5	0	2020	Western Pennsylvania		2	45957	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	11	7b;	7b1;
H5533	7	0	1	4	1	H5533_007_0	8	1			07/03/2019	2020.01	07/03/2019 11:42:52 AM Eastern Daylight Time	08/05/2019 11:37:14 PM Eastern Daylight Time	07/31/2019 01:42:26 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH NETWORK, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO Rx Enhanced (PPO)	1	4		1			H5533	7	0	2020	Berks County		2	3784	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(844)870-2231		(844)870-2231		(844)703-2379		(844)703-2379		(844)870-2231		(844)870-2231		(844)703-2379		(844)703-2379		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	11	7b;	7b1;
H5533	8	0	1	4	1	H5533_008_0	8	1			07/03/2019	2020.01	07/03/2019 11:47:40 AM Eastern Daylight Time	08/05/2019 11:39:54 PM Eastern Daylight Time	07/31/2019 01:44:06 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH NETWORK, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO Rx Enhanced (PPO)	1	4		1			H5533	8	0	2020	South Central PA		2	13118	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						1	11	7b;	7b1;
H5533	801	0	1	4	1	H5533_801_0	5	1			05/31/2019	2020.01	05/31/2019 02:47:41 PM Eastern Daylight Time					06/02/2019 04:00:18 PM Eastern Daylight Time	"UPMC HEALTH NETWORK, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PPO)	1	4		1			H5533	801	0	2020	Western Pennsylvania		1	49	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;6;7c;7i;7k;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1									
H5533	802	0	1	4	1	H5533_802_0	5	1			06/01/2019	2020.01	06/01/2019 11:28:54 AM Eastern Daylight Time					06/02/2019 04:00:18 PM Eastern Daylight Time	"UPMC HEALTH NETWORK, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare/	UPMC Employer Group Rx (PPO)	1	4		1			H5533	802	0	2020	Western Pennsylvania		1	6736	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7c;7i;7k;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1									
H5533	803	0	1	4	1	H5533_803_0	5	1			05/31/2019	2020.01	05/31/2019 02:51:36 PM Eastern Daylight Time					06/02/2019 04:00:18 PM Eastern Daylight Time	"UPMC HEALTH NETWORK, INC."	UPMC for Life	http://www.upmchealthplan.com/medicare/	UPMC Employer Group Rx (PPO)	1	4		1			H5533	803	0	2020	Western Pennsylvania		1	12	2			2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/	www.upmchealthplan.com/medicare/	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;6;7c;7i;7k;8a;8b1;8b2;9a1;9b;10a;11a;11b;15;	2		1									
H5549	3	0	1	1	1	H5549_003_0	4	1	2	1	05/31/2019	2020.01	05/31/2019 04:18:33 PM Eastern Daylight Time	08/06/2019 10:51:43 AM Eastern Daylight Time	08/06/2019 10:51:43 AM Eastern Daylight Time			08/06/2019 11:06:01 AM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Total (HMO D-SNP)	1	1		1			H5549	3	0	2020	New York Metro Area		2	37174	2			1	3		1		1	http://www.vnsnychoice.org/	http://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	2			
H5576	8	0	1	2	1	H5576_008_0	11	1			08/02/2019	2020.01	08/02/2019 10:21:33 AM Central Daylight Time	08/02/2019 10:10:04 AM Central Daylight Time	08/02/2019 10:04:24 AM Central Daylight Time			08/05/2019 08:48:05 AM Central Daylight Time	"VANTAGE HEALTH PLAN, INC."	"Vantage Health Plan, Inc."	www.VantageMedicare.com	Vantage TRADITIONAL PLUS (HMO-POS)	1	2		1			H5576	8	0	2020	State of Louisiana		2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	2			
H5576	17	1	1	2	1	H5576_017_1	10	1			08/02/2019	2020.01	08/02/2019 10:21:54 AM Central Daylight Time	08/02/2019 10:11:14 AM Central Daylight Time	08/02/2019 10:05:04 AM Central Daylight Time			08/05/2019 08:48:05 AM Central Daylight Time	"VANTAGE HEALTH PLAN, INC."	"Vantage Health Plan, Inc."	www.VantageMedicare.com	Vantage STANDARD (HMO-POS)	1	2		1			H5576	17	1	2020	"North, Central, and South LA"	"NE LA, EBR, SHEL, and TANG parishes"	2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	1	1	7a;7c;7e1;7e2;7g;7h1;7h2;7i;8a1;8b1;8b3;9a1;9c;14e2;	
H5576	17	2	1	2	1	H5576_017_2	10	1			08/02/2019	2020.01	08/02/2019 10:22:19 AM Central Daylight Time	08/02/2019 10:13:04 AM Central Daylight Time	08/02/2019 10:05:50 AM Central Daylight Time			08/05/2019 08:48:05 AM Central Daylight Time	"VANTAGE HEALTH PLAN, INC."	"Vantage Health Plan, Inc."	www.VantageMedicare.com	Vantage STANDARD (HMO-POS)	1	2		1			H5576	17	2	2020	"North, Central, and South LA"	"North, Central, and South LA"	2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	2			
H5576	18	1	1	2	1	H5576_018_1	10	1			08/02/2019	2020.01	08/02/2019 10:22:35 AM Central Daylight Time	08/02/2019 10:14:46 AM Central Daylight Time	08/02/2019 10:06:46 AM Central Daylight Time			08/05/2019 08:48:05 AM Central Daylight Time	"VANTAGE HEALTH PLAN, INC."	"Vantage Health Plan, Inc."	www.VantageMedicare.com	Vantage PREMIUM (HMO-POS)	1	2		1			H5576	18	1	2020	"North, Central, and South LA"	"NE LA, EBR, SHEL, and TANG parishes"	2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	1	1	7a;7c;7e1;7e2;7g;7h1;7h2;7i;8a1;8b1;8b3;9a1;9c;14e2;	
H5576	18	2	1	2	1	H5576_018_2	10	1			08/02/2019	2020.01	08/02/2019 10:22:57 AM Central Daylight Time	08/02/2019 10:17:08 AM Central Daylight Time	08/02/2019 10:07:26 AM Central Daylight Time			08/05/2019 08:48:05 AM Central Daylight Time	"VANTAGE HEALTH PLAN, INC."	"Vantage Health Plan, Inc."	www.VantageMedicare.com	Vantage PREMIUM (HMO-POS)	1	2		1			H5576	18	2	2020	"North, Central, and South LA"	"North, Central, and South LA"	2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	2			
H5576	19	0	1	2	1	H5576_019_0	11	1	2	1	08/02/2019	2020.01	08/02/2019 10:20:28 AM Central Daylight Time	08/02/2019 10:16:08 AM Central Daylight Time	08/02/2019 10:08:26 AM Central Daylight Time			08/05/2019 08:48:05 AM Central Daylight Time	"VANTAGE HEALTH PLAN, INC."	"Vantage Health Plan, Inc."	www.VantageMedicare.com	Vantage DUAL PLUS (HMO-POS D-SNP)	1	2		1			H5576	19	0	2020	State of Louisiana		2		2			1	3		2		2	www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	2			
H5576	20	1	1	2	1	H5576_020_1	11	1			08/02/2019	2020.01	08/02/2019 10:23:16 AM Central Daylight Time	08/02/2019 10:15:56 AM Central Daylight Time	08/02/2019 10:09:06 AM Central Daylight Time			08/05/2019 08:48:05 AM Central Daylight Time	"VANTAGE HEALTH PLAN, INC."	"Vantage Health Plan, Inc."	www.VantageMedicare.com	Vantage BASIC (HMO-POS)	1	2		1			H5576	20	1	2020	"North, Central, and South LA"	"NE LA, EBR, SHEL, and TANG parishes"	2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	1	1	7a;7c;7e1;7e2;7g;7h1;7h2;7i;8a1;8b1;8b3;9a1;9c;14e2;	
H5576	20	2	1	2	1	H5576_020_2	11	1			08/02/2019	2020.01	08/02/2019 10:23:36 AM Central Daylight Time	08/02/2019 10:14:58 AM Central Daylight Time	08/02/2019 10:10:32 AM Central Daylight Time			08/05/2019 08:48:05 AM Central Daylight Time	"VANTAGE HEALTH PLAN, INC."	"Vantage Health Plan, Inc."	www.VantageMedicare.com	Vantage BASIC (HMO-POS)	1	2		1			H5576	20	2	2020	"North, Central, and South LA"	"North, Central, and South LA"	2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	2			
H5576	22	0	1	2	1	H5576_022_0	11	1			08/05/2019	2020.01	08/05/2019 09:33:00 AM Central Daylight Time	08/02/2019 10:13:50 AM Central Daylight Time	08/02/2019 10:11:48 AM Central Daylight Time			08/05/2019 09:41:15 AM Central Daylight Time	"VANTAGE HEALTH PLAN, INC."	"Vantage Health Plan, Inc."	www.VantageMedicare.com	Vantage 100 (HMO-POS)	1	2		1			H5576	22	0	2020	East and West Carroll parishes		2		2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	2			
H5576	801	0	1	2	1	H5576_801_0	9	1			06/27/2019	2020.01	06/27/2019 02:38:52 PM Central Daylight Time					06/27/2019 03:17:06 PM Central Daylight Time	"VANTAGE HEALTH PLAN, INC."	"Vantage Health Plan, Inc."	www.VantageMedicare.com	Vantage - MAPD Employer Calendar (HMO-POS)	1	2		1			H5576	801	0	2020	Louisiana		1	22164	2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	2			
H5576	802	0	1	2	1	H5576_802_0	9	1			06/27/2019	2020.01	06/27/2019 02:39:36 PM Central Daylight Time					06/27/2019 03:17:06 PM Central Daylight Time	"VANTAGE HEALTH PLAN, INC."	"Vantage Health Plan, Inc."	www.VantageMedicare.com	Vantage - MAPD Emp Non-Calendar (HMO-POS)	1	2		1			H5576	802	0	2020	Louisiana		1	0	2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1	(866)704-0109		(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	2			
H5576	803	0	1	2	1	H5576_803_0	9	1			06/27/2019	2020.01	06/27/2019 02:39:58 PM Central Daylight Time					06/27/2019 03:17:06 PM Central Daylight Time	"VANTAGE HEALTH PLAN, INC."	"Vantage Health Plan, Inc."	www.VantageMedicare.com	Vantage - MA Employer Calendar (HMO-POS)	1	2		1			H5576	803	0	2020	Louisiana		1	0	2			2						www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(866)704-0109		(318)361-0900	1	(866)704-0109		(318)361-0900	1									(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131										2					2					2	2			
H5577	2	0	1	1	1	H5577_002_0	9	1	1	1	07/15/2019	2020.01	07/15/2019 10:20:12 AM SA Western Standard Time	08/06/2019 03:37:13 PM SA Western Standard Time	08/06/2019 02:27:09 PM SA Western Standard Time			08/06/2019 04:14:53 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Ideal + (HMO D-SNP)	1	1		1			H5577	2	0	2020	Puerto Rico		2	69238	2		1	1	3		2		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	2			
H5577	5	0	1	1	1	H5577_005_0	7	1			07/15/2019	2020.01	07/15/2019 10:19:48 AM SA Western Standard Time	08/06/2019 02:27:10 PM SA Western Standard Time	08/06/2019 02:27:10 PM SA Western Standard Time			08/06/2019 04:14:53 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare InteliCare + (HMO)	1	1		1			H5577	5	0	2020	Puerto Rico		2	131476	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	1	1	7d;7f;8a2;	
H5577	8	0	1	2	1	H5577_008_0	7	1			07/15/2019	2020.01	07/15/2019 10:19:22 AM SA Western Standard Time	08/06/2019 02:27:11 PM SA Western Standard Time	08/06/2019 02:29:14 PM SA Western Standard Time			08/06/2019 04:14:53 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare Essential + (HMO-POS)	1	2		1			H5577	8	0	2020	Puerto Rico		2	459737	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	1	1	7d;7f;8a2;	
H5577	14	0	1	1	1	H5577_014_0	6	1			07/15/2019	2020.01	07/15/2019 10:20:54 AM SA Western Standard Time	08/06/2019 02:08:01 PM SA Western Standard Time	08/06/2019 02:27:13 PM SA Western Standard Time			08/06/2019 04:14:53 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MediCa$h + (HMO)	1	1		1			H5577	14	0	2020	Puerto Rico		2	10070	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	2			
H5577	16	0	1	1	1	H5577_016_0	4	1			07/10/2019	2020.01	07/10/2019 04:55:11 PM SA Western Standard Time	06/03/2019 03:50:24 PM SA Western Standard Time				07/10/2019 05:07:05 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MediOnlyNoRx + (HMO)	1	1		1			H5577	16	0	2020	Puerto Rico		2	5111	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										2					2					2	1	1	7d;7f;8a2;	
H5577	17	0	1	1	1	H5577_017_0	8	1	1	1	07/15/2019	2020.01	07/15/2019 10:21:44 AM SA Western Standard Time	08/06/2019 02:27:15 PM SA Western Standard Time	08/06/2019 02:27:15 PM SA Western Standard Time			08/06/2019 04:14:53 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Progreso + (HMO D-SNP)	1	1		1			H5577	17	0	2020	Puerto Rico		2	438582	2		1	1	3		2		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	2			
H5577	28	0	1	1	1	H5577_028_0	8	1	1	1	07/15/2019	2020.01	07/15/2019 10:22:20 AM SA Western Standard Time	08/06/2019 02:27:18 PM SA Western Standard Time	08/06/2019 02:27:17 PM SA Western Standard Time			08/06/2019 04:14:53 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Clsico + (HMO D-SNP)	1	1		1			H5577	28	0	2020	Puerto Rico		2	367545	2		1	1	3		2		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	2			
H5577	29	0	1	1	1	H5577_029_0	8	1	1	1	07/15/2019	2020.01	07/15/2019 10:22:50 AM SA Western Standard Time	08/06/2019 03:37:14 PM SA Western Standard Time	08/06/2019 02:29:46 PM SA Western Standard Time			08/06/2019 04:14:53 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino MsCa$h + (HMO D-SNP)	1	1		1			H5577	29	0	2020	Puerto Rico		2	51252	2		1	1	3		2		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	2			
H5577	31	0	1	1	1	H5577_031_0	7	1			07/15/2019	2020.01	07/15/2019 10:23:21 AM SA Western Standard Time	08/06/2019 02:08:04 PM SA Western Standard Time	08/06/2019 02:27:22 PM SA Western Standard Time			08/06/2019 04:14:53 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare Activo + (HMO)	1	1		1			H5577	31	0	2020	Puerto Rico		2	188128	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	1	1	7d;7f;8a2;	
H5577	36	0	1	1	1	H5577_036_0	9	1	1	1	07/15/2019	2020.01	07/15/2019 10:25:11 AM SA Western Standard Time	08/06/2019 02:08:05 PM SA Western Standard Time	08/06/2019 02:30:38 PM SA Western Standard Time			08/06/2019 04:14:53 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Te Lleva + (HMO D-SNP)	1	1		1			H5577	36	0	2020	Puerto Rico		2	177262	2		1	1	3		2		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	2			
H5577	37	0	1	1	1	H5577_037_0	8	1	1	1	07/15/2019	2020.01	07/15/2019 10:26:53 AM SA Western Standard Time	08/06/2019 03:37:15 PM SA Western Standard Time	08/06/2019 02:31:06 PM SA Western Standard Time			08/06/2019 04:14:53 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Expreso + (HMO D-SNP)	1	1		1			H5577	37	0	2020	Puerto Rico West - 27		2	26100	2		1	1	3		2		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	2			
H5577	38	0	1	1	1	H5577_038_0	7	1		1	07/15/2019	2020.01	07/15/2019 10:27:20 AM SA Western Standard Time	08/06/2019 02:08:07 PM SA Western Standard Time	08/06/2019 02:31:07 PM SA Western Standard Time			08/06/2019 04:14:53 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare Primero + (HMO C-SNP)	1	1		1			H5577	38	0	2020	Puerto Rico		2	21891	2			1	4			10		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	1	1	7d;7f;8a2;	
H5577	39	0	1	1	1	H5577_039_0	7	1			07/15/2019	2020.01	07/15/2019 10:28:07 AM SA Western Standard Time	08/06/2019 02:31:37 PM SA Western Standard Time	08/06/2019 02:31:36 PM SA Western Standard Time			08/06/2019 04:14:53 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare Te Mueve + (HMO)	1	1		1			H5577	39	0	2020	Puerto Rico		2	23424	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	1	1	7d;7f;8a2;	
H5577	801	0	1	1	1	H5577_801_0	5	1			06/01/2019	2020.01	06/01/2019 12:25:17 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA Group (HMO)	1	1		1			H5577	801	0	2020	Puerto Rico		1	1200	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	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	802	0	1	1	1	H5577_802_0	5	1			06/01/2019	2020.01	06/01/2019 12:26:35 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group (HMO)	1	1		1			H5577	802	0	2020	Puerto Rico		1	78576	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	809	0	1	1	1	H5577_809_0	5	1			06/01/2019	2020.01	06/01/2019 12:28:01 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2nd Formulary Opt. (HMO)	1	1		1			H5577	809	0	2020	Puerto Rico		1	241152	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	816	0	1	1	1	H5577_816_0	5	1			06/01/2019	2020.01	06/01/2019 12:21:19 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2A (HMO)	1	1		1			H5577	816	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	817	0	1	1	1	H5577_817_0	5	1			05/30/2019	2020.01	05/30/2019 06:11:25 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2B (HMO)	1	1		1			H5577	817	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	818	0	1	1	1	H5577_818_0	5	1			05/30/2019	2020.01	05/30/2019 06:11:35 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2C (HMO)	1	1		1			H5577	818	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	819	0	1	1	1	H5577_819_0	5	1			06/01/2019	2020.01	06/01/2019 12:29:14 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2D (HMO)	1	1		1			H5577	819	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	820	0	1	1	1	H5577_820_0	5	1			05/30/2019	2020.01	05/30/2019 06:11:56 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2E (HMO)	1	1		1			H5577	820	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	821	0	1	1	1	H5577_821_0	5	1			05/30/2019	2020.01	05/30/2019 06:12:10 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2F (HMO)	1	1		1			H5577	821	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	822	0	1	1	1	H5577_822_0	5	1			05/30/2019	2020.01	05/30/2019 06:12:21 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2G (HMO)	1	1		1			H5577	822	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	823	0	1	1	1	H5577_823_0	5	1			05/30/2019	2020.01	05/30/2019 06:15:23 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2H (HMO)	1	1		1			H5577	823	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	824	0	1	1	1	H5577_824_0	5	1			05/30/2019	2020.01	05/30/2019 06:15:34 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2I (HMO)	1	1		1			H5577	824	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	825	0	1	1	1	H5577_825_0	5	1			05/30/2019	2020.01	05/30/2019 06:15:46 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2J (HMO)	1	1		1			H5577	825	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	826	0	1	1	1	H5577_826_0	5	1			05/30/2019	2020.01	05/30/2019 06:15:58 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2K (HMO)	1	1		1			H5577	826	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	827	0	1	1	1	H5577_827_0	5	1			05/30/2019	2020.01	05/30/2019 06:16:10 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2L (HMO)	1	1		1			H5577	827	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	828	0	1	1	1	H5577_828_0	5	1			05/30/2019	2020.01	05/30/2019 06:16:22 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2M (HMO)	1	1		1			H5577	828	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	829	0	1	1	1	H5577_829_0	5	1			05/30/2019	2020.01	05/30/2019 06:16:33 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2N (HMO)	1	1		1			H5577	829	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	830	0	1	1	1	H5577_830_0	5	1			05/30/2019	2020.01	05/30/2019 06:16:45 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2O (HMO)	1	1		1			H5577	830	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5577	831	0	1	1	1	H5577_831_0	5	1			05/30/2019	2020.01	05/30/2019 06:17:07 PM SA Western Standard Time					06/03/2019 08:33:06 PM SA Western Standard Time	"MCS ADVANTAGE, INC."	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 2P (HMO)	1	1		1			H5577	831	0	2020	Puerto Rico		1	1200	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		1	1	1a;1b;2;3-1;3-2;5;6;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;15;16b;	2		2					2				
H5580	1	0	1	1	1	H5580_001_0	5	1	2	1	08/05/2019	2020.01	08/05/2019 09:54:44 AM Pacific Daylight Time	07/31/2019 04:17:17 PM Pacific Daylight Time	07/30/2019 02:00:52 PM Pacific Daylight Time			08/05/2019 09:55:22 AM Pacific Daylight Time	MERCY CARE	Mercy Care Advantage	www.MercyCareAdvantage.com	Mercy Care Advantage (HMO D-SNP)	1	1		1			H5580	1	0	2020	"Maricopa, Pinal, and Gila Counties"		2	126516	2			1	3		1		1	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	(877)436-5288		(602)586-1730		(866)571-5781		(602)414-7630		(877)436-5288		(602)586-1730		(866)571-5781		(602)414-7630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5580	4	0	1	1	1	H5580_004_0	5	1	2	1	07/16/2019	2020.01	07/16/2019 04:54:22 PM Pacific Daylight Time	07/31/2019 04:24:25 PM Pacific Daylight Time	07/30/2019 02:01:55 PM Pacific Daylight Time			08/05/2019 09:55:22 AM Pacific Daylight Time	MERCY CARE	Mercy Care Advantage	www.MercyCareAdvantage.com	Mercy Care Advantage (HMO D-SNP)	1	1		1			H5580	4	0	2020	"Maricopa, Gila, Pinal, and Pima Counties"		2	60353	2			1	3		1		1	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	(877)436-5288		(602)586-1730		(866)571-5781		(602)414-7630		(877)436-5288		(602)586-1730		(866)571-5781		(602)414-7630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5580	5	0	1	1	1	H5580_005_0	6	1	2	1	07/16/2019	2020.01	07/16/2019 04:57:31 PM Pacific Daylight Time	07/30/2019 02:35:58 PM Pacific Daylight Time	07/30/2019 02:02:55 PM Pacific Daylight Time			08/05/2019 09:55:22 AM Pacific Daylight Time	MERCY CARE	Mercy Care Advantage	www.MercyCareAdvantage.com	Mercy Care Advantage (HMO D-SNP)	1	1		1			H5580	5	0	2020	Arizona Statewide		2	15147	2			1	3		1		1	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	(877)436-5288		(602)586-1730		(866)571-5781		(602)414-7630		(877)436-5288		(602)586-1730		(866)571-5781		(602)414-7630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5587	2	0	1	1	1	H5587_002_0	7	1	2	1	08/01/2019	2020.01	08/01/2019 09:31:47 AM Pacific Daylight Time	08/05/2019 09:42:51 AM Pacific Daylight Time	08/05/2019 09:43:46 AM Pacific Daylight Time			08/05/2019 09:55:02 AM Pacific Daylight Time	"HEALTH CHOICE ARIZONA, INC."	Steward Health Choice Arizona	https://www.stewardhcgenerations.org/az/	Steward Health Choice Generations (HMO D-SNP)	1	1		1			H5587	2	0	2020	"Counties: APA, CCN, GIL, MAR, MOH, NAV, PIN, YAV"		2		2			1	3		2		2	http://www.hcgenerations.com	https://www.stewardhcgenerations.org/az/members/prescription-drug-information/	https://www.stewardhcgenerations.org/az/members/member-information/	(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	2			
H5590	4	0	1	1	1	H5590_004_0	3	1			05/29/2019	2020.01	05/29/2019 12:27:42 PM US Mountain Standard Time	08/05/2019 04:03:36 PM Central Daylight Time	08/05/2019 03:29:28 PM Central Daylight Time			08/06/2019 12:51:01 PM Central Daylight Time	BRIDGEWAY HEALTH SOLUTIONS	Allwell	allwell.azcompletehealth.com	Allwell Medicare (HMO)	1	1		1			H5590	4	0	2020	Yavapai and Yuma Counties		2		2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(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	2			
H5590	5	0	1	1	1	H5590_005_0	4	1			08/01/2019	2020.01	08/01/2019 09:46:42 AM US Mountain Standard Time	08/05/2019 04:03:25 PM Central Daylight Time	08/05/2019 03:29:31 PM Central Daylight Time			08/06/2019 12:51:01 PM Central Daylight Time	BRIDGEWAY HEALTH SOLUTIONS	Allwell	allwell.azcompletehealth.com	Allwell Medicare Essentials (HMO)	1	1		1			H5590	5	0	2020	Maricopa and Pinal counties		2		2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(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	2			
H5590	7	0	1	1	1	H5590_007_0	4	1			07/11/2019	2020.01	07/11/2019 05:03:45 PM Eastern Daylight Time	07/16/2019 03:15:42 PM Pacific Daylight Time	07/09/2019 03:30:38 PM Pacific Daylight Time			07/19/2019 01:26:40 PM Pacific Daylight Time	BRIDGEWAY HEALTH SOLUTIONS	Allwell	allwell.azcompletehealth.com	Allwell Medicare Essentials I (HMO)	1	1		1			H5590	7	0	2020	Southern & Central AZ Counties		2		2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(877)935-8020		(877)935-8020		(800)333-3930		(800)333-3930		(877)935-8020		(877)935-8020		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5590	8	0	1	1	1	H5590_008_0	5	1	2	1	08/01/2019	2020.01	08/01/2019 09:27:29 AM Pacific Daylight Time	08/05/2019 04:03:32 PM Central Daylight Time	08/05/2019 03:29:25 PM Central Daylight Time			08/06/2019 12:51:01 PM Central Daylight Time	BRIDGEWAY HEALTH SOLUTIONS	Allwell	allwell.azcompletehealth.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H5590	8	0	2020	Central and Southern AZ Counties		2		2			1	3		2		2	allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(877)935-8020		(877)935-8020		(800)333-3930		(800)333-3930		(877)935-8020		(877)935-8020		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	1	0	1	2	1	H5591_001_0	6	1			07/26/2019	2020.01	07/26/2019 10:11:55 AM Eastern Daylight Time	08/05/2019 01:19:30 PM Eastern Daylight Time	08/05/2019 01:19:31 PM Eastern Daylight Time			08/05/2019 02:20:17 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	1	2		1			H5591	1	0	2020	Northern Maine & Northern New Hampshire		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	2			
H5591	3	0	1	1	1	H5591_003_0	5	1			07/23/2019	2020.01	07/23/2019 08:50:26 AM Eastern Daylight Time	07/11/2019 08:50:20 AM Eastern Daylight Time				07/23/2019 08:55:35 AM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Value (HMO)	1	1		1			H5591	3	0	2020	All Maine & NH Counties-except Belknap & Merrimack		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	2			
H5591	5	0	1	2	1	H5591_005_0	6	1			07/17/2019	2020.01	07/17/2019 04:58:30 PM Eastern Daylight Time	08/05/2019 01:19:32 PM Eastern Daylight Time	08/05/2019 01:19:33 PM Eastern Daylight Time			08/05/2019 02:20:17 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	1	2		1			H5591	5	0	2020	"So. NH Counties: Chesh, Hills, Rock, Straff, Sull"		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	2			
H5591	6	1	1	2	1	H5591_006_1	6	1			08/05/2019	2020.01	08/05/2019 01:53:12 PM Eastern Daylight Time	08/05/2019 01:19:34 PM Eastern Daylight Time	08/05/2019 01:19:35 PM Eastern Daylight Time			08/05/2019 02:00:26 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	1	2		1			H5591	6	1	2020	"Southern Maine: Andr, Cumb, Kenn, Saga, York"	Cumberland County	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	2			
H5591	6	2	1	2	1	H5591_006_2	6	1			07/17/2019	2020.01	07/17/2019 04:59:54 PM Eastern Daylight Time	08/05/2019 01:19:36 PM Eastern Daylight Time	08/05/2019 01:19:37 PM Eastern Daylight Time			08/05/2019 02:20:17 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	1	2		1			H5591	6	2	2020	"Southern Maine: Andr, Cumb, Kenn, Saga, York"	"Androscoggin, Kennebec, Sagadahoc, &York Counties"	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	2			
H5591	6	4	1	2	1	H5591_006_4	6	1			07/17/2019	2020.01	07/17/2019 05:01:12 PM Eastern Daylight Time	08/05/2019 01:19:38 PM Eastern Daylight Time	08/05/2019 01:19:39 PM Eastern Daylight Time			08/05/2019 02:20:17 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	1	2		1			H5591	6	4	2020	"Southern Maine: Andr, Cumb, Kenn, Saga, York"	York County	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	2			
H5591	7	0	1	1	1	H5591_007_0	6	1		1	07/26/2019	2020.01	07/26/2019 10:13:02 AM Eastern Daylight Time	08/05/2019 01:19:40 PM Eastern Daylight Time	08/05/2019 01:19:41 PM Eastern Daylight Time			08/05/2019 02:20:17 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Focus DC (HMO C-SNP)	1	1		1			H5591	7	0	2020	Cumberland County		2		2			1	4			1E+13		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	2			
H5591	9	0	1	1	1	H5591_009_0	6	1			07/26/2019	2020.01	07/26/2019 10:13:15 AM Eastern Daylight Time	08/05/2019 01:19:42 PM Eastern Daylight Time	08/05/2019 01:19:43 PM Eastern Daylight Time			08/05/2019 02:20:17 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Value Plus (HMO)	1	1		1			H5591	9	0	2020	"Northern, Central, and Midcoast 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		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5591	13	0	1	1	1	H5591_013_0	6	1			07/17/2019	2020.01	07/17/2019 05:02:26 PM Eastern Daylight Time	08/05/2019 01:19:45 PM Eastern Daylight Time	08/05/2019 01:19:46 PM Eastern Daylight Time			08/05/2019 02:20:17 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Value Plus (HMO)	1	1		1			H5591	13	0	2020	"ME: Andro, Kenn, Saga, York & NH: Hills, Strafford"		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	2			
H5591	801	0	1	2	1	H5591_801_0	2	1			04/15/2019	2020.01	04/15/2019 02:06:36 PM Eastern Daylight Time					06/01/2019 08:09:03 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime Group (HMO-POS)	1	2		1			H5591	801	0	2020	National		1	0	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	2			
H5591	802	0	1	2	1	H5591_802_0	2	1			04/15/2019	2020.01	04/15/2019 02:08:53 PM Eastern Daylight Time					06/01/2019 08:09:03 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime Group (HMO-POS)	1	2		1			H5591	802	0	2020	National		1	0	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	2			
H5593	1	0	1	1	1	H5593_001_0	8	1	2	1	07/10/2019	2020.01	07/10/2019 03:24:27 PM Central Daylight Time	07/31/2019 01:49:24 PM Central Daylight Time	07/31/2019 03:28:47 AM Central Daylight Time			08/06/2019 08:47:32 AM Central Daylight Time	AETNA HEALTH OF IOWA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Premier (HMO D-SNP)	1	1		1			H5593	1	0	2020	Partial state of Iowa		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5593	801	0	1	1	1	H5593_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:53:55 AM Eastern Daylight Time					05/30/2019 07:02:01 PM Eastern Daylight Time	AETNA HEALTH OF IOWA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H5593	801	0	2020	Iowa		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5593	802	0	1	1	1	H5593_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:54:05 AM Eastern Daylight Time					05/30/2019 07:02:01 PM Eastern Daylight Time	AETNA HEALTH OF IOWA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H5593	802	0	2020	Iowa		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5593	803	0	1	1	1	H5593_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:54:16 AM Eastern Daylight Time					05/30/2019 07:02:01 PM Eastern Daylight Time	AETNA HEALTH OF IOWA INC.	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H5593	803	0	2020	Iowa		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5594	1	0	1	1	1	H5594_001_0	8	1			07/23/2019	2020.01	07/23/2019 10:21:54 AM Eastern Daylight Time	08/05/2019 12:59:45 PM Eastern Daylight Time	08/05/2019 06:03:05 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	1	1		1			H5594	1	0	2020	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	2	0	1	1	1	H5594_002_0	8	1			07/23/2019	2020.01	07/23/2019 10:22:17 AM Eastern Daylight Time	08/05/2019 01:01:18 PM Eastern Daylight Time	08/05/2019 06:03:46 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Platinum Plan (HMO)	1	1		1			H5594	2	0	2020	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	16	0	1	1	1	H5594_016_0	8	1	2	1	07/23/2019	2020.01	07/23/2019 10:22:33 AM Eastern Daylight Time	08/05/2019 01:02:37 PM Eastern Daylight Time	08/05/2019 06:04:26 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Emerald Partial (HMO D-SNP)	1	1		1			H5594	16	0	2020	Select Counties in Florida		2	0	2			1	3		2		2	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	17	0	1	1	1	H5594_017_0	8	1	2	1	07/23/2019	2020.01	07/23/2019 10:22:50 AM Eastern Daylight Time	08/05/2019 01:04:04 PM Eastern Daylight Time	08/05/2019 06:05:12 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Emerald Full (HMO D-SNP)	1	1		1			H5594	17	0	2020	Select Counties in Florida		2	0	2			1	3		1		1	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	19	0	1	1	1	H5594_019_0	9	1			07/23/2019	2020.01	07/23/2019 10:23:08 AM Eastern Daylight Time	08/05/2019 01:05:24 PM Eastern Daylight Time	08/05/2019 01:03:19 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Platinum Plan (HMO)	1	1		1			H5594	19	0	2020	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	22	0	1	1	1	H5594_022_0	9	1			07/23/2019	2020.01	07/23/2019 10:23:24 AM Eastern Daylight Time	08/05/2019 01:09:10 PM Eastern Daylight Time	08/05/2019 01:04:06 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	1	1		1			H5594	22	0	2020	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	26	0	1	1	1	H5594_026_0	9	1			07/23/2019	2020.01	07/23/2019 10:23:40 AM Eastern Daylight Time	08/05/2019 01:10:41 PM Eastern Daylight Time	08/05/2019 01:04:56 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO)	1	1		1			H5594	26	0	2020	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	28	0	1	1	1	H5594_028_0	8	1		1	07/23/2019	2020.01	07/23/2019 10:23:56 AM Eastern Daylight Time	08/05/2019 01:12:06 PM Eastern Daylight Time	08/05/2019 06:07:49 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO C-SNP)	1	1		1			H5594	28	0	2020	Select Counties in Florida		2	0	2			1	4			10		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	29	0	1	1	1	H5594_029_0	8	1		1	07/23/2019	2020.01	07/23/2019 10:24:13 AM Eastern Daylight Time	08/05/2019 01:15:19 PM Eastern Daylight Time	08/05/2019 06:08:29 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO C-SNP)	1	1		1			H5594	29	0	2020	Select Counties in Florida		2	0	2			1	4			100000000		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	30	0	1	1	1	H5594_030_0	8	1		1	07/23/2019	2020.01	07/23/2019 10:24:30 AM Eastern Daylight Time	08/05/2019 01:17:27 PM Eastern Daylight Time	08/05/2019 06:09:08 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO C-SNP)	1	1		1			H5594	30	0	2020	Select Counties in Florida		2	0	2			1	4			10		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	31	0	1	1	1	H5594_031_0	9	1		1	07/23/2019	2020.01	07/23/2019 10:24:45 AM Eastern Daylight Time	08/05/2019 01:18:47 PM Eastern Daylight Time	08/05/2019 01:50:25 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO C-SNP)	1	1		1			H5594	31	0	2020	Select Counties in Florida		2	0	2			1	4			100000000		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	32	0	1	1	1	H5594_032_0	8	1			07/23/2019	2020.01	07/23/2019 10:24:58 AM Eastern Daylight Time	08/05/2019 01:20:35 PM Eastern Daylight Time	08/05/2019 06:11:24 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Gold Plus Plan (HMO)	1	1		1			H5594	32	0	2020	Select Counties in Florida		2	0	2			2						www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	34	0	1	1	1	H5594_034_0	9	1		1	07/23/2019	2020.01	07/23/2019 10:26:40 AM Eastern Daylight Time	08/05/2019 01:21:57 PM Eastern Daylight Time	08/05/2019 01:52:01 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO C-SNP)	1	1		1			H5594	34	0	2020	select counties in FL		2	0	2			1	4			10		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5594	35	0	1	1	1	H5594_035_0	9	1		1	07/23/2019	2020.01	07/23/2019 10:55:25 AM Eastern Daylight Time	08/05/2019 01:23:19 PM Eastern Daylight Time	08/05/2019 01:52:46 PM Eastern Daylight Time			08/06/2019 07:25:47 AM Eastern Daylight Time	"OPTIMUM HEALTHCARE, INC."	"Optimum HealthCare, Inc."	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO C-SNP)	1	1		1			H5594	35	0	2020	select counties in FL		2	0	2			1	4			100000000		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(866)245-5360		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5608	1	0	1	1	1	H5608_001_0	6	1	2	1	08/05/2019	2020.01	08/05/2019 12:06:59 PM Mountain Daylight Time	08/06/2019 10:57:00 AM Mountain Daylight Time	08/06/2019 10:57:00 AM Mountain Daylight Time			08/06/2019 10:59:31 AM Mountain Daylight Time	"DENVER HEALTH MEDICAL PLAN, INC."	"Denver Health Medical Plan, Inc."	https://www.denverhealthmedicalplan.org	Denver Health Medicare Choice (HMO D-SNP)	1	1		1			H5608	1	0	2020	Denver County		2	19421	1	1		1	3		1		1	https://www.denverhealthmedicalplan.org	https://www.denverhealthmedicalplan.org	https://www.denverhealthmedicalplan.org	(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5608	2	0	1	1	1	H5608_002_0	6	1			08/05/2019	2020.01	08/05/2019 12:07:24 PM Mountain Daylight Time	08/06/2019 10:57:01 AM Mountain Daylight Time	08/06/2019 10:57:02 AM Mountain Daylight Time			08/06/2019 10:59:31 AM Mountain Daylight Time	"DENVER HEALTH MEDICAL PLAN, INC."	"Denver Health Medical Plan, Inc."	https://www.denverhealthmedicalplan.org	Denver Health Medicare Select (HMO)	1	1		1			H5608	2	0	2020	"Adams, Denver, and Jefferson counties"		2	43146	1	1		2						https://www.denverhealthmedicalplan.org	https://www.denverhealthmedicalplan.org	https://www.denverhealthmedicalplan.org	(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5610	1	0	1	20	8	H5610_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:05:39 PM Eastern Daylight Time		05/22/2019 12:56:39 PM Eastern Daylight Time			05/22/2019 01:07:58 PM Eastern Daylight Time	CARE RESOURCES	Care Resources	www.care-resources.org	Care Resources (PACE)	8	20		1			H5610	1	0	2020	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	3	0	1	20	8	H5610_003_0	1	1			05/22/2019	2020.01	05/22/2019 01:06:12 PM Eastern Daylight Time		05/22/2019 12:53:04 PM Eastern Daylight Time			05/22/2019 01:07:58 PM Eastern Daylight Time	CARE RESOURCES	Care Resources	www.care-resources.org	Care Resources (PACE)	8	20		1			H5610	3	0	2020	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																
H5613	2	0		7	2	H5613_002_0	6	2			05/28/2019	2020.01	05/28/2019 01:04:29 PM Eastern Daylight Time			05/30/2019 07:58:20 AM Eastern Daylight Time		05/30/2019 08:53:21 AM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	mvphealthcare.com	MVP SmartFund (MSA)	2	7	2				H5613	2	0	2020	Eastern NY		2	1980	2			2									(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																								
H5613	801	0		7	2	H5613_801_0	3	2			05/28/2019	2020.01	05/28/2019 01:15:58 PM Eastern Daylight Time					05/30/2019 08:53:21 AM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	mvphealthcare.com	MVP SmartFund EG (MSA)	2	7	2				H5613	801	0	2020	Western NY		1	0	2			2									(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																								
H5613	802	0		7	2	H5613_802_0	3	2			05/28/2019	2020.01	05/28/2019 01:05:43 PM Eastern Daylight Time					05/30/2019 08:53:21 AM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	mvphealthcare.com	MVP SmartFund EG (MSA)	2	7	2				H5613	802	0	2020	Eastern NY		1	360	2			2									(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																								
H5619	1	0	1	1	1	H5619_001_0	4	1			08/01/2019	2020.01	08/01/2019 04:10:10 PM Eastern Daylight Time	08/01/2019 04:34:34 PM Eastern Daylight Time	08/02/2019 01:18:40 PM Eastern Daylight Time			08/05/2019 11:22:42 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-001 (HMO)	1	1		1			H5619	1	0	2020	Southern Maine Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	3	0	1	1	1	H5619_003_0	5	1	2	1	07/19/2019	2020.01	07/19/2019 03:39:09 PM Eastern Daylight Time	08/02/2019 03:08:08 PM Eastern Daylight Time	08/02/2019 01:18:40 PM Eastern Daylight Time			08/05/2019 11:22:42 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)	1	1		1			H5619	3	0	2020	Select Counties in Maine		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	12	0	1	1	1	H5619_012_0	3	1			08/01/2019	2020.01	08/01/2019 04:11:09 PM Eastern Daylight Time	08/03/2019 10:25:29 AM Eastern Daylight Time	08/02/2019 01:18:40 PM Eastern Daylight Time			08/05/2019 10:50:08 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-012 (HMO)	1	1		1			H5619	12	0	2020	Fresno County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	13	0	1	1	1	H5619_013_0	3	1			08/01/2019	2020.01	08/01/2019 04:36:17 PM Eastern Daylight Time	08/03/2019 10:39:15 AM Eastern Daylight Time	08/02/2019 01:18:41 PM Eastern Daylight Time			08/05/2019 10:50:08 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-013 (HMO)	1	1		1			H5619	13	0	2020	Madera County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	15	0	1	1	1	H5619_015_0	4	1			08/01/2019	2020.01	08/01/2019 04:40:50 PM Eastern Daylight Time	08/03/2019 10:27:12 AM Eastern Daylight Time	08/02/2019 01:18:41 PM Eastern Daylight Time			08/05/2019 10:50:08 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-015 (HMO)	1	1		1			H5619	15	0	2020	Tulare and Kings counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	3-1;3-2;3-4;4b;7c;7d;7e1;7e2;7f;7g;7h1;7h2;7i;7k;8a1;8b1;8b2;8b3;9c;16b;17a;18a;	
H5619	16	0	1	1	1	H5619_016_0	3	1			08/01/2019	2020.01	08/01/2019 04:43:02 PM Eastern Daylight Time	08/03/2019 10:30:05 AM Eastern Daylight Time	08/02/2019 01:18:41 PM Eastern Daylight Time			08/05/2019 10:50:08 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-016 (HMO)	1	1		1			H5619	16	0	2020	San Diego County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	21	0	1	1	1	H5619_021_0	2	1			08/01/2019	2020.01	08/01/2019 04:43:32 PM Eastern Daylight Time	08/03/2019 10:34:45 AM Eastern Daylight Time	08/02/2019 01:18:41 PM Eastern Daylight Time			08/05/2019 10:50:08 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-021 (HMO)	1	1		1			H5619	21	0	2020	Los Angeles and Orange counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	23	0	1	1	1	H5619_023_0	3	1			08/01/2019	2020.01	08/01/2019 04:44:24 PM Eastern Daylight Time	08/03/2019 10:36:28 AM Eastern Daylight Time	08/02/2019 01:18:41 PM Eastern Daylight Time			08/05/2019 10:50:08 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-023 (HMO)	1	1		1			H5619	23	0	2020	Santa Barbara (partial) and Ventura counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	26	0	1	1	1	H5619_026_0	3	1			07/15/2019	2020.01	07/15/2019 03:31:53 PM Eastern Daylight Time	08/03/2019 10:31:53 AM Eastern Daylight Time	08/02/2019 01:18:41 PM Eastern Daylight Time			08/05/2019 10:50:08 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-026 (HMO)	1	1		1			H5619	26	0	2020	San Joaquin County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	29	0	1	1	1	H5619_029_0	3	1			07/15/2019	2020.01	07/15/2019 03:32:27 PM Eastern Daylight Time	08/03/2019 10:33:17 AM Eastern Daylight Time	08/02/2019 01:18:41 PM Eastern Daylight Time			08/05/2019 10:50:08 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-029 (HMO)	1	1		1			H5619	29	0	2020	Contra Costa County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	32	0	1	1	1	H5619_032_0	3	1			08/01/2019	2020.01	08/01/2019 04:44:53 PM Eastern Daylight Time	08/03/2019 10:28:39 AM Eastern Daylight Time	08/02/2019 01:18:41 PM Eastern Daylight Time			08/05/2019 11:00:12 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-032 (HMO)	1	1		1			H5619	32	0	2020	Stanislaus County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	37	0	1	1	1	H5619_037_0	2	1			05/31/2019	2020.01	05/31/2019 01:50:42 PM Eastern Daylight Time	08/03/2019 10:37:51 AM Eastern Daylight Time	08/02/2019 01:18:42 PM Eastern Daylight Time			08/05/2019 11:00:12 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Value Plus H5619-037 (HMO)	1	1		1			H5619	37	0	2020	Select Counties in California		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	38	0	1	1	1	H5619_038_0	7	1	2	1	07/19/2019	2020.01	07/19/2019 03:08:10 PM Eastern Daylight Time	08/03/2019 10:52:19 AM Eastern Daylight Time	08/02/2019 01:18:42 PM Eastern Daylight Time			08/05/2019 11:00:12 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP)	1	1		1			H5619	38	0	2020	Select Counties in California		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	39	1	1	1	1	H5619_039_1	2	1			08/01/2019	2020.01	08/01/2019 04:46:33 PM Eastern Daylight Time	08/03/2019 10:42:33 AM Eastern Daylight Time	08/02/2019 01:18:42 PM Eastern Daylight Time			08/05/2019 11:00:12 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-039 (HMO)	1	1		1			H5619	39	1	2020	Riverside and San Bernardino counties	Riverside County	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	39	2	1	1	1	H5619_039_2	2	1			08/01/2019	2020.01	08/01/2019 04:48:46 PM Eastern Daylight Time	08/03/2019 10:44:31 AM Eastern Daylight Time	08/02/2019 01:18:42 PM Eastern Daylight Time			08/05/2019 11:00:12 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-039 (HMO)	1	1		1			H5619	39	2	2020	Riverside and San Bernardino counties	San Bernardino County	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	40	1	1	1	1	H5619_040_1	4	1			07/15/2019	2020.01	07/15/2019 04:00:00 PM Eastern Daylight Time	08/01/2019 04:39:34 PM Eastern Daylight Time	08/02/2019 01:18:42 PM Eastern Daylight Time			08/05/2019 11:22:42 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-040 (HMO)	1	1		1			H5619	40	1	2020	Select Counties in Maine and New Hampshire	Select Counties in Maine and New Hampshire	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	40	2	1	1	1	H5619_040_2	4	1			07/15/2019	2020.01	07/15/2019 04:00:38 PM Eastern Daylight Time	08/01/2019 04:29:38 PM Eastern Daylight Time	08/02/2019 01:18:42 PM Eastern Daylight Time			08/05/2019 11:22:42 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-040 (HMO)	1	1		1			H5619	40	2	2020	Select Counties in Maine and New Hampshire	Select Counties in Maine and New Hampshire	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	40	3	1	1	1	H5619_040_3	4	1			07/15/2019	2020.01	07/15/2019 04:09:54 PM Eastern Daylight Time	08/01/2019 04:40:32 PM Eastern Daylight Time	08/02/2019 01:18:42 PM Eastern Daylight Time			08/05/2019 11:22:42 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-040 (HMO)	1	1		1			H5619	40	3	2020	Select Counties in Maine and New Hampshire	Kennebec County	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	41	0	1	1	1	H5619_041_0	4	1			07/15/2019	2020.01	07/15/2019 03:47:54 PM Eastern Daylight Time	08/04/2019 04:31:37 PM Eastern Daylight Time	08/02/2019 01:18:42 PM Eastern Daylight Time			08/05/2019 11:08:39 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-041 (HMO)	1	1		1			H5619	41	0	2020	Albemarle and Charlottesville City Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	42	1	1	1	1	H5619_042_1	4	1			08/01/2019	2020.01	08/01/2019 07:10:28 PM Eastern Daylight Time	08/04/2019 04:40:37 PM Eastern Daylight Time	08/02/2019 01:18:42 PM Eastern Daylight Time			08/05/2019 11:08:39 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-042 (HMO)	1	1		1			H5619	42	1	2020	Roanoke Metro Area	Roanoke Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	42	2	1	1	1	H5619_042_2	4	1			08/01/2019	2020.01	08/01/2019 07:12:06 PM Eastern Daylight Time	08/04/2019 04:41:36 PM Eastern Daylight Time	08/02/2019 01:18:43 PM Eastern Daylight Time			08/05/2019 11:08:39 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-042 (HMO)	1	1		1			H5619	42	2	2020	Roanoke Metro Area	Roanoke Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	44	0	1	1	1	H5619_044_0	5	1			08/02/2019	2020.01	08/02/2019 06:19:03 PM Eastern Daylight Time	08/04/2019 04:26:03 PM Eastern Daylight Time	08/02/2019 01:18:43 PM Eastern Daylight Time			08/05/2019 11:08:39 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-044 (HMO)	1	1		1			H5619	44	0	2020	Richmond Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	45	0	1	1	1	H5619_045_0	4	1			08/01/2019	2020.01	08/01/2019 07:17:21 PM Eastern Daylight Time	08/04/2019 04:30:50 PM Eastern Daylight Time	08/02/2019 01:18:43 PM Eastern Daylight Time			08/05/2019 11:08:39 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-045 (HMO)	1	1		1			H5619	45	0	2020	Tidewater Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	46	0	1	1	1	H5619_046_0	4	1		1	08/01/2019	2020.01	08/01/2019 07:19:16 PM Eastern Daylight Time	08/04/2019 04:32:25 PM Eastern Daylight Time	08/02/2019 01:18:43 PM Eastern Daylight Time			08/05/2019 11:08:39 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	1	1		1			H5619	46	0	2020	Richmond - Tidewater Area		2		2			1	4			10		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	47	0	1	1	1	H5619_047_0	5	1			08/02/2019	2020.01	08/02/2019 02:33:53 PM Eastern Daylight Time	08/04/2019 04:33:14 PM Eastern Daylight Time	08/02/2019 01:18:43 PM Eastern Daylight Time			08/05/2019 11:08:39 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-047 (HMO)	1	1		1			H5619	47	0	2020	Northern Virginia Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	49	0	1	1	1	H5619_049_0	4	1			08/01/2019	2020.01	08/01/2019 02:36:37 PM Eastern Daylight Time	08/04/2019 02:36:27 PM Eastern Daylight Time	08/02/2019 01:18:43 PM Eastern Daylight Time			08/05/2019 11:14:55 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-049 (HMO)	1	1		1			H5619	49	0	2020	Indianapolis Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	50	0	1	1	1	H5619_050_0	3	1			08/01/2019	2020.01	08/01/2019 02:36:58 PM Eastern Daylight Time	08/04/2019 02:42:33 PM Eastern Daylight Time	08/02/2019 01:18:43 PM Eastern Daylight Time			08/05/2019 11:14:55 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-050 (HMO)	1	1		1			H5619	50	0	2020	Evansville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	51	0	1	1	1	H5619_051_0	3	1			08/01/2019	2020.01	08/01/2019 02:37:13 PM Eastern Daylight Time	08/04/2019 02:41:47 PM Eastern Daylight Time	08/02/2019 01:18:43 PM Eastern Daylight Time			08/05/2019 11:14:55 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-051 (HMO)	1	1		1			H5619	51	0	2020	Fort Wayne Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	52	0	1	1	1	H5619_052_0	3	1			08/01/2019	2020.01	08/01/2019 02:37:36 PM Eastern Daylight Time	08/04/2019 02:45:35 PM Eastern Daylight Time	08/02/2019 01:18:44 PM Eastern Daylight Time			08/05/2019 11:14:55 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-052 (HMO)	1	1		1			H5619	52	0	2020	South Bend Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	53	0	1	1	1	H5619_053_0	3	1			08/01/2019	2020.01	08/01/2019 02:38:00 PM Eastern Daylight Time	08/04/2019 02:54:37 PM Eastern Daylight Time	08/02/2019 01:18:44 PM Eastern Daylight Time			08/05/2019 11:18:00 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-053 (HMO)	1	1		1			H5619	53	0	2020	Lake and Porter County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	54	0	1	1	1	H5619_054_0	6	1	2	1	07/19/2019	2020.01	07/19/2019 03:14:13 PM Eastern Daylight Time	08/04/2019 02:47:06 PM Eastern Daylight Time	08/02/2019 01:18:44 PM Eastern Daylight Time			08/05/2019 10:59:57 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-054 (HMO D-SNP)	1	1		1			H5619	54	0	2020	Select counties in Indiana		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	55	0	1	1	1	H5619_055_0	3	1		1	07/15/2019	2020.01	07/15/2019 03:56:14 PM Eastern Daylight Time	08/04/2019 02:50:07 PM Eastern Daylight Time	08/02/2019 01:18:44 PM Eastern Daylight Time			08/05/2019 10:59:57 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	1	1		1			H5619	55	0	2020	Select counties in Kentucky and Indiana		2		2			1	4			10		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	56	0	1	1	1	H5619_056_0	5	1			08/01/2019	2020.01	08/01/2019 07:10:15 PM Eastern Daylight Time	08/04/2019 04:37:11 PM Eastern Daylight Time	08/02/2019 01:18:44 PM Eastern Daylight Time			08/05/2019 12:28:07 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-056 (HMO)	1	1		1			H5619	56	0	2020	Clark County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	57	0	1	1	1	H5619_057_0	5	1			08/01/2019	2020.01	08/01/2019 07:10:48 PM Eastern Daylight Time	08/04/2019 04:43:26 PM Eastern Daylight Time	08/02/2019 01:18:44 PM Eastern Daylight Time			08/05/2019 12:28:07 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-057 (HMO)	1	1		1			H5619	57	0	2020	King County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	59	0	1	1	1	H5619_059_0	7	1			08/05/2019	2020.01	08/05/2019 01:35:42 PM Eastern Daylight Time	08/04/2019 04:38:13 PM Eastern Daylight Time	08/02/2019 01:18:44 PM Eastern Daylight Time			08/05/2019 02:21:17 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-059 (HMO)	1	1		1			H5619	59	0	2020	Snohomish County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	60	0	1	1	1	H5619_060_0	5	1			08/02/2019	2020.01	08/02/2019 09:55:08 AM Eastern Daylight Time	08/04/2019 04:39:15 PM Eastern Daylight Time	08/02/2019 01:18:44 PM Eastern Daylight Time			08/05/2019 12:28:07 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-060 (HMO)	1	1		1			H5619	60	0	2020	Spokane County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	61	0	1	1	1	H5619_061_0	6	1			08/02/2019	2020.01	08/02/2019 04:14:46 PM Eastern Daylight Time	08/04/2019 04:47:54 PM Eastern Daylight Time	08/02/2019 01:18:45 PM Eastern Daylight Time			08/05/2019 10:56:52 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-061 (HMO)	1	1		1			H5619	61	0	2020	Pierce County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	62	0	1	1	1	H5619_062_0	5	1			08/02/2019	2020.01	08/02/2019 05:03:49 PM Eastern Daylight Time	08/04/2019 04:48:56 PM Eastern Daylight Time	08/02/2019 01:18:45 PM Eastern Daylight Time			08/05/2019 12:28:07 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-062 (HMO)	1	1		1			H5619	62	0	2020	Thurston County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	63	0	1	1	1	H5619_063_0	7	1			08/05/2019	2020.01	08/05/2019 01:46:27 PM Eastern Daylight Time	08/04/2019 04:49:57 PM Eastern Daylight Time	08/02/2019 01:18:45 PM Eastern Daylight Time			08/05/2019 02:21:17 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-063 (HMO)	1	1		1			H5619	63	0	2020	Snohomish County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	64	0	1	1	1	H5619_064_0	3	1			08/01/2019	2020.01	08/01/2019 01:50:18 PM Eastern Daylight Time	08/04/2019 04:52:00 PM Eastern Daylight Time	08/02/2019 01:18:45 PM Eastern Daylight Time			08/05/2019 10:56:52 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-064 (HMO)	1	1		1			H5619	64	0	2020	Thurston County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	65	0	1	1	1	H5619_065_0	2	1			05/31/2019	2020.01	05/31/2019 12:31:30 PM Eastern Daylight Time	08/01/2019 04:37:29 PM Eastern Daylight Time	08/02/2019 01:18:45 PM Eastern Daylight Time			08/05/2019 11:22:42 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Value Plus H5619-065 (HMO)	1	1		1			H5619	65	0	2020	Select Counties in New Hampshire		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	66	0	1	1	1	H5619_066_0	3	1			08/01/2019	2020.01	08/01/2019 04:10:36 PM Eastern Daylight Time	08/01/2019 04:42:29 PM Eastern Daylight Time	08/02/2019 01:18:45 PM Eastern Daylight Time			08/05/2019 11:22:42 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-066 (HMO)	1	1		1			H5619	66	0	2020	Select Counties in Maine		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	67	0	1	1	1	H5619_067_0	6	1	2	1	08/04/2019	2020.01	08/04/2019 01:20:10 PM Eastern Daylight Time	08/04/2019 04:45:48 PM Eastern Daylight Time	08/02/2019 01:18:45 PM Eastern Daylight Time			08/05/2019 10:56:52 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-067 (HMO D-SNP)	1	1		1			H5619	67	0	2020	Select counties in Washington		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	69	0	1	1	1	H5619_069_0	2	1			08/02/2019	2020.01	08/02/2019 04:19:15 PM Eastern Daylight Time	08/02/2019 10:02:48 AM Eastern Daylight Time	08/02/2019 01:18:45 PM Eastern Daylight Time			08/05/2019 10:50:23 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-069 (HMO)	1	1		1			H5619	69	0	2020	Select Counties in Arkansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	71	0	1	1	1	H5619_071_0	5	1			08/02/2019	2020.01	08/02/2019 03:12:44 PM Eastern Daylight Time	08/04/2019 06:21:04 PM Eastern Daylight Time	08/02/2019 01:18:46 PM Eastern Daylight Time			08/05/2019 11:11:35 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-071 (HMO)	1	1		1			H5619	71	0	2020	Lexington Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	73	0	1	1	1	H5619_073_0	7	1			08/04/2019	2020.01	08/04/2019 04:07:08 PM Eastern Daylight Time	08/04/2019 06:05:47 PM Eastern Daylight Time	08/02/2019 01:18:46 PM Eastern Daylight Time			08/05/2019 11:11:35 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-073 (HMO)	1	1		1			H5619	73	0	2020	Louisville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	75	0	1	1	1	H5619_075_0	6	1	2	1	07/19/2019	2020.01	07/19/2019 03:15:25 PM Eastern Daylight Time	08/04/2019 06:53:12 PM Eastern Daylight Time	08/02/2019 01:18:46 PM Eastern Daylight Time			08/05/2019 11:11:35 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-075 (HMO D-SNP)	1	1		1			H5619	75	0	2020	Central Kentucky Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	76	0	1	1	1	H5619_076_0	4	1	2	1	05/30/2019	2020.01	05/30/2019 04:25:46 PM Eastern Daylight Time	08/04/2019 06:55:08 PM Eastern Daylight Time	08/02/2019 01:18:46 PM Eastern Daylight Time			08/05/2019 11:11:35 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-076 (HMO D-SNP)	1	1		1			H5619	76	0	2020	Clark and Floyd counties		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	77	0	1	1	1	H5619_077_0	3	1			07/15/2019	2020.01	07/15/2019 11:39:56 AM Eastern Daylight Time	08/04/2019 04:35:08 PM Eastern Daylight Time	08/02/2019 01:18:46 PM Eastern Daylight Time			08/05/2019 10:56:52 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-077 (HMO)	1	1		1			H5619	77	0	2020	"Ada, Canyon and Payette counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	78	0	1	1	1	H5619_078_0	3	1			07/15/2019	2020.01	07/15/2019 11:41:23 AM Eastern Daylight Time	08/04/2019 04:36:09 PM Eastern Daylight Time	08/02/2019 01:18:46 PM Eastern Daylight Time			08/05/2019 10:56:52 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-078 (HMO)	1	1		1			H5619	78	0	2020	Bonner and Kootenai counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	79	0	1	1	1	H5619_079_0	3	1			08/02/2019	2020.01	08/02/2019 05:05:12 PM Eastern Daylight Time	08/04/2019 04:50:58 PM Eastern Daylight Time	08/02/2019 01:18:46 PM Eastern Daylight Time			08/05/2019 10:56:52 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-079 (HMO)	1	1		1			H5619	79	0	2020	"Ada, Canyon and Payette counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	80	0	1	1	1	H5619_080_0	3	1			07/15/2019	2020.01	07/15/2019 01:42:58 PM Eastern Daylight Time	08/04/2019 11:52:06 AM Eastern Daylight Time	08/02/2019 01:18:46 PM Eastern Daylight Time			08/05/2019 11:09:48 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-080 (HMO)	1	1		1			H5619	80	0	2020	Richland County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	81	0	1	1	1	H5619_081_0	3	1			07/15/2019	2020.01	07/15/2019 01:45:44 PM Eastern Daylight Time	08/04/2019 11:46:20 AM Eastern Daylight Time	08/02/2019 01:18:47 PM Eastern Daylight Time			08/05/2019 11:09:48 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-081 (HMO)	1	1		1			H5619	81	0	2020	Richland County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	82	0	1	1	1	H5619_082_0	2	1	2	1	05/30/2019	2020.01	05/30/2019 10:57:45 AM Eastern Daylight Time	08/04/2019 11:39:06 AM Eastern Daylight Time	08/02/2019 01:18:47 PM Eastern Daylight Time			08/05/2019 11:09:48 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP)	1	1		1			H5619	82	0	2020	Greater South Carolina		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	83	0	1	1	1	H5619_083_0	3	1			07/15/2019	2020.01	07/15/2019 01:48:26 PM Eastern Daylight Time	08/04/2019 11:40:20 AM Eastern Daylight Time	08/02/2019 01:18:47 PM Eastern Daylight Time			08/05/2019 11:09:48 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-083 (HMO)	1	1		1			H5619	83	0	2020	Charleston Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	84	0	1	1	1	H5619_084_0	3	1			07/15/2019	2020.01	07/15/2019 01:50:01 PM Eastern Daylight Time	08/04/2019 11:47:25 AM Eastern Daylight Time	08/02/2019 01:18:47 PM Eastern Daylight Time			08/05/2019 11:09:48 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-084 (HMO)	1	1		1			H5619	84	0	2020	Charleston Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	86	0	1	1	1	H5619_086_0	5	1			08/01/2019	2020.01	08/01/2019 06:59:04 PM Eastern Daylight Time	08/04/2019 11:54:33 AM Eastern Daylight Time	08/02/2019 01:18:47 PM Eastern Daylight Time			08/05/2019 11:09:48 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-086 (HMO)	1	1		1			H5619	86	0	2020	Spartanburg/Greenville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	87	0	1	1	1	H5619_087_0	3	1		1	08/01/2019	2020.01	08/01/2019 07:00:01 PM Eastern Daylight Time	08/04/2019 11:45:14 AM Eastern Daylight Time	08/02/2019 01:18:47 PM Eastern Daylight Time			08/05/2019 11:09:48 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	1	1		1			H5619	87	0	2020	Upstate South Carolina		2		2			1	4			10		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	88	0	1	1	1	H5619_088_0	3	1			07/31/2019	2020.01	07/31/2019 05:03:27 PM Eastern Daylight Time	08/02/2019 05:34:02 PM Eastern Daylight Time	08/02/2019 01:18:47 PM Eastern Daylight Time			08/05/2019 11:17:40 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-088 (HMO)	1	1		1			H5619	88	0	2020	Birmingham Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	89	0	1	1	1	H5619_089_0	3	1			07/31/2019	2020.01	07/31/2019 05:04:58 PM Eastern Daylight Time	08/02/2019 05:35:07 PM Eastern Daylight Time	08/02/2019 01:18:48 PM Eastern Daylight Time			08/05/2019 11:17:40 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-089 (HMO)	1	1		1			H5619	89	0	2020	Mobile Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	90	0	1	1	1	H5619_090_0	2	1			05/25/2019	2020.01	05/25/2019 09:27:54 AM Eastern Daylight Time	08/02/2019 05:36:10 PM Eastern Daylight Time	08/02/2019 01:18:48 PM Eastern Daylight Time			08/05/2019 11:17:40 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-090 (HMO)	1	1		1			H5619	90	0	2020	Select VA Counties in the Tri-Cities Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	91	0	1	1	1	H5619_091_0	2	1			05/25/2019	2020.01	05/25/2019 09:29:33 AM Eastern Daylight Time	08/02/2019 05:37:18 PM Eastern Daylight Time	08/02/2019 01:18:48 PM Eastern Daylight Time			08/05/2019 11:17:40 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-091 (HMO)	1	1		1			H5619	91	0	2020	Select VA Counties in the Tri-Cities Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	93	0	1	1	1	H5619_093_0	2	1	2	1	05/30/2019	2020.01	05/30/2019 10:47:46 AM Eastern Daylight Time	08/02/2019 05:38:26 PM Eastern Daylight Time	08/02/2019 01:18:48 PM Eastern Daylight Time			08/05/2019 11:17:40 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)	1	1		1			H5619	93	0	2020	Greater Alabama		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	94	0	1	1	1	H5619_094_0	3	1			07/15/2019	2020.01	07/15/2019 10:57:56 AM Eastern Daylight Time	08/02/2019 05:39:25 PM Eastern Daylight Time	08/02/2019 01:18:48 PM Eastern Daylight Time			08/05/2019 11:17:40 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-094 (HMO)	1	1		1			H5619	94	0	2020	Huntsville Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	95	0	1	1	1	H5619_095_0	3	1			07/31/2019	2020.01	07/31/2019 05:06:47 PM Eastern Daylight Time	08/02/2019 05:45:30 PM Eastern Daylight Time	08/02/2019 01:18:48 PM Eastern Daylight Time			08/05/2019 11:17:40 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-095 (HMO)	1	1		1			H5619	95	0	2020	Select VA Counties in the Tri-Cities Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	97	0	1	1	1	H5619_097_0	4	1			08/02/2019	2020.01	08/02/2019 04:19:43 PM Eastern Daylight Time	08/04/2019 06:46:07 PM Eastern Daylight Time	08/02/2019 01:18:48 PM Eastern Daylight Time			08/05/2019 11:11:28 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-097 (HMO)	1	1		1			H5619	97	0	2020	King County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	99	0	1	1	1	H5619_099_0	3	1			08/02/2019	2020.01	08/02/2019 05:07:50 PM Eastern Daylight Time	08/04/2019 05:57:48 PM Eastern Daylight Time	08/02/2019 01:18:48 PM Eastern Daylight Time			08/05/2019 11:11:28 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-099 (HMO)	1	1		1			H5619	99	0	2020	Kitsap County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	100	0	1	1	1	H5619_100_0	4	1			08/01/2019	2020.01	08/01/2019 01:56:59 PM Eastern Daylight Time	08/04/2019 05:44:08 PM Eastern Daylight Time	08/02/2019 01:18:48 PM Eastern Daylight Time			08/05/2019 11:11:28 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-100 (HMO)	1	1		1			H5619	100	0	2020	Pierce County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	101	0	1	1	1	H5619_101_0	4	1			08/02/2019	2020.01	08/02/2019 04:20:54 PM Eastern Daylight Time	08/04/2019 05:52:00 PM Eastern Daylight Time	08/02/2019 01:18:49 PM Eastern Daylight Time			08/05/2019 11:11:28 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-101 (HMO)	1	1		1			H5619	101	0	2020	Clark County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	102	0	1	1	1	H5619_102_0	4	1			07/15/2019	2020.01	07/15/2019 11:45:19 AM Eastern Daylight Time	08/04/2019 05:54:36 PM Eastern Daylight Time	08/02/2019 01:18:49 PM Eastern Daylight Time			08/05/2019 11:11:28 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-102 (HMO)	1	1		1			H5619	102	0	2020	Spokane County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	109	0	1	1	1	H5619_109_0	2	1			06/24/2019	2020.01	06/24/2019 11:52:03 AM Eastern Daylight Time	08/02/2019 10:25:41 AM Eastern Daylight Time	08/02/2019 01:18:49 PM Eastern Daylight Time			08/05/2019 10:50:23 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Value Plus H5619-109 (HMO)	1	1		1			H5619	109	0	2020	Select Counties in Arkansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	110	0	1	1	1	H5619_110_0	3	1			08/01/2019	2020.01	08/01/2019 07:01:24 PM Eastern Daylight Time	08/04/2019 12:02:23 PM Eastern Daylight Time	08/02/2019 01:18:49 PM Eastern Daylight Time			08/05/2019 11:09:48 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-110 (HMO)	1	1		1			H5619	110	0	2020	Select Counties in South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	111	0	1	1	1	H5619_111_0	3	1			08/01/2019	2020.01	08/01/2019 02:39:41 PM Eastern Daylight Time	08/02/2019 10:04:58 AM Eastern Daylight Time	08/02/2019 01:18:49 PM Eastern Daylight Time			08/05/2019 11:14:25 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-111 (HMO)	1	1		1			H5619	111	0	2020	Northwest Arkansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	112	0	1	1	1	H5619_112_0	3	1			07/31/2019	2020.01	07/31/2019 05:08:20 PM Eastern Daylight Time	08/02/2019 05:50:14 PM Eastern Daylight Time	08/02/2019 01:18:49 PM Eastern Daylight Time			08/05/2019 11:17:40 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-112 (HMO)	1	1		1			H5619	112	0	2020	Select Counties in Alabama		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	113	0	1	1	1	H5619_113_0	3	1			08/04/2019	2020.01	08/04/2019 02:05:24 PM Eastern Daylight Time	08/04/2019 07:26:04 PM Eastern Daylight Time	08/02/2019 01:18:49 PM Eastern Daylight Time			08/05/2019 11:34:27 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-113 (HMO)	1	1		1			H5619	113	0	2020	Select Counties in West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	114	0	1	1	1	H5619_114_0	5	1			08/01/2019	2020.01	08/01/2019 07:14:55 PM Eastern Daylight Time	08/04/2019 06:05:42 PM Eastern Daylight Time	08/02/2019 01:18:49 PM Eastern Daylight Time			08/05/2019 12:28:07 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-114 (HMO)	1	1		1			H5619	114	0	2020	Whatcom and Skagit Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	115	0	1	1	1	H5619_115_0	5	1			08/02/2019	2020.01	08/02/2019 05:04:36 PM Eastern Daylight Time	08/04/2019 06:08:59 PM Eastern Daylight Time	08/02/2019 01:18:50 PM Eastern Daylight Time			08/05/2019 12:28:07 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-115 (HMO)	1	1		1			H5619	115	0	2020	Whatcom and Skagit Counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	116	0	1	1	1	H5619_116_0	2	1			08/01/2019	2020.01	08/01/2019 04:49:32 PM Eastern Daylight Time	08/03/2019 10:50:39 AM Eastern Daylight Time	08/02/2019 01:18:50 PM Eastern Daylight Time			08/05/2019 11:00:12 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-116 (HMO)	1	1		1			H5619	116	0	2020	Kern County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	117	0	1	1	1	H5619_117_0	3	1	2	1	07/15/2019	2020.01	07/15/2019 11:04:22 AM Eastern Daylight Time	08/04/2019 12:17:22 PM Eastern Daylight Time	08/02/2019 01:18:50 PM Eastern Daylight Time			08/05/2019 11:06:27 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-117 (HMO D-SNP)	1	1		1			H5619	117	0	2020	Select Counties in South Carolina		2		2			1	3		2		2	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	118	0	1	1	1	H5619_118_0	3	1			08/01/2019	2020.01	08/01/2019 04:09:26 PM Eastern Daylight Time	08/04/2019 12:12:30 PM Eastern Daylight Time	08/02/2019 01:18:50 PM Eastern Daylight Time			08/05/2019 11:06:27 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-118 (HMO)	1	1		1			H5619	118	0	2020	Select Counties in South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	119	0	1	1	1	H5619_119_0	3	1			08/01/2019	2020.01	08/01/2019 04:50:26 PM Eastern Daylight Time	08/03/2019 10:59:48 AM Eastern Daylight Time	08/02/2019 01:18:50 PM Eastern Daylight Time			08/05/2019 11:00:12 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-119 (HMO)	1	1		1			H5619	119	0	2020	San Luis Obispo County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	120	0	1	1	1	H5619_120_0	1	1			05/31/2019	2020.01	05/31/2019 01:51:23 PM Eastern Daylight Time	05/31/2019 09:28:17 AM Eastern Daylight Time				05/31/2019 02:29:07 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-120 (HMO)	1	1		1			H5619	120	0	2020	"Los Angeles, Orange and San Diego counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5619	121	0	1	1	1	H5619_121_0	1	1			05/31/2019	2020.01	05/31/2019 01:51:30 PM Eastern Daylight Time	05/31/2019 09:28:58 AM Eastern Daylight Time				05/31/2019 02:29:07 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-121 (HMO)	1	1		1			H5619	121	0	2020	"Kern, Riverside, San Bernardino, Ventura counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5619	122	0	1	1	1	H5619_122_0	2	1			06/24/2019	2020.01	06/24/2019 11:57:51 AM Eastern Daylight Time	08/02/2019 10:29:53 AM Eastern Daylight Time	08/02/2019 01:18:50 PM Eastern Daylight Time			08/05/2019 11:14:25 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-122 (HMO)	1	1		1			H5619	122	0	2020	Select Counties in Arkansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	123	0	1	1	1	H5619_123_0	2	1	2	1	08/02/2019	2020.01	08/02/2019 04:27:49 PM Eastern Daylight Time	08/02/2019 10:31:34 AM Eastern Daylight Time	08/02/2019 01:18:50 PM Eastern Daylight Time			08/05/2019 11:14:25 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-123 (HMO D-SNP)	1	1		1			H5619	123	0	2020	Select Counties in Arkansas		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	124	0	1	1	1	H5619_124_0	3	1			08/02/2019	2020.01	08/02/2019 03:30:16 PM Eastern Daylight Time	08/04/2019 03:13:23 PM Eastern Daylight Time	08/02/2019 01:18:50 PM Eastern Daylight Time			08/05/2019 11:18:00 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-124 (HMO)	1	1		1			H5619	124	0	2020	Indianapolis Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	125	0	1	1	1	H5619_125_0	3	1			08/02/2019	2020.01	08/02/2019 03:30:33 PM Eastern Daylight Time	08/04/2019 03:14:08 PM Eastern Daylight Time	08/02/2019 01:18:51 PM Eastern Daylight Time			08/05/2019 11:18:00 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-125 (HMO)	1	1		1			H5619	125	0	2020	Fort Wayne Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	126	0	1	1	1	H5619_126_0	2	1	2	1	05/30/2019	2020.01	05/30/2019 04:59:05 PM Eastern Daylight Time	08/04/2019 07:43:26 PM Eastern Daylight Time	08/02/2019 01:18:51 PM Eastern Daylight Time			08/05/2019 11:34:27 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H5619-126 (HMO D-SNP)	1	1		1			H5619	126	0	2020	Select Counties in West Virginia		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	128	0	1	1	1	H5619_128_0	3	1			08/01/2019	2020.01	08/01/2019 05:58:44 PM Eastern Daylight Time	08/04/2019 07:35:49 PM Eastern Daylight Time	08/02/2019 01:18:51 PM Eastern Daylight Time			08/05/2019 11:37:17 AM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-128 (HMO)	1	1		1			H5619	128	0	2020	Bowling Green Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	129	0	1	1	1	H5619_129_0	4	1			07/15/2019	2020.01	07/15/2019 11:35:18 AM Eastern Daylight Time	08/04/2019 06:10:20 PM Eastern Daylight Time	08/02/2019 01:18:51 PM Eastern Daylight Time			08/05/2019 12:28:07 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H5619-129 (HMO)	1	1		1			H5619	129	0	2020	Island County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5619	802	0	1	1	1	H5619_802_0	1	1			05/29/2019	2020.01	05/29/2019 10:56:22 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H5619	802	0	2020	Select Counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5619	803	0	1	1	1	H5619_803_0	1	1			05/29/2019	2020.01	05/29/2019 10:56:53 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H5619	803	0	2020	Select Counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5619	805	0	1	1	1	H5619_805_0	1	1			05/29/2019	2020.01	05/29/2019 12:50:58 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H5619	805	0	2020	Select Counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H5619	806	0	1	1	1	H5619_806_0	1	1			05/29/2019	2020.01	05/29/2019 12:52:06 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"ARCADIAN HEALTH PLAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H5619	806	0	2020	Select Counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H5628	1	0	1	1	1	H5628_001_0	7	1	2	1	08/05/2019	2020.01	08/05/2019 11:26:33 AM Pacific Daylight Time	08/05/2019 09:40:42 AM Pacific Daylight Time	07/31/2019 11:12:26 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF UTAH, INC."	Molina Healthcare of Utah	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	1	1		1			H5628	1	0	2020	Select Counties in Utah		2		2			1	3		2		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	2			
H5628	7	0	1	1	1	H5628_007_0	8	1			08/02/2019	2020.01	08/02/2019 05:29:30 PM Pacific Daylight Time	08/05/2019 09:43:50 AM Pacific Daylight Time	07/31/2019 11:16:10 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF UTAH, INC."	Molina Healthcare of Utah	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	1	1		1			H5628	7	0	2020	"Davis, SLake, Utah, Weber, Summit, Tooele counties"		2		2			2						www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(877)644-0344		(877)644-0344		(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	2			
H5628	8	0	1	1	1	H5628_008_0	8	1	2	1	06/11/2019	2020.01	06/11/2019 10:23:50 AM Pacific Daylight Time	08/05/2019 09:45:44 AM Pacific Daylight Time	07/31/2019 11:17:26 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF UTAH, INC."	Molina Healthcare of Utah	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	1	1		1			H5628	8	0	2020	Select Counties in Idaho		2		2			1	3		1		2	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(844)239-4913		(844)239-4913		(866)403-8293		(866)403-8293		(844)239-4913		(844)239-4913		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5628	9	0	1	1	1	H5628_009_0	8	1			08/02/2019	2020.01	08/02/2019 05:27:57 PM Pacific Daylight Time	08/05/2019 09:47:44 AM Pacific Daylight Time	07/31/2019 11:19:26 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF UTAH, INC."	Molina Healthcare of Utah	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	1	1		1			H5628	9	0	2020	Ada and Canyon Counties		2		2			2						www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(844)560-9811		(844)560-9811		(866)403-8293		(866)403-8293		(844)560-9811		(844)560-9811		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5628	10	0	1	1	1	H5628_010_0	8	1			08/02/2019	2020.01	08/02/2019 05:40:08 PM Pacific Daylight Time	08/05/2019 09:51:16 AM Pacific Daylight Time	07/31/2019 11:22:40 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF UTAH, INC."	Molina Healthcare of Utah	www.molinahealthcare.com/medicare	Molina Medicare Choice Care (HMO)	1	1		1			H5628	10	0	2020	Twin Falls County		2		2			2						www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(844)560-9811		(844)560-9811		(866)403-8293		(866)403-8293		(844)560-9811		(844)560-9811		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5629	1	0	1	20	8	H5629_001_0	1	1			05/31/2019	2020.01	05/31/2019 07:41:15 AM Pacific Daylight Time		05/31/2019 07:33:40 AM Pacific Daylight Time			05/31/2019 07:53:02 AM Pacific Daylight Time	COMMUNITY ELDERCARE OF SAN DIEGO	St. Paul's PACE	http://www.stpaulspace.org/	St. Paul's PACE (PACE)	8	20		1			H5629	1	0	2020	"San Diego County, South County, East County"		2		2			2						stpaulspace.org	stpaulspace.org										(619)677-3800		(619)677-3800		(619)677-3800		(619)677-3800										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H5629	2	0	1	20	8	H5629_002_0	1	1			05/30/2019	2020.01	05/30/2019 12:00:49 PM Pacific Daylight Time		05/31/2019 07:33:40 AM Pacific Daylight Time			05/31/2019 07:53:02 AM Pacific Daylight Time	COMMUNITY ELDERCARE OF SAN DIEGO	St. Paul's PACE	http://www.stpaulspace.org/	St. Paul's PACE (PACE)	8	20		1			H5629	2	0	2020	"San Diego County, South County, East County"		2		2			2						stpaulspace.org	stpaulspace.org										(619)271-7100		(619)271-7100		(619)271-7100		(619)271-7100										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H5644	2	0	1	1	1	H5644_002_0	8	1			06/28/2019	2020.01	06/28/2019 08:42:38 AM Central Daylight Time	08/04/2019 10:47:01 AM Central Daylight Time	08/04/2019 09:25:44 AM Central Daylight Time			08/06/2019 11:59:36 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealth.com	Network Health Medicare Explore (HMO)	1	1		1			H5644	2	0	2020	Southeast Wisconsin		2		2			2						www.networkhealthmedicare.com	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com/search/providers/index.php	(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					2	2			
H5649	1	0	1	1	1	H5649_001_0	5	1			08/05/2019	2020.01	08/05/2019 03:56:18 PM Eastern Daylight Time	08/01/2019 03:58:59 PM Eastern Daylight Time	08/01/2019 02:06:29 PM Eastern Daylight Time			08/05/2019 03:59:59 PM Eastern Daylight Time	"CENTRAL HEALTH PLAN OF CALIFORNIA, INC."	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Medicare Plan (HMO)	1	1		1			H5649	1	0	2020	"Counties:  LA, SB, RS,  partial OC"		2	328047	2			2						www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/PartD/Formulary	www.centralhealthplan.com/NetworkProviders/Directory.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	2			
H5649	2	0	1	1	1	H5649_002_0	5	1	2	1	06/03/2019	2020.01	06/03/2019 02:41:01 PM Eastern Daylight Time	08/01/2019 04:00:29 PM Eastern Daylight Time	08/01/2019 02:27:32 PM Eastern Daylight Time			08/05/2019 03:59:59 PM Eastern Daylight Time	"CENTRAL HEALTH PLAN OF CALIFORNIA, INC."	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Medi-Medi Plan (HMO D-SNP)	1	1		1			H5649	2	0	2020	Counties: LA and SB		2	37392	2			1	3		1		2	www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/PartD/Formulary	www.centralhealthplan.com/NetworkProviders/Directory.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	2			
H5649	4	0	1	1	1	H5649_004_0	5	1			06/03/2019	2020.01	06/03/2019 02:41:44 PM Eastern Daylight Time	08/01/2019 04:01:43 PM Eastern Daylight Time	08/01/2019 02:35:18 PM Eastern Daylight Time			08/05/2019 03:59:59 PM Eastern Daylight Time	"CENTRAL HEALTH PLAN OF CALIFORNIA, INC."	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Premier Plan (HMO)	1	1		1			H5649	4	0	2020	"Counties:  LA, SB, RS and partial OC"		2	126330	2			2						www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/PartD/Formulary	www.centralhealthplan.com/NetworkProviders/Directory.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	2			
H5649	6	0	1	1	1	H5649_006_0	5	1		1	06/03/2019	2020.01	06/03/2019 02:42:20 PM Eastern Daylight Time	08/01/2019 04:03:14 PM Eastern Daylight Time	08/01/2019 02:37:16 PM Eastern Daylight Time			08/05/2019 03:59:59 PM Eastern Daylight Time	"CENTRAL HEALTH PLAN OF CALIFORNIA, INC."	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Focus Plan (HMO C-SNP)	1	1		1			H5649	6	0	2020	"Counties:  LA, SB, and partial OC"		2	31794	2			1	4			10		www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/PartD/Formulary	www.centralhealthplan.com/NetworkProviders/Directory.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	2			
H5649	8	0	1	1	1	H5649_008_0	5	1			06/03/2019	2020.01	06/03/2019 02:48:09 PM Eastern Daylight Time	08/01/2019 04:04:32 PM Eastern Daylight Time	08/01/2019 02:41:39 PM Eastern Daylight Time			08/05/2019 03:59:59 PM Eastern Daylight Time	"CENTRAL HEALTH PLAN OF CALIFORNIA, INC."	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Ventura Medicare Plan (HMO)	1	1		1			H5649	8	0	2020	Ventura County		2	17367	2			2						www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/PartD/Formulary	www.centralhealthplan.com/NetworkProviders/Directory.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	2			
H5649	9	0	1	1	1	H5649_009_0	5	1	2	1	06/03/2019	2020.01	06/03/2019 02:43:27 PM Eastern Daylight Time	08/01/2019 04:05:53 PM Eastern Daylight Time	08/01/2019 02:42:25 PM Eastern Daylight Time			08/05/2019 03:59:59 PM Eastern Daylight Time	"CENTRAL HEALTH PLAN OF CALIFORNIA, INC."	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Ventura Medi-Medi Plan (HMO D-SNP)	1	1		1			H5649	9	0	2020	Ventura County		2	7269	2			1	3		1		2	www.centralhealthplan.com/Benefits/Pharmacy.aspx	www.centralhealthplan.com/PartD/Formulary	www.centralhealthplan.com/NetworkProviders/Directory.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	2			
H5649	13	0	1	1	1	H5649_013_0	6	1			06/03/2019	2020.01	06/03/2019 02:45:28 PM Eastern Daylight Time	08/01/2019 04:18:14 PM Eastern Daylight Time	08/01/2019 02:43:14 PM Eastern Daylight Time			08/05/2019 03:59:59 PM Eastern Daylight Time	"CENTRAL HEALTH PLAN OF CALIFORNIA, INC."	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Inspire (HMO)	1	1		1			H5649	13	0	2020	Counties: San Joaquin		2	21503	2			2						www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/PartD/Formulary	www.centralhealthplan.com/NetworkProviders/Directory.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	2			
H5649	14	0	1	1	1	H5649_014_0	6	1	2	1	06/03/2019	2020.01	06/03/2019 02:46:08 PM Eastern Daylight Time	08/01/2019 04:19:48 PM Eastern Daylight Time	08/01/2019 02:44:11 PM Eastern Daylight Time			08/05/2019 03:59:59 PM Eastern Daylight Time	"CENTRAL HEALTH PLAN OF CALIFORNIA, INC."	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Elite (HMO D-SNP)	1	1		1			H5649	14	0	2020	Counties: San Joaquin		2	945	2			1	3		1		2	www.centralhealthplan.com/Benefits/PharmacyList.aspx	www.centralhealthplan.com/PartD/Formulary	www.centralhealthplan.com/NetworkProviders/Directory.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	2			
H5652	1	0	1	2	1	H5652_001_0	3	1			08/02/2019	2020.01	08/02/2019 09:57:44 AM Central Daylight Time	08/02/2019 11:00:08 AM Central Daylight Time	07/30/2019 09:51:43 PM Central Daylight Time			08/06/2019 01:43:00 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Signature with Drugs (HMO-POS)	1	2		1			H5652	1	0	2020	"Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC"		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	2			
H5652	2	0	1	1	1	H5652_002_0	2	1			07/11/2019	2020.01	07/11/2019 03:10:42 PM Central Daylight Time	05/31/2019 11:44:32 AM Central Daylight Time				07/12/2019 12:51:19 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Liberty without Drugs (HMO)	1	1		1			H5652	2	0	2020	"Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC"		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	2			
H5652	3	0	1	2	1	H5652_003_0	2	1		1	08/06/2019	2020.01	08/06/2019 10:19:21 AM Central Daylight Time	08/02/2019 11:00:53 AM Central Daylight Time	07/30/2019 09:52:15 PM Central Daylight Time			08/06/2019 01:43:00 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Guardian (HMO-POS I-SNP)	1	2		1			H5652	3	0	2020	"Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC"		2		2			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	2			
H5652	4	0	1	2	1	H5652_004_0	3	1		1	08/06/2019	2020.01	08/06/2019 10:20:01 AM Central Daylight Time	08/02/2019 11:01:15 AM Central Daylight Time	07/30/2019 09:52:47 PM Central Daylight Time			08/06/2019 01:43:00 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Champion (HMO-POS C-SNP)	1	2		1			H5652	4	0	2020	"Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC"		2		2			1	4			1.101E+16		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	2			
H5652	6	0	1	2	1	H5652_006_0	2	1			08/02/2019	2020.01	08/02/2019 10:00:07 AM Central Daylight Time	08/02/2019 11:01:37 AM Central Daylight Time	07/30/2019 09:53:22 PM Central Daylight Time			08/06/2019 01:43:00 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Freedom (HMO-POS)	1	2		1			H5652	6	0	2020	"Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC"		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	2			
H5652	8	0	1	1	1	H5652_008_0	3	1			08/02/2019	2020.01	08/02/2019 10:01:02 AM Central Daylight Time	08/02/2019 11:01:59 AM Central Daylight Time	07/30/2019 09:53:55 PM Central Daylight Time			08/06/2019 01:43:00 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Liberty with Drugs (HMO)	1	1		1			H5652	8	0	2020	CO/KS/MD/MA/MI/NJ/NC/PA/TX/VA		2		1	1		2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	2			
H5656	1	0	1	1	1	H5656_001_0	6	1			07/16/2019	2020.01	07/16/2019 01:33:20 PM Eastern Daylight Time	08/02/2019 08:13:51 AM Eastern Daylight Time	07/30/2019 11:05:45 PM Eastern Daylight Time			08/05/2019 04:03:16 PM Eastern Daylight Time	"SELECTCARE HEALTH PLANS, INC."	WellCare	www.wellcare.com/medicare	WellCare TexanPlus Classic (HMO)	1	1		1			H5656	1	0	2020	Select counties in TX		2	28896	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5656	801	0	1	1	1	H5656_801_0	3	1			05/24/2019	2020.01	05/24/2019 11:05:33 AM Eastern Daylight Time					05/31/2019 09:08:01 PM Eastern Daylight Time	"SELECTCARE HEALTH PLANS, INC."	WellCare	www.wellcare.com/medicare	Retiree - MA-PD CY (HMO)	1	1		1			H5656	801	0	2020	Employer Group--North Texas (MAPD--CY)		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5656	802	0	1	1	1	H5656_802_0	3	1			05/24/2019	2020.01	05/24/2019 11:06:53 AM Eastern Daylight Time					05/31/2019 09:08:01 PM Eastern Daylight Time	"SELECTCARE HEALTH PLANS, INC."	WellCare	www.wellcare.com/medicare	Retiree - MA-PD non-CY (HMO)	1	1		1			H5656	802	0	2020	Employer Group--North Texas (MAPD--non-CY)		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5656	803	0	1	1	1	H5656_803_0	3	1			05/24/2019	2020.01	05/24/2019 11:08:16 AM Eastern Daylight Time					05/31/2019 09:08:01 PM Eastern Daylight Time	"SELECTCARE HEALTH PLANS, INC."	WellCare	www.wellcare.com/medicare	Retiree - MA (HMO)	1	1		1			H5656	803	0	2020	Employer Group--North Texas (MA--CY)		1	300	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H5703	1	0	1	1	1	H5703_001_0	5	1	2	1	05/29/2019	2020.01	05/29/2019 01:55:06 PM Central Daylight Time	07/31/2019 11:17:35 AM Central Daylight Time	07/31/2019 11:23:48 AM Central Daylight Time			07/31/2019 11:28:27 AM Central Daylight Time	SOUTH COUNTRY HEALTH ALLIANCE	South Country Health Alliance	www.mnscha.org	AbilityCare (HMO D-SNP)	1	1		1			H5703	1	0	2020	Select Counties in Minnesota		2	5797	1	1		1	3		1		1	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	2			
H5742	1	0	1	1	1	H5742_001_0	5	1	2	1	08/06/2019	2020.01	08/06/2019 04:46:41 PM Central Daylight Time	08/05/2019 02:58:28 PM Central Daylight Time	07/31/2019 12:04:06 PM Central Daylight Time			08/06/2019 05:10:23 PM Central Daylight Time	"SHA, LLC"	FirstCare Advantage	www.firstcare.com/dualsnp	FirstCare Advantage Dual SNP (HMO D-SNP)	1	1		1			H5742	1	0	2020	FirstCare Advantage Dual SNP		2		1	1		1	3		1		1	www.firstcare.com/dualsnp	www.firstcare.com/dualsnp	www.firstcare.com/dualsnp	(866)229-4969		(806)784-4300		(866)229-4969		(806)784-4300		(866)229-4969		(806)784-4300		(866)229-4969		(806)784-4300		(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	2			
H5746	16	0	1	1	1	H5746_016_0	10	1			06/25/2019	2020.01	06/25/2019 04:45:54 PM Pacific Daylight Time	08/05/2019 07:07:30 AM Pacific Daylight Time	07/30/2019 04:43:03 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC."	Amerigroup Community Care of New Mexico	https://shop.amerigroup.com/medicare/	Amerivantage Care Access (HMO)	1	1		1			H5746	16	0	2020	Greater Albuquerque Area		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(866)805-4589		(866)805-4589		(844)726-6749		(844)726-6749		(866)805-4589		(866)805-4589		(844)726-6750		(844)726-6750		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5746	18	0	1	1	1	H5746_018_0	10	1			06/25/2019	2020.01	06/25/2019 04:46:23 PM Pacific Daylight Time	08/05/2019 07:07:31 AM Pacific Daylight Time	07/30/2019 04:43:45 PM Pacific Daylight Time			08/05/2019 02:32:08 PM Pacific Daylight Time	"AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC."	Amerigroup Community Care of New Mexico	https://shop.amerigroup.com/medicare/	Amerivantage Plus (HMO)	1	1		1			H5746	18	0	2020	Greater Albuquerque area		2		2			2						www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	https://shop.amerigroup.com/medicare/	(866)805-4589		(866)805-4589		(844)726-6749		(844)726-6749		(866)805-4589		(866)805-4589		(844)726-6750		(844)726-6750		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5774	3	0	1	1	1	H5774_003_0	3	1			06/03/2019	2020.01	06/03/2019 04:13:11 PM SA Western Standard Time	06/03/2019 08:10:25 PM SA Western Standard Time				06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Basic (HMO)	1	1		1			H5774	3	0	2020	Puerto Rico		2	4200	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										2					2					2	1	11	7d;7f;7g;8a1;8a2;8b1;18a;	7f;18a1;18a2;
H5774	5	0	1	1	1	H5774_005_0	4	1			06/03/2019	2020.01	06/03/2019 04:15:15 PM SA Western Standard Time	08/01/2019 06:24:58 PM SA Western Standard Time	08/05/2019 10:09:11 AM SA Western Standard Time			08/05/2019 06:25:09 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Royal (HMO)	1	1		1			H5774	5	0	2020	Puerto Rico		2	78000	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(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	1	11	7d;7f;7g;8a1;8a2;8b1;	7f;
H5774	22	0	1	1	1	H5774_022_0	5	1		1	07/16/2019	2020.01	07/16/2019 08:53:57 AM SA Western Standard Time	08/01/2019 06:25:52 PM SA Western Standard Time	08/05/2019 10:09:40 AM SA Western Standard Time			08/05/2019 06:25:09 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Contigo Plus (HMO C-SNP)	1	1		1			H5774	22	0	2020	Puerto Rico		2	30000	2			1	4			10		www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(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	1	11	7d;7f;7g;8a1;8a2;8b1;18a;	7f;18a1;18a2;
H5774	23	0	1	2	1	H5774_023_0	4	1			06/03/2019	2020.01	06/03/2019 04:20:24 PM SA Western Standard Time	08/01/2019 06:26:46 PM SA Western Standard Time	08/05/2019 10:10:09 AM SA Western Standard Time			08/05/2019 06:25:09 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Royal Plus (HMO-POS)	1	2		1			H5774	23	0	2020	Puerto Rico		2	11400	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(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	1	11	7d;7f;7g;8a1;8a2;8b1;	7f;
H5774	24	0	1	1	1	H5774_024_0	5	1	1	1	06/03/2019	2020.01	06/03/2019 04:21:54 PM SA Western Standard Time	08/01/2019 06:27:39 PM SA Western Standard Time	08/05/2019 10:10:44 AM SA Western Standard Time			08/05/2019 06:25:09 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Platino Plus (HMO D-SNP)	1	1		1			H5774	24	0	2020	Puerto Rico		2	324000	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(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	2			
H5774	25	0	1	1	1	H5774_025_0	5	1	1	1	06/03/2019	2020.01	06/03/2019 04:24:18 PM SA Western Standard Time	08/01/2019 06:28:33 PM SA Western Standard Time	08/05/2019 10:11:13 AM SA Western Standard Time			08/05/2019 06:25:09 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Platino Ultra (HMO D-SNP)	1	1		1			H5774	25	0	2020	Puerto Rico		2	162000	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(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	2			
H5774	26	0	1	1	1	H5774_026_0	9	1	1	1	07/05/2019	2020.01	07/05/2019 11:02:27 AM SA Western Standard Time	08/01/2019 06:29:27 PM SA Western Standard Time	08/05/2019 10:11:42 AM SA Western Standard Time			08/05/2019 06:25:09 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Platino Advance (HMO D-SNP)	1	1		1			H5774	26	0	2020	Puerto Rico		2	13200	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(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	1	1	7f;	
H5774	27	0	1	2	1	H5774_027_0	4	1			06/03/2019	2020.01	06/03/2019 04:27:19 PM SA Western Standard Time	08/01/2019 06:30:21 PM SA Western Standard Time	08/05/2019 10:12:12 AM SA Western Standard Time			08/05/2019 06:25:09 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Magno (HMO-POS)	1	2		1			H5774	27	0	2020	Puerto Rico		2	318000	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(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	1	1	7d;7g;8b1;	
H5774	28	0	1	1	1	H5774_028_0	5	1	1	1	06/03/2019	2020.01	06/03/2019 04:28:27 PM SA Western Standard Time	08/01/2019 06:31:16 PM SA Western Standard Time	08/05/2019 10:12:41 AM SA Western Standard Time			08/05/2019 06:25:09 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Platino Blindao (HMO D-SNP)	1	1		1			H5774	28	0	2020	Puerto Rico		2	120348	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(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	2			
H5774	31	0	1	2	1	H5774_031_0	4	1			06/03/2019	2020.01	06/03/2019 04:29:22 PM SA Western Standard Time	08/01/2019 06:32:10 PM SA Western Standard Time	08/05/2019 10:13:10 AM SA Western Standard Time			08/05/2019 06:25:09 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Brillante (HMO-POS)	1	2		1			H5774	31	0	2020	Puerto Rico		2	84000	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(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	1	1	7d;7g;8b1;	
H5774	32	0	1	1	1	H5774_032_0	6	1	1	1	07/15/2019	2020.01	07/15/2019 04:05:47 PM SA Western Standard Time	08/01/2019 06:33:05 PM SA Western Standard Time	08/05/2019 10:13:40 AM SA Western Standard Time			08/05/2019 06:25:09 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Platino Enlace (HMO D-SNP)	1	1		1			H5774	32	0	2020	Puerto Rico		2	8400	2		1	1	3		2		2	www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(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	2			
H5774	33	0	1	1	1	H5774_033_0	5	1			07/15/2019	2020.01	07/15/2019 03:50:12 PM SA Western Standard Time	08/01/2019 06:34:00 PM SA Western Standard Time	08/05/2019 10:14:09 AM SA Western Standard Time			08/05/2019 06:25:09 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Enlace (HMO)	1	1		1			H5774	33	0	2020	Puerto Rico		2	700	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(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	1	11	7d;7f;7g;8a1;8a2;8b1;	7f;
H5774	802	0	1	1	1	H5774_802_0	3	1			06/03/2019	2020.01	06/03/2019 04:32:53 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Royal A (HMO)	1	1		1			H5774	802	0	2020	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1					2				
H5774	806	0	1	1	1	H5774_806_0	3	1			06/03/2019	2020.01	06/03/2019 04:33:59 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Royal B (HMO)	1	1		1			H5774	806	0	2020	Puerto Rico		1	10	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1					2				
H5774	808	0	1	1	1	H5774_808_0	3	1			06/03/2019	2020.01	06/03/2019 04:34:43 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Royal C (HMO)	1	1		1			H5774	808	0	2020	Puerto Rico		1	10956	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1					2				
H5774	809	0	1	2	1	H5774_809_0	3	1			06/03/2019	2020.01	06/03/2019 04:40:40 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Royal D (HMO-POS)	1	2		1			H5774	809	0	2020	Puerto Rico		1	384931	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		2				
H5774	810	0	1	1	1	H5774_810_0	3	1			06/03/2019	2020.01	06/03/2019 04:41:40 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Royal E (HMO)	1	1		1			H5774	810	0	2020	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1					2				
H5774	811	0	1	2	1	H5774_811_0	3	1			06/03/2019	2020.01	06/03/2019 04:42:33 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Royal Plus A (HMO-POS)	1	2		1			H5774	811	0	2020	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		2				
H5774	812	0	1	2	1	H5774_812_0	3	1			06/03/2019	2020.01	06/03/2019 04:43:51 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Employer BD 1 (HMO-POS)	1	2		1			H5774	812	0	2020	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		2				
H5774	814	0	1	2	1	H5774_814_0	3	1			06/03/2019	2020.01	06/03/2019 04:45:20 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Employer BD 3 (HMO-POS)	1	2		1			H5774	814	0	2020	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		2				
H5774	816	0	1	2	1	H5774_816_0	3	1			06/03/2019	2020.01	06/03/2019 04:46:19 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Employer BD 5 (HMO-POS)	1	2		1			H5774	816	0	2020	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		2				
H5774	818	0	1	2	1	H5774_818_0	3	1			06/03/2019	2020.01	06/03/2019 04:48:07 PM SA Western Standard Time					06/03/2019 08:59:46 PM SA Western Standard Time	"TRIPLE S ADVANTAGE, INC."	Triple S Advantage	www.sssadvantage.com	Employer BD 7 (HMO-POS)	1	2		1			H5774	818	0	2020	Puerto Rico		1	120	2			2						www.sssadvantage.com	www.sssadvantage.com	www.sssadvantage.com	(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(888)620-1919		(888)620-1919		(877)207-8777		(877)207-8777		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		1	1	2;3-1;3-2;3-3;5;6;7c;7d;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;10a;11a;11b;15;16b;	2		2				
H5779	2	0	1	1	1	H5779_002_0	6	1			05/30/2019	2020.01	05/30/2019 03:28:48 PM Eastern Daylight Time	08/02/2019 08:15:28 AM Eastern Daylight Time	07/30/2019 11:06:21 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF ILLINOIS, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO)	1	1		1			H5779	2	0	2020	Select counties in IL		2	19807	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5779	5	0	1	1	1	H5779_005_0	6	1			05/30/2019	2020.01	05/30/2019 03:29:12 PM Eastern Daylight Time	08/02/2019 08:17:04 AM Eastern Daylight Time	07/30/2019 11:06:57 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF ILLINOIS, INC."	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO)	1	1		1			H5779	5	0	2020	Select counties in IL		2	11161	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5779	6	0	1	1	1	H5779_006_0	7	1			07/12/2019	2020.01	07/12/2019 04:17:53 PM Eastern Daylight Time	08/02/2019 08:18:43 AM Eastern Daylight Time	07/30/2019 11:07:33 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF ILLINOIS, INC."	WellCare	www.wellcare.com/medicare	WellCare Edge (HMO)	1	1		1			H5779	6	0	2020	Select counties in IL		2	13240	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	2			
H5779	7	0	1	1	1	H5779_007_0	7	1			07/12/2019	2020.01	07/12/2019 04:20:31 PM Eastern Daylight Time	08/02/2019 08:20:18 AM Eastern Daylight Time	07/30/2019 11:08:09 PM Eastern Daylight Time			08/05/2019 03:25:27 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF ILLINOIS, INC."	WellCare	www.wellcare.com/medicare	WellCare Exclusive (HMO)	1	1		1			H5779	7	0	2020	Select counties in IL		2	5267	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(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	1	1	7a;	
H5793	1	0	1	1	1	H5793_001_0	5	1			07/03/2019	2020.01	07/03/2019 05:29:30 PM Eastern Daylight Time	08/02/2019 10:09:39 AM Eastern Daylight Time	07/31/2019 04:29:59 AM Eastern Daylight Time			08/02/2019 07:36:58 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	1	1		1			H5793	1	0	2020	Connecticut		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	10	0	1	1	1	H5793_010_0	4	1			08/01/2019	2020.01	08/01/2019 03:14:11 PM Eastern Daylight Time	08/02/2019 10:12:08 AM Eastern Daylight Time	07/31/2019 04:31:10 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	1	1		1			H5793	10	0	2020	Connecticut		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	12	0	1	1	1	H5793_012_0	4	1			08/01/2019	2020.01	08/01/2019 03:14:32 PM Eastern Daylight Time	08/02/2019 10:13:46 AM Eastern Daylight Time	07/31/2019 04:32:21 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime PCP Elite Plan (HMO)	1	1		1			H5793	12	0	2020	Connecticut		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5793	801	0	1	1	1	H5793_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:55:05 AM Eastern Daylight Time					05/30/2019 07:03:51 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H5793	801	0	2020	Connecticut		1	190	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5793	802	0	1	1	1	H5793_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:55:14 AM Eastern Daylight Time					05/30/2019 07:03:51 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H5793	802	0	2020	Connecticut		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5793	804	0	1	1	1	H5793_804_0	1	1			05/24/2019	2020.01	05/24/2019 09:55:26 AM Eastern Daylight Time					05/30/2019 07:03:51 PM Eastern Daylight Time	AETNA HEALTH INC. (CT)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H5793	804	0	2020	Connecticut		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H5810	1	0	1	1	1	H5810_001_0	6	1	2	1	08/02/2019	2020.01	08/02/2019 05:23:29 PM Pacific Daylight Time	08/05/2019 09:53:12 AM Pacific Daylight Time	07/31/2019 11:26:46 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	1	1		1			H5810	1	0	2020	"Counties: LA, SD, parts of Riv. and S. Bernardino"		2		2			1	3		1		1	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	2			
H5810	13	0	1	1	1	H5810_013_0	8	1	2	1	06/01/2019	2020.01	06/01/2019 11:53:36 AM Pacific Daylight Time	08/05/2019 09:55:18 AM Pacific Daylight Time	07/31/2019 11:28:26 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	1	1		1			H5810	13	0	2020	Imperial County		2		2			1	3		1		1	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	2			
H5822	1	0	1	20	8	H5822_001_0	1	1			05/30/2019	2020.01	05/30/2019 12:17:02 PM Central Daylight Time		05/30/2019 12:06:20 PM Central Daylight Time			05/30/2019 12:27:17 PM Central Daylight Time	MIDLAND CARE CONNECTION	Midland Care PACE	www.midlandcc.org	Midland Care Connection - Dual Eligibles (PACE)	8	20		1			H5822	1	0	2020	"DG,JA,JF,LY,LV,MS,NM,OS,PT,SN,WB,WY counties"		2		1	1		2						N/A	N/A										(800)726-7450		(785)232-2044		(800)726-7450		(785)232-2044										(711)-		(711)-		(711)-		(711)-																
H5822	2	0	1	20	8	H5822_002_0	2	1			05/30/2019	2020.01	05/30/2019 12:24:28 PM Central Daylight Time		05/30/2019 12:06:20 PM Central Daylight Time			05/30/2019 02:37:31 PM Central Daylight Time	MIDLAND CARE CONNECTION	Midland Care PACE	www.midlandcc.org	Midland Care Connection - Medicare Only (PACE)	8	20		1			H5822	2	0	2020	"DG,JA,JF,LY,LV,MS,NM,OS,PT,SN,WB,WYcounties"		2		1	1		2						N/A	N/A										(800)491-3691		(785)232-2044		(800)491-3691		(785)232-2044										(711)-		(711)-		(711)-		(711)-																
H5823	6	0	1	1	1	H5823_006_0	7	1	2	1	05/30/2019	2020.01	05/30/2019 11:41:48 PM Pacific Daylight Time	08/05/2019 09:58:28 AM Pacific Daylight Time	07/31/2019 11:30:22 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF WASHINGTON, INC."	"Molina Healthcare of Washington, Inc."	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	1	1		1			H5823	6	0	2020	Select Counties in Washington		2		2			1	3		2		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	2			
H5826	6	0	1	1	1	H5826_006_0	5	1			07/17/2019	2020.01	07/17/2019 02:03:47 PM Pacific Daylight Time	06/01/2019 04:35:55 PM Pacific Daylight Time				07/17/2019 03:22:06 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Plan (HMO)	1	1		1			H5826	6	0	2020	Western Washington and Spokane Counties		2	1187	2			2						www.healthfirst.chpw.org	www.healthfirst.chpw.org	http://healthfirst.chpw.org/	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5826	8	0	1	1	1	H5826_008_0	7	1			07/17/2019	2020.01	07/17/2019 02:03:26 PM Pacific Daylight Time	08/06/2019 10:00:50 AM Pacific Daylight Time	07/30/2019 03:12:55 PM Pacific Daylight Time			08/06/2019 10:41:01 AM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Pharmacy Plan (HMO)	1	1		1			H5826	8	0	2020	Western Washington and Spokane Counties		2	16672	2			2						http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	http://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	2			
H5826	9	0	1	1	1	H5826_009_0	7	1			07/17/2019	2020.01	07/17/2019 02:03:05 PM Pacific Daylight Time	08/06/2019 10:05:10 AM Pacific Daylight Time	08/01/2019 04:18:35 PM Pacific Daylight Time			08/06/2019 10:41:01 AM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Pharmacy Plan (HMO)	1	1		1			H5826	9	0	2020	Eastern and Western Washington State		2	9504	2			2						http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	http://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	2			
H5826	10	0	1	1	1	H5826_010_0	7	1			07/17/2019	2020.01	07/17/2019 02:02:47 PM Pacific Daylight Time	08/06/2019 10:02:39 AM Pacific Daylight Time	07/30/2019 03:15:01 PM Pacific Daylight Time			08/06/2019 10:41:01 AM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Extra Plan (HMO)	1	1		1			H5826	10	0	2020	Eastern and Western Washington State		2	29944	2			2						http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	http://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	2			
H5826	14	0	1	1	1	H5826_014_0	6	1	2	1	08/02/2019	2020.01	08/02/2019 10:50:49 AM Pacific Daylight Time	08/06/2019 10:03:27 AM Pacific Daylight Time	07/30/2019 03:16:13 PM Pacific Daylight Time			08/06/2019 10:41:01 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 D-SNP)	1	1		1			H5826	14	0	2020	Eastern and Western Washington State		2	47142	2			1	3		1		1	http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	http://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	2			
H5826	16	0	1	1	1	H5826_016_0	8	1			07/17/2019	2020.01	07/17/2019 02:04:09 PM Pacific Daylight Time	08/06/2019 10:04:08 AM Pacific Daylight Time	08/01/2019 03:08:14 PM Pacific Daylight Time			08/06/2019 10:41:01 AM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Value Plan (HMO) (HMO)	1	1		1			H5826	16	0	2020	Western Washington		2	6116	2			2						http://healthfirst.chpw.org/	http://healthfirst.chpw.org/	http://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	2			
H5841	1	0	1	4	1	H5841_001_0	6	1			07/16/2019	2020.01	07/16/2019 12:32:02 PM Central Daylight Time	08/02/2019 04:28:15 PM Central Daylight Time	08/02/2019 04:46:59 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex (PPO)	1	4		1			H5841	1	0	2020	Greater Denver Area		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5841	2	0	1	4	1	H5841_002_0	7	1			07/16/2019	2020.01	07/16/2019 12:34:06 PM Central Daylight Time	08/02/2019 04:28:08 PM Central Daylight Time	08/02/2019 04:46:25 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex Plus (PPO)	1	4		1			H5841	2	0	2020	Greater Denver Area		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5841	3	0	1	4	1	H5841_003_0	6	1			07/16/2019	2020.01	07/16/2019 01:52:12 PM Central Daylight Time	08/02/2019 04:28:02 PM Central Daylight Time	08/02/2019 04:45:51 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex (PPO)	1	4		1			H5841	3	0	2020	Maricopa County		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5841	4	0	1	4	1	H5841_004_0	6	1			07/16/2019	2020.01	07/16/2019 01:31:48 PM Central Daylight Time	08/02/2019 04:26:49 PM Central Daylight Time	08/02/2019 04:44:54 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex Plus (PPO)	1	4		1			H5841	4	0	2020	Maricopa County		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5841	5	0	1	4	1	H5841_005_0	6	1			07/16/2019	2020.01	07/16/2019 12:36:42 PM Central Daylight Time	08/02/2019 04:26:25 PM Central Daylight Time	08/02/2019 04:44:44 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex (PPO)	1	4		1			H5841	5	0	2020	"Dodge, Douglas, and Sarpy Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-7728		(844)221-7728		(833)412-6737		(833)412-6737		(844)221-7728		(844)221-7728		(833)412-6737		(833)412-6737		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5841	7	0	1	4	1	H5841_007_0	6	1			07/16/2019	2020.01	07/16/2019 01:51:33 PM Central Daylight Time	08/02/2019 04:26:20 PM Central Daylight Time	08/02/2019 04:44:09 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Access (PPO)	1	4		1			H5841	7	0	2020	Greater Denver Area		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5841	8	0	1	4	1	H5841_008_0	6	1			07/16/2019	2020.01	07/16/2019 01:53:59 PM Central Daylight Time	08/02/2019 04:26:15 PM Central Daylight Time	08/02/2019 04:43:24 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Access (PPO)	1	4		1			H5841	8	0	2020	Maricopa County		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(844)202-4463		(844)202-4463		(844)679-2028		(844)679-2028		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5852	1	0	1	1	1	H5852_001_0	4	1		1	06/27/2019	2020.01	06/27/2019 09:19:54 AM Pacific Daylight Time	08/02/2019 03:07:48 PM Pacific Daylight Time	08/02/2019 03:07:48 PM Pacific Daylight Time			08/02/2019 03:09:46 PM Pacific Daylight Time	AIDS HEALTHCARE FOUNDATION	AHF	www.php-ca.org	PHP (HMO C-SNP)	1	1		1			H5852	1	0	2020	"Los Angeles County, California"		2		2			1	4			1000000000		www.php-ca.org/provider-find	www.php-ca.org/for-members/drug-benefit/formulary	www.php-ca.org/provider-find	(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	2			
H5854	7	0	1	1	1	H5854_007_0	9	1			08/05/2019	2020.01	08/05/2019 02:42:22 PM Pacific Daylight Time	08/05/2019 07:07:31 AM Pacific Daylight Time	07/30/2019 04:44:26 PM Pacific Daylight Time			08/05/2019 02:42:52 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Plus (HMO)	1	1		1			H5854	7	0	2020	Hartford County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(844)364-2128		(844)364-2128		(866)673-4157		(866)673-4157		(844)364-2123		(844)364-2123		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	8	0	1	1	1	H5854_008_0	7	1	2	1	07/25/2019	2020.01	07/25/2019 11:23:16 AM Pacific Daylight Time	08/05/2019 07:07:32 AM Pacific Daylight Time	07/30/2019 04:45:07 PM Pacific Daylight Time			08/05/2019 02:28:05 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H5854	8	0	2020	State of Connecticut		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)533-2091		(844)533-2091		(844)834-6071		(844)834-6071		(844)533-2091		(844)533-2091		(844)834-6072		(844)834-6072		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	9	0	1	1	1	H5854_009_0	8	1			07/25/2019	2020.01	07/25/2019 11:23:22 AM Pacific Daylight Time	08/05/2019 07:07:32 AM Pacific Daylight Time	07/30/2019 04:45:46 PM Pacific Daylight Time			08/05/2019 02:28:05 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Plus (HMO)	1	1		1			H5854	9	0	2020	Select Counties in Connecticut		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(844)364-2128		(844)364-2128		(866)673-4157		(866)673-4157		(844)364-2123		(844)364-2123		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	10	0	1	1	1	H5854_010_0	8	1			08/01/2019	2020.01	08/01/2019 03:45:01 PM Pacific Daylight Time	08/05/2019 07:07:32 AM Pacific Daylight Time	07/30/2019 04:46:23 PM Pacific Daylight Time			08/05/2019 02:28:05 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Select (HMO)	1	1		1			H5854	10	0	2020	Select Counties in Connecticut		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(844)364-2128		(844)364-2128		(866)673-4157		(866)673-4157		(844)364-2123		(844)364-2123		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	11	0	1	1	1	H5854_011_0	8	1			07/25/2019	2020.01	07/25/2019 11:23:03 AM Pacific Daylight Time	08/05/2019 07:07:33 AM Pacific Daylight Time	07/30/2019 04:47:01 PM Pacific Daylight Time			08/05/2019 02:28:05 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Extra (HMO)	1	1		1			H5854	11	0	2020	State of Connecticut		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)469-6744		(844)469-6744		(844)364-2128		(844)364-2128		(844)469-6744		(844)469-6744		(844)364-2123		(844)364-2123		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	12	0	1	2	1	H5854_012_0	9	1		1	07/25/2019	2020.01	07/25/2019 11:23:28 AM Pacific Daylight Time		07/30/2019 04:47:38 PM Pacific Daylight Time		08/05/2019 07:07:33 AM Pacific Daylight Time	08/05/2019 02:28:05 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue ESRD (HMO-POS C-SNP)	1	2		1			H5854	12	0	2020	Select Counties in Connecticut		2		2			1	4			1E+11		https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)469-6821		(844)469-6821		(844)364-2128		(844)364-2128		(844)469-6821		(844)469-6821		(844)364-2123		(844)364-2123		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	13	0	1	1	1	H5854_013_0	9	1	2	1	07/25/2019	2020.01	07/25/2019 11:22:59 AM Pacific Daylight Time	08/05/2019 07:07:33 AM Pacific Daylight Time	07/30/2019 04:48:16 PM Pacific Daylight Time			08/05/2019 02:28:05 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Dual Advantage Select (HMO D-SNP)	1	1		1			H5854	13	0	2020	State of Connecticut		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(844)533-2091		(844)533-2091		(844)834-6071		(844)834-6071		(844)533-2091		(844)533-2091		(844)834-6072		(844)834-6072		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	14	0	1	1	1	H5854_014_0	12	1		1	07/25/2019	2020.01	07/25/2019 11:17:42 AM Pacific Daylight Time	08/05/2019 07:07:34 AM Pacific Daylight Time	07/30/2019 04:48:54 PM Pacific Daylight Time			08/05/2019 02:28:05 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Care on Site (HMO I-SNP)	1	1		1			H5854	14	0	2020	Select Counties in CT		2		2			1	1	3				https://shop.anthem.com/medicare	https://shop.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	2			
H5854	15	0	1	1	1	H5854_015_0	9	1			08/01/2019	2020.01	08/01/2019 05:52:58 AM Eastern Daylight Time	08/05/2019 10:07:34 AM Eastern Daylight Time	07/30/2019 07:49:31 PM Eastern Daylight Time			08/05/2019 04:07:36 PM Eastern Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Prime (HMO)	1	1		1			H5854	15	0	2020	New Haven		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(844)364-2128		(844)364-2128		(866)673-4157		(866)673-4157		(844)364-2123		(844)364-2123		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5854	801	0	1	1	1	H5854_801_0	3	1			05/22/2019	2020.01	05/22/2019 01:44:26 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	1	1		1			H5854	801	0	2020	Connecticut - Select Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	803	0	1	1	1	H5854_803_0	3	1			05/22/2019	2020.01	05/22/2019 01:44:42 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	1	1		1			H5854	803	0	2020	Connecticut - Select Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	806	0	2	1	1	H5854_806_0	3	1			05/30/2019	2020.01	05/30/2019 07:27:31 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	1	1		2	1		H5854	806	0	2020	Conneticut - Select Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	807	0	2	1	1	H5854_807_0	3	1			05/30/2019	2020.01	05/30/2019 07:27:42 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	1	1		2	1		H5854	807	0	2020	Select Conneticut Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	808	0	1	1	1	H5854_808_0	3	1			05/22/2019	2020.01	05/22/2019 01:46:12 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	1	1		1			H5854	808	0	2020	Select Conneticut Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	809	0	1	1	1	H5854_809_0	3	1			05/22/2019	2020.01	05/22/2019 01:46:37 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	1	1		1			H5854	809	0	2020	Select Conneticut Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	810	0	2	1	1	H5854_810_0	3	1			05/30/2019	2020.01	05/30/2019 07:27:57 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	1	1		2	1		H5854	810	0	2020	Select Conneticut Counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5854	811	0	2	1	1	H5854_811_0	3	1			05/30/2019	2020.01	05/30/2019 07:28:04 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/ct/medicare	Anthem MediBlue (HMO)	1	1		2	1		H5854	811	0	2020	Select CT counties		1	600	2			2						www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	www.anthem.com/ct/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H5859	1	0	1	2	1	H5859_001_0	8	1	2	1	08/01/2019	2020.01	08/01/2019 04:23:42 PM Pacific Daylight Time	08/02/2019 10:09:02 AM Pacific Daylight Time	08/02/2019 10:08:30 AM Pacific Daylight Time			08/06/2019 08:48:14 AM Pacific Daylight Time	"HEALTH PLAN OF CAREOREGON, INC."	CareOregon Advantage	www.careoregonadvantage.org	CareOregon Advantage Plus (HMO-POS D-SNP)	1	2		1			H5859	1	0	2020	"Portland Metro Area, Jackson, Tillamook, Columbia"		2	136987	2			1	3		2		2	http://www.careoregonadvantage.org/member-resources/find-a-provider	http://www.careoregonadvantage.org/member-resources/rx-and-drug-information/are-my-drugs-covered-	http://www.careoregonadvantage.org/member-resources/find-a-provider	(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	2			
H5883	1	1	1	2	1	H5883_001_1	5	1			07/08/2019	2020.01	07/08/2019 08:52:33 AM Eastern Daylight Time	06/03/2019 09:16:31 PM Eastern Daylight Time				07/09/2019 12:53:03 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	1	2		1			H5883	1	1	2020	Michigan	Region 1	2	3899	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	1	2	1	2	1	H5883_001_2	5	1			07/08/2019	2020.01	07/08/2019 08:54:15 AM Eastern Daylight Time	06/03/2019 09:17:19 PM Eastern Daylight Time				07/09/2019 12:53:03 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	1	2		1			H5883	1	2	2020	Michigan	Region 2	2	1579	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	1	3	1	2	1	H5883_001_3	5	1			07/08/2019	2020.01	07/08/2019 08:54:22 AM Eastern Daylight Time	06/03/2019 09:18:09 PM Eastern Daylight Time				07/09/2019 12:53:03 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	1	2		1			H5883	1	3	2020	Michigan	Region 3	2	723	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	1	4	1	2	1	H5883_001_4	5	1			07/08/2019	2020.01	07/08/2019 08:54:31 AM Eastern Daylight Time	06/03/2019 09:18:57 PM Eastern Daylight Time				07/09/2019 12:53:03 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	1	2		1			H5883	1	4	2020	Michigan	Region 4	2	2645	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	1	5	1	2	1	H5883_001_5	5	1			07/08/2019	2020.01	07/08/2019 08:54:39 AM Eastern Daylight Time	06/03/2019 09:19:46 PM Eastern Daylight Time				07/09/2019 12:53:03 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Elements (HMO-POS)	1	2		1			H5883	1	5	2020	Michigan	Region 5	2	3496	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5883	2	1	1	2	1	H5883_002_1	9	1			07/08/2019	2020.01	07/08/2019 07:37:03 AM Eastern Daylight Time	08/05/2019 08:11:32 AM Eastern Daylight Time	08/01/2019 11:12:08 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Classic (HMO-POS)	1	2		1			H5883	2	1	2020	Michigan	Region 1	2	50922	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	2	2	1	2	1	H5883_002_2	9	1			07/08/2019	2020.01	07/08/2019 08:18:36 AM Eastern Daylight Time	08/05/2019 08:12:31 AM Eastern Daylight Time	08/01/2019 11:12:37 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Classic (HMO-POS)	1	2		1			H5883	2	2	2020	Michigan	Region 2	2	29441	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	2	3	1	2	1	H5883_002_3	9	1			07/08/2019	2020.01	07/08/2019 08:18:51 AM Eastern Daylight Time	08/05/2019 08:13:30 AM Eastern Daylight Time	08/01/2019 11:13:05 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Classic (HMO-POS)	1	2		1			H5883	2	3	2020	Michigan	Region 3	2	16468	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	2	4	1	2	1	H5883_002_4	9	1			07/08/2019	2020.01	07/08/2019 10:11:56 AM Eastern Daylight Time	08/05/2019 08:14:29 AM Eastern Daylight Time	08/01/2019 11:13:34 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Classic (HMO-POS)	1	2		1			H5883	2	4	2020	Michigan	Region 4	2	44267	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	2	7	1	2	1	H5883_002_7	9	1			07/08/2019	2020.01	07/08/2019 10:12:05 AM Eastern Daylight Time	08/05/2019 08:15:25 AM Eastern Daylight Time	08/01/2019 11:14:02 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Classic (HMO-POS)	1	2		1			H5883	2	7	2020	Michigan	Region 5	2	78876	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	3	1	1	2	1	H5883_003_1	7	1			08/05/2019	2020.01	08/05/2019 05:10:23 PM Eastern Daylight Time	08/05/2019 08:16:21 AM Eastern Daylight Time	08/01/2019 11:14:31 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prestige (HMO-POS)	1	2		1			H5883	3	1	2020	Michigan	Region 1	2	2998	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	3	2	1	2	1	H5883_003_2	7	1			07/08/2019	2020.01	07/08/2019 02:30:16 PM Eastern Daylight Time	08/05/2019 08:17:18 AM Eastern Daylight Time	08/01/2019 11:15:00 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prestige (HMO-POS)	1	2		1			H5883	3	2	2020	Michigan	Region 2	2	2070	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	3	3	1	2	1	H5883_003_3	7	1			07/08/2019	2020.01	07/08/2019 02:30:35 PM Eastern Daylight Time	08/05/2019 08:18:15 AM Eastern Daylight Time	08/01/2019 11:15:28 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prestige (HMO-POS)	1	2		1			H5883	3	3	2020	Michigan	Region 3	2	730	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	3	4	1	2	1	H5883_003_4	7	1			07/08/2019	2020.01	07/08/2019 02:31:05 PM Eastern Daylight Time	08/05/2019 08:19:13 AM Eastern Daylight Time	08/01/2019 11:15:57 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prestige (HMO-POS)	1	2		1			H5883	3	4	2020	Michigan	Region 4	2	3140	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	3	5	1	2	1	H5883_003_5	7	1			07/08/2019	2020.01	07/08/2019 02:31:22 PM Eastern Daylight Time	08/05/2019 08:20:09 AM Eastern Daylight Time	08/01/2019 11:16:25 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Prestige (HMO-POS)	1	2		1			H5883	3	5	2020	Michigan	Region 5	2	11052	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	4	1	1	2	1	H5883_004_1	6	1			08/05/2019	2020.01	08/05/2019 05:12:21 PM Eastern Daylight Time	08/05/2019 08:21:06 AM Eastern Daylight Time	08/01/2019 11:16:54 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	1	2		1			H5883	4	1	2020	Michigan	Region 1	2	48758	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	4	2	1	2	1	H5883_004_2	6	1			08/05/2019	2020.01	08/05/2019 05:12:54 PM Eastern Daylight Time	08/05/2019 08:22:02 AM Eastern Daylight Time	08/01/2019 11:17:23 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	1	2		1			H5883	4	2	2020	Michigan	Region 2	2	49006	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	4	3	1	2	1	H5883_004_3	6	1			08/05/2019	2020.01	08/05/2019 05:13:12 PM Eastern Daylight Time	08/05/2019 08:23:01 AM Eastern Daylight Time	08/01/2019 11:17:51 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	1	2		1			H5883	4	3	2020	Michigan	Region 3	2	39279	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	4	4	1	2	1	H5883_004_4	6	1			08/05/2019	2020.01	08/05/2019 05:13:28 PM Eastern Daylight Time	08/05/2019 08:23:59 AM Eastern Daylight Time	08/01/2019 11:18:20 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	1	2		1			H5883	4	4	2020	Michigan	Region 4	2	66445	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	4	5	1	2	1	H5883_004_5	6	1			08/05/2019	2020.01	08/05/2019 05:14:19 PM Eastern Daylight Time	08/05/2019 08:24:55 AM Eastern Daylight Time	08/01/2019 11:18:48 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO-POS Basic (HMO-POS)	1	2		1			H5883	4	5	2020	Michigan	Region 5	2	127195	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	7	0	1	1	1	H5883_007_0	6	1			07/08/2019	2020.01	07/08/2019 03:18:21 PM Eastern Daylight Time	08/05/2019 08:25:52 AM Eastern Daylight Time	08/01/2019 11:19:17 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO ConnectedCare (HMO)	1	1		1			H5883	7	0	2020	"Kalamazoo, Metro Detroit Area and Bay Region"		2	53156	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	8	1	1	1	1	H5883_008_1	6	1			07/08/2019	2020.01	07/08/2019 03:18:52 PM Eastern Daylight Time	08/05/2019 08:26:47 AM Eastern Daylight Time	08/01/2019 11:19:47 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO MyChoice Wellness (HMO)	1	1		1			H5883	8	1	2020	West Michigan	Region 1	2	38334	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	8	2	1	1	1	H5883_008_2	6	1			07/08/2019	2020.01	07/08/2019 03:19:20 PM Eastern Daylight Time	08/05/2019 08:27:42 AM Eastern Daylight Time	08/01/2019 11:20:15 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO MyChoice Wellness (HMO)	1	1		1			H5883	8	2	2020	West Michigan	Region 2	2	14610	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	9	1	1	1	1	H5883_009_1	7	1			07/08/2019	2020.01	07/08/2019 03:20:06 PM Eastern Daylight Time	08/05/2019 01:22:37 PM Eastern Daylight Time	08/01/2019 11:20:44 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO HealthySaver (HMO)	1	1		1			H5883	9	1	2020	"West Michigan, Detroit Metro Area and Bay Region"	Region 1	2	11820	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	9	2	1	1	1	H5883_009_2	7	1			07/08/2019	2020.01	07/08/2019 03:23:53 PM Eastern Daylight Time	08/05/2019 01:23:35 PM Eastern Daylight Time	08/01/2019 11:21:12 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO HealthySaver (HMO)	1	1		1			H5883	9	2	2020	"West Michigan, Detroit Metro Area and Bay Region"	Region 2	2	5378	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	9	3	1	1	1	H5883_009_3	7	1			07/08/2019	2020.01	07/08/2019 03:24:04 PM Eastern Daylight Time	08/05/2019 01:24:35 PM Eastern Daylight Time	08/01/2019 11:21:41 AM Eastern Daylight Time			08/05/2019 06:06:38 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO HealthySaver (HMO)	1	1		1			H5883	9	3	2020	"West Michigan, Detroit Metro Area and Bay Region"	Region 3	2	36920	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	11	1	1	1	1	H5883_011_1	7	1			08/05/2019	2020.01	08/05/2019 05:17:56 PM Eastern Daylight Time	08/05/2019 08:31:22 AM Eastern Daylight Time	08/08/2019 10:59:52 AM Eastern Daylight Time			08/08/2019 03:48:54 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO HealthyValue (HMO)	1	1		1			H5883	11	1	2020	"West Michigan, Detroit Metro Area and Bay Region"	Region 1	2	3111	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	11	2	1	1	1	H5883_011_2	7	1			08/05/2019	2020.01	08/05/2019 05:21:05 PM Eastern Daylight Time	08/05/2019 08:32:17 AM Eastern Daylight Time	08/08/2019 11:00:15 AM Eastern Daylight Time			08/08/2019 03:48:54 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO HealthyValue (HMO)	1	1		1			H5883	11	2	2020	"West Michigan, Detroit Metro Area and Bay Region"	Region 2	2	2032	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	11	3	1	1	1	H5883_011_3	7	1			08/05/2019	2020.01	08/05/2019 05:23:53 PM Eastern Daylight Time	08/05/2019 08:33:14 AM Eastern Daylight Time	08/08/2019 11:00:39 AM Eastern Daylight Time			08/08/2019 03:48:54 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage HMO HealthyValue (HMO)	1	1		1			H5883	11	3	2020	"West Michigan, Detroit Metro Area and Bay Region"	Region 3	2	24421	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	2			
H5883	801	0	1	2	1	H5883_801_0	3	1			05/20/2019	2020.01	05/20/2019 08:13:42 AM Eastern Daylight Time					06/03/2019 11:39:22 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage (HMO-POS)	1	2		1			H5883	801	0	2020	Employer Group		1	300635	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7j;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;	1	6;7b;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9d;12;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;10a;11a;11b;11c;14a;14d;15;16b;18a;	2		1				
H5883	805	0	1	2	1	H5883_805_0	3	1			05/20/2019	2020.01	05/20/2019 08:28:55 AM Eastern Daylight Time					06/03/2019 11:39:22 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/medicare	BCN Advantage (HMO-POS)	1	2		1			H5883	805	0	2020	Employer Group		1	92617	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7j;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;	1	6;7b;7g;7i;8a;8b1;8b2;8b3;9a1;9b;9d;12;	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7j;8a;8b1;8b2;8b3;9a1;9b;9c;9d;10a;11a;11b;11c;14a;14d;15;16b;18a;	2		1				
H5902	1	0	1	20	8	H5902_001_0	1	1			05/20/2019	2020.01	05/20/2019 02:13:54 PM Eastern Daylight Time		05/20/2019 01:04:35 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"SENIOR LIFE ALTOONA, INC."	"Senior LIFE Altoona, Inc."	www.seniorlifepa.com	Senior LIFE Altoona Dual Eligible (PACE)	8	20		1			H5902	1	0	2020	"Blair, Indiana, and Cambria Counties"		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5902	2	0	1	20	8	H5902_002_0	1	1			05/20/2019	2020.01	05/20/2019 02:14:03 PM Eastern Daylight Time		05/20/2019 01:04:33 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"SENIOR LIFE ALTOONA, INC."	"Senior LIFE Altoona, Inc."	www.seniorlifepa.com	Senior LIFE Altoona Medicare Only (PACE)	8	20		1			H5902	2	0	2020	"Blair, Indiana, and Cambria Counties"		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5926	1	0	1	1	1	H5926_001_0	8	1	2	1	08/02/2019	2020.01	08/02/2019 05:35:38 PM Pacific Daylight Time	08/05/2019 10:03:08 AM Pacific Daylight Time	07/31/2019 11:32:54 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF MICHIGAN, INC."	Molina Healthcare of Michigan	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	1	1		1			H5926	1	0	2020	Select Counties in Michigan		2		2			1	3		2		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	2			
H5928	1	0	1	1	1	H5928_001_0	5	1	2	1	08/05/2019	2020.01	08/05/2019 03:31:47 PM Pacific Daylight Time	08/06/2019 01:37:08 PM Pacific Daylight Time	08/06/2019 12:04:27 PM Pacific Daylight Time			08/06/2019 02:11:18 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise TotalDual Plan (HMO D-SNP)	1	1		1			H5928	1	0	2020	Los Angeles County		2		2			1	3		2		1	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(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	2			
H5928	4	0	1	1	1	H5928_004_0	5	1			08/05/2019	2020.01	08/05/2019 03:22:54 PM Pacific Daylight Time	08/06/2019 01:37:15 PM Pacific Daylight Time	08/06/2019 12:04:32 PM Pacific Daylight Time			08/06/2019 02:11:18 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise AdvantageOptimum Plan (HMO)	1	1		1			H5928	4	0	2020	Los Angeles and Orange Counties		2		2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(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	2			
H5928	5	0	1	1	1	H5928_005_0	5	1	2	1	08/05/2019	2020.01	08/05/2019 03:32:28 PM Pacific Daylight Time	08/06/2019 01:37:21 PM Pacific Daylight Time	08/06/2019 12:04:36 PM Pacific Daylight Time			08/06/2019 02:11:18 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise TotalDual Plan (HMO D-SNP)	1	1		1			H5928	5	0	2020	Orange and San Bernardino Counties		2		2			1	3		2		1	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(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	2			
H5928	9	0	1	1	1	H5928_009_0	6	1	2	1	08/05/2019	2020.01	08/05/2019 03:32:55 PM Pacific Daylight Time	08/06/2019 01:37:27 PM Pacific Daylight Time	08/06/2019 12:04:41 PM Pacific Daylight Time			08/06/2019 02:11:18 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise TotalDual Plan (HMO D-SNP)	1	1		1			H5928	9	0	2020	San Diego County		2		2			1	3		2		1	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(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	2			
H5928	10	0	1	1	1	H5928_010_0	5	1			07/09/2019	2020.01	07/09/2019 09:30:40 AM Pacific Daylight Time	08/06/2019 01:37:33 PM Pacific Daylight Time	08/06/2019 12:04:46 PM Pacific Daylight Time			08/06/2019 02:13:05 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise AdvantageOptimum Plan 1 (HMO)	1	1		1			H5928	10	0	2020	San Diego County		2		2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(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	2			
H5928	16	0	1	1	1	H5928_016_0	5	1			08/05/2019	2020.01	08/05/2019 03:20:01 PM Pacific Daylight Time	08/06/2019 01:37:39 PM Pacific Daylight Time	08/06/2019 12:04:51 PM Pacific Daylight Time			08/06/2019 02:13:05 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise AdvantageOptimum Plan (HMO)	1	1		1			H5928	16	0	2020	Santa Clara County		2		2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(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	2			
H5928	37	0	1	1	1	H5928_037_0	5	1			08/05/2019	2020.01	08/05/2019 03:23:48 PM Pacific Daylight Time	08/06/2019 01:37:45 PM Pacific Daylight Time	08/06/2019 12:04:55 PM Pacific Daylight Time			08/06/2019 02:13:05 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise Coordinated Choice Plan (HMO)	1	1		1			H5928	37	0	2020	"Counties: LA, OR, SD, SB, RV, SC, FR, ME, SJ, ST"		2		2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(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	2			
H5928	44	0	1	1	1	H5928_044_0	4	1			08/05/2019	2020.01	08/05/2019 03:20:51 PM Pacific Daylight Time	08/06/2019 01:37:51 PM Pacific Daylight Time	08/06/2019 12:05:00 PM Pacific Daylight Time			08/06/2019 02:13:05 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise AdvantageOptimum Plan (HMO)	1	1		1			H5928	44	0	2020	Fresno County		2		2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(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	2			
H5928	50	0	1	1	1	H5928_050_0	4	1			08/05/2019	2020.01	08/05/2019 03:21:33 PM Pacific Daylight Time	08/06/2019 01:37:58 PM Pacific Daylight Time	08/06/2019 12:05:05 PM Pacific Daylight Time			08/06/2019 02:14:46 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise AdvantageOptimum Plan (HMO)	1	1		1			H5928	50	0	2020	Merced County		2		2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(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	2			
H5928	51	0	1	1	1	H5928_051_0	4	1			07/09/2019	2020.01	07/09/2019 09:35:38 AM Pacific Daylight Time	08/06/2019 01:38:04 PM Pacific Daylight Time	08/06/2019 12:05:10 PM Pacific Daylight Time			08/06/2019 02:14:46 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise AdvantageOptimum Plan (HMO)	1	1		1			H5928	51	0	2020	Stanislaus County		2		2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(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	2			
H5928	52	0	1	1	1	H5928_052_0	4	1			07/09/2019	2020.01	07/09/2019 09:36:23 AM Pacific Daylight Time	08/06/2019 01:38:10 PM Pacific Daylight Time	08/06/2019 12:05:14 PM Pacific Daylight Time			08/06/2019 02:14:46 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise AdvantageOptimum Plan (HMO)	1	1		1			H5928	52	0	2020	San Joaquin County		2		2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(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	2			
H5928	53	0	1	1	1	H5928_053_0	6	1			08/05/2019	2020.01	08/05/2019 03:22:19 PM Pacific Daylight Time	08/06/2019 01:38:17 PM Pacific Daylight Time	08/06/2019 12:05:19 PM Pacific Daylight Time			08/06/2019 02:14:46 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise AdvantageOptimum Plan 2 (HMO)	1	1		1			H5928	53	0	2020	San Diego County		2		2			2						www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(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	2			
H5928	54	0	1	1	1	H5928_054_0	4	1	2	1	08/05/2019	2020.01	08/05/2019 03:33:17 PM Pacific Daylight Time	08/06/2019 01:38:23 PM Pacific Daylight Time	08/06/2019 12:05:24 PM Pacific Daylight Time			08/06/2019 02:14:46 PM Pacific Daylight Time	BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN	Blue Shield of California Promise Health Plan	www.blueshieldca.com/promise/medicare	Blue Shield Promise TotalDual Plan (HMO D-SNP)	1	1		1			H5928	54	0	2020	Fresno/San Joaquin/Stanislaus Counties		2		2			1	3		2		1	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	www.blueshieldca.com/promise/medicare	(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	2			
H5932	1	0	1	1	1	H5932_001_0	5	1	2	1	08/05/2019	2020.01	08/05/2019 10:42:50 AM Eastern Daylight Time	08/02/2019 09:59:48 AM Eastern Daylight Time	08/02/2019 09:59:49 AM Eastern Daylight Time			08/06/2019 09:15:41 AM Eastern Daylight Time	"GATEWAY HEALTH PLAN, INC."	Gateway Health Medicare Assured	www.gatewayhealthplan.com/medicare	Gateway Health Medicare Assured Diamond (HMO D-SNP)	1	1		1			H5932	1	0	2020	Pennsylvania Counties		2	497578	2			1	3		1		1	www.gatewayhealthplan.com/medicare	www.gatewayhealthplan.com/medicare	www.gatewayhealthplan.com/medicare	(800)685-5209		(412)255-1323		(877)428-3929		(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	2			
H5932	9	0	1	1	1	H5932_009_0	7	1	2	1	08/02/2019	2020.01	08/02/2019 08:40:16 AM Eastern Daylight Time	08/02/2019 09:59:50 AM Eastern Daylight Time	08/02/2019 09:59:50 AM Eastern Daylight Time			08/06/2019 09:15:41 AM Eastern Daylight Time	"GATEWAY HEALTH PLAN, INC."	Gateway Health Medicare Assured	www.gatewayhealthplan.com/medicare	Gateway Health Medicare Assured Ruby (HMO D-SNP)	1	1		1			H5932	9	0	2020	Pennsylvania Counties		2	73786	2			1	3		2		2	www.gatewayhealthplan.com/medicare	www.gatewayhealthplan.com/medicare	www.gatewayhealthplan.com/medicare	(800)685-5209		(412)255-1323		(877)428-3929		(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	2			
H5934	1	0	1	20	8	H5934_001_0	1	1			05/29/2019	2020.01	05/29/2019 10:35:56 AM Eastern Daylight Time		05/29/2019 10:33:00 AM Eastern Daylight Time			05/29/2019 10:37:53 AM Eastern Daylight Time	"HOPE HOSPICE AND COMMUNITY SERVICES, INC."	Hope PACE	www.hopepace.org	Hope PACE (PACE)	8	20		1			H5934	1	0	2020	"Lee, Charlotte and Collier Counties Florida"		2		2			2						carekinesis.com	hopehcs.org/pace										(800)835-1673		(239)985-6400		(800)835-1673		(239)985-6400										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771																
H5934	2	0	1	20	8	H5934_002_0	1	1			05/29/2019	2020.01	05/29/2019 10:36:11 AM Eastern Daylight Time		05/29/2019 10:32:31 AM Eastern Daylight Time			05/29/2019 10:37:53 AM Eastern Daylight Time	"HOPE HOSPICE AND COMMUNITY SERVICES, INC."	Hope PACE	www.hopepace.org	Hope PACE (PACE)	8	20		1			H5934	2	0	2020	"Lee, Charlotte and Collier Counties Florida"		2		2			2						carekinesis.com	hopehcs.org/pace										(800)835-1673		(239)985-6400		(800)835-1673		(239)985-6400										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771																
H5937	1	0	1	1	1	H5937_001_0	3	1	2	1	08/06/2019	2020.01	08/06/2019 12:34:09 PM Central Daylight Time	08/06/2019 09:58:39 AM Central Daylight Time	07/31/2019 10:14:15 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare Connect + Medicare (HMO D-SNP)	1	1		1			H5937	1	0	2020	62 Counties		2		2			1	3		1		1	www.ucare.org	www.ucare.org	home.ucare.org/en-us/search-network	(855)260-9707		(612)676-3310		(800)707-1711		(612)676-3554		(855)260-9707		(612)676-3310		(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	2			
H5938	1	0	1	1	1	H5938_001_0	8	1			07/11/2019	2020.01	07/11/2019 09:10:19 PM Eastern Daylight Time	08/02/2019 04:27:49 PM Eastern Daylight Time	08/02/2019 04:28:20 PM Eastern Daylight Time			08/05/2019 10:07:25 AM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Advantage Plus (HMO)	1	1		1			H5938	1	0	2020	Leon and surrounding counties		2	115982	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	2			
H5938	6	0	1	1	1	H5938_006_0	8	1			07/11/2019	2020.01	07/11/2019 04:59:45 PM Eastern Daylight Time	08/02/2019 04:28:48 PM Eastern Daylight Time	08/02/2019 04:29:19 PM Eastern Daylight Time			08/05/2019 10:07:25 AM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Preferred Advantage (HMO)	1	1		1			H5938	6	0	2020	Leon and surrounding counties		2	33350	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	2			
H5938	802	0	1	1	1	H5938_802_0	6	1			05/20/2019	2020.01	05/20/2019 03:39:38 PM Eastern Daylight Time					06/01/2019 03:54:59 PM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	1	1		1			H5938	802	0	2020	Leon and surrounding counties		1	108214	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	1a;1b;2;3-1;3-2;3-3;5;7i;8a;8b1;8b2;9a1;9b;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;14d;14e2;14e3;14e4;14e5;14e6;16b;	1					1				
H5938	803	0	1	1	1	H5938_803_0	6	1			05/03/2019	2020.01	05/03/2019 03:27:58 PM Eastern Daylight Time					06/01/2019 03:54:59 PM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	1	1		1			H5938	803	0	2020	Leon and surrounding counties		1	12949	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	1a;1b;2;3-1;3-2;3-3;5;7i;8a;8b1;8b2;9a1;9b;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;14d;14e2;14e3;14e4;14e5;14e6;16b;	1					1				
H5938	804	0	1	1	1	H5938_804_0	6	1			05/03/2019	2020.01	05/03/2019 03:17:15 PM Eastern Daylight Time					06/01/2019 03:54:59 PM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	1	1		1			H5938	804	0	2020	Leon and surrounding counties		1	21275	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	1a;1b;2;3-1;3-2;3-3;5;7i;8a;8b1;8b2;9a1;9b;11a;11b;15;16b;	1	1a;1b;2;3-1;3-2;3-3;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;9d;12;14a;14d;14e2;14e3;14e4;14e5;16b;	1					1				
H5943	1	0	1	2	1	H5943_001_0	7	1		1	08/02/2019	2020.01	08/02/2019 09:05:39 AM Pacific Daylight Time		08/02/2019 04:19:32 PM Pacific Daylight Time		08/01/2019 09:51:09 AM Pacific Daylight Time	08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	VillageHealth	www.villagehealthca.com	VillageHealth (HMO-POS C-SNP)	1	2		1			H5943	1	0	2020	Riverside and  San Bernardino Counties		2		2			1	4			1E+11		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	2			
H5943	2	0	1	2	1	H5943_002_0	8	1		1	08/01/2019	2020.01	08/01/2019 11:04:57 AM Pacific Daylight Time		08/02/2019 04:19:35 PM Pacific Daylight Time		08/01/2019 09:52:34 AM Pacific Daylight Time	08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	VillageHealth	www.villagehealthca.com	VillageHealth (HMO-POS C-SNP)	1	2		1			H5943	2	0	2020	Los Angeles and Orange Counties		2		2			1	4			1E+11		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	2			
H5945	1	0	1	1	1	H5945_001_0	15	1			08/05/2019	2020.01	08/05/2019 04:05:53 PM Pacific Daylight Time	07/31/2019 04:12:30 PM Pacific Daylight Time	07/31/2019 04:02:08 PM Pacific Daylight Time			08/06/2019 04:18:40 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	1	1		1			H5945	1	0	2020	"Carson City, Douglas, Lyon, Storey"		2	43560	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5945	2	0	1	1	1	H5945_002_0	15	1			08/05/2019	2020.01	08/05/2019 04:06:44 PM Pacific Daylight Time	07/31/2019 04:13:46 PM Pacific Daylight Time	07/31/2019 04:02:45 PM Pacific Daylight Time			08/06/2019 04:22:59 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO)	1	1		1			H5945	2	0	2020	Washoe County		2	75936	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5945	801	0	1	1	1	H5945_801_0	2	1			06/25/2019	2020.01	06/25/2019 03:58:05 PM Pacific Daylight Time					07/01/2019 04:51:31 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	1	1		1			H5945	801	0	2020	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H5945	802	0	1	1	1	H5945_802_0	2	1			06/25/2019	2020.01	06/25/2019 03:58:21 PM Pacific Daylight Time					07/01/2019 04:51:31 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	1	1		1			H5945	802	0	2020	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5945	803	0	1	1	1	H5945_803_0	3	1			07/10/2019	2020.01	07/10/2019 01:08:28 PM Pacific Daylight Time					07/10/2019 01:19:00 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	1	1		1			H5945	803	0	2020	National		1	0	1	1		2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5959	7	1	1	4	1	H5959_007_1	2	1			05/30/2019	2020.01	05/30/2019 02:35:26 PM Central Daylight Time	05/30/2019 09:36:26 AM Central Daylight Time				05/31/2019 09:36:28 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice MA Only (PPO)	1	4		1			H5959	7	1	2020	50 County Region	Nine County Region	2	17926	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5959	7	2	1	4	1	H5959_007_2	2	1			05/30/2019	2020.01	05/30/2019 03:09:13 PM Central Daylight Time	05/30/2019 09:38:56 AM Central Daylight Time				05/31/2019 09:36:28 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice MA Only (PPO)	1	4		1			H5959	7	2	2020	50 County Region	41 County Region	2	21987	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5959	8	0	1	4	1	H5959_008_0	2	1			05/30/2019	2020.01	05/30/2019 03:16:08 PM Central Daylight Time	05/30/2019 09:33:26 AM Central Daylight Time				05/31/2019 09:36:28 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice MA Only (PPO)	1	4		1			H5959	8	0	2020	16 County Region		2	7095	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5959	9	0	1	4	1	H5959_009_0	3	1			06/01/2019	2020.01	06/01/2019 07:54:17 AM Central Daylight Time	07/31/2019 11:17:20 AM Central Daylight Time	07/30/2019 04:46:44 PM Central Daylight Time			08/01/2019 02:00:11 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice (PPO)	1	4		1			H5959	9	0	2020	16 County Region		2	88793	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	10	1	1	4	1	H5959_010_1	3	1			06/01/2019	2020.01	06/01/2019 08:21:24 AM Central Daylight Time	07/31/2019 11:23:42 AM Central Daylight Time	07/30/2019 04:47:20 PM Central Daylight Time			08/01/2019 02:20:13 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Complete (PPO)	1	4		1			H5959	10	1	2020	50 County Region	Nine County Region	2	157328	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	10	2	1	4	1	H5959_010_2	3	1			06/01/2019	2020.01	06/01/2019 08:17:18 AM Central Daylight Time	07/31/2019 11:22:52 AM Central Daylight Time	07/30/2019 04:47:56 PM Central Daylight Time			08/01/2019 02:20:13 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Complete (PPO)	1	4		1			H5959	10	2	2020	50 County Region	41 County Region	2	59783	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	11	0	1	4	1	H5959_011_0	3	1			06/01/2019	2020.01	06/01/2019 08:19:59 AM Central Daylight Time	07/31/2019 11:21:58 AM Central Daylight Time	07/30/2019 04:48:32 PM Central Daylight Time			08/01/2019 02:20:13 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Complete (PPO)	1	4		1			H5959	11	0	2020	16 County Region		2	31401	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	12	0	1	4	1	H5959_012_0	4	1			08/01/2019	2020.01	08/01/2019 01:25:34 PM Central Daylight Time	07/31/2019 03:00:30 PM Central Daylight Time	07/30/2019 04:49:08 PM Central Daylight Time			08/01/2019 02:12:40 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Core (PPO)	1	4		1			H5959	12	0	2020	16 County Region		2	21125	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	13	1	1	4	1	H5959_013_1	4	1			08/01/2019	2020.01	08/01/2019 01:24:28 PM Central Daylight Time	07/31/2019 03:02:44 PM Central Daylight Time	07/30/2019 04:49:42 PM Central Daylight Time			08/01/2019 02:12:40 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Core (PPO)	1	4		1			H5959	13	1	2020	50 County Region	Nine County Region	2	68708	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	13	2	1	4	1	H5959_013_2	5	1			08/01/2019	2020.01	08/01/2019 01:24:54 PM Central Daylight Time	07/31/2019 03:01:40 PM Central Daylight Time	07/30/2019 04:50:18 PM Central Daylight Time			08/01/2019 02:12:40 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Core (PPO)	1	4		1			H5959	13	2	2020	50 County Region	41 County Region	2	43995	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	14	1	1	4	1	H5959_014_1	3	1			06/01/2019	2020.01	06/01/2019 08:22:49 AM Central Daylight Time	07/31/2019 11:02:28 AM Central Daylight Time	07/30/2019 04:50:56 PM Central Daylight Time			08/01/2019 02:00:11 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice (PPO)	1	4		1			H5959	14	1	2020	50 County Region	Nine County Region	2	279263	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	14	2	1	4	1	H5959_014_2	3	1			06/01/2019	2020.01	06/01/2019 08:25:13 AM Central Daylight Time	07/31/2019 11:01:10 AM Central Daylight Time	07/30/2019 04:51:32 PM Central Daylight Time			08/01/2019 02:00:11 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Blue Cross Medicare Advantage Choice (PPO)	1	4		1			H5959	14	2	2020	50 County Region	41 County Region	2	193094	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5959	801	0	1	4	1	H5959_801_0	1	1			04/24/2019	2020.01	04/24/2019 10:33:56 AM Central Daylight Time					05/31/2019 10:25:20 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Group EGWP MAPD (PPO)	1	4		1			H5959	801	0	2020	66 County region		1	1000	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949		(800)711-9865		(800)711-9865		(855)579-7658		(651)662-9949		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H5959	807	0	1	4	1	H5959_807_0	1	1			04/20/2019	2020.01	04/20/2019 11:11:29 AM Central Daylight Time					05/31/2019 10:25:20 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross Blue Shield of Minnesota	www.bluecrossmnonline.com	Group EGWP Medical Only (PPO)	1	4		1			H5959	807	0	2020	66 County Region		1	455	2			2						www.myprime.com	www.myprime.com	www.bluecrossmnonline.com	(800)711-9865		(651)662-5513		(855)579-7658		(651)662-9949										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7h;7i;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;12;15;16b;	2		1									
H5965	1	0	1	4	1	H5965_001_0	5	1			07/12/2019	2020.01	07/12/2019 05:25:52 PM Eastern Daylight Time	08/02/2019 08:21:54 AM Eastern Daylight Time	07/30/2019 11:08:45 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	WellCare	www.wellcare.com/medicare	WellCare Prime (PPO)	1	4		1			H5965	1	0	2020	Select counties in WA		2	757	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5965	2	0	1	4	1	H5965_002_0	5	1			05/29/2019	2020.01	05/29/2019 03:25:35 PM Eastern Daylight Time	08/02/2019 08:23:29 AM Eastern Daylight Time	07/30/2019 11:09:21 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H5965	2	0	2020	Select counties in WA		2	324	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5969	2	0	1	1	1	H5969_002_0	4	1	2	1	06/03/2019	2020.01	06/03/2019 09:34:59 AM Hawaiian Standard Time	08/01/2019 09:41:45 AM Pacific Daylight Time	07/30/2019 02:27:16 PM Pacific Daylight Time			08/05/2019 02:36:41 PM Pacific Daylight Time	ALOHACARE	AlohaCare	AlohaCare.org	AlohaCare Advantage Plus (HMO D-SNP)	1	1		1			H5969	2	0	2020	State of Hawaii		2	52000	2			1	3		2		2	AlohaCare.org	AlohaCare.org	AlohaCare.org	(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	2			
H5970	1	0	1	4	1	H5970_001_0	4	1			07/15/2019	2020.01	07/15/2019 11:50:08 AM Eastern Daylight Time	08/01/2019 04:32:37 PM Eastern Daylight Time	08/02/2019 01:18:51 PM Eastern Daylight Time			08/05/2019 11:17:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-001 (PPO)	1	4		1			H5970	1	0	2020	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	15	0	1	4	1	H5970_015_0	3	1			08/01/2019	2020.01	08/01/2019 05:03:18 PM Eastern Daylight Time	08/01/2019 04:45:21 PM Eastern Daylight Time	08/02/2019 01:18:51 PM Eastern Daylight Time			08/05/2019 11:17:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-015 (PPO)	1	4		1			H5970	15	0	2020	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	16	0	1	4	1	H5970_016_0	2	1			07/15/2019	2020.01	07/15/2019 11:20:25 AM Eastern Daylight Time	07/15/2019 04:47:33 PM Eastern Daylight Time				07/16/2019 05:47:55 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-016 (PPO)	1	4		1			H5970	16	0	2020	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
H5970	18	0	1	4	1	H5970_018_0	3	1			08/01/2019	2020.01	08/01/2019 05:05:57 PM Eastern Daylight Time	08/01/2019 04:46:18 PM Eastern Daylight Time	08/02/2019 01:18:51 PM Eastern Daylight Time			08/05/2019 11:17:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-018 (PPO)	1	4		1			H5970	18	0	2020	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	19	0	1	4	1	H5970_019_0	4	1			07/15/2019	2020.01	07/15/2019 11:28:07 AM Eastern Daylight Time	08/01/2019 04:41:31 PM Eastern Daylight Time	08/02/2019 01:18:51 PM Eastern Daylight Time			08/05/2019 11:17:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-019 (PPO)	1	4		1			H5970	19	0	2020	Select Counties in New York		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	20	0	1	4	1	H5970_020_0	5	1	2	1	07/19/2019	2020.01	07/19/2019 03:26:21 PM Eastern Daylight Time	08/01/2019 04:59:46 PM Eastern Daylight Time	08/02/2019 01:18:51 PM Eastern Daylight Time			08/05/2019 11:17:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H5970-020 (PPO D-SNP)	1	4		1			H5970	20	0	2020	"Cattaraugus, Chautauqua and Madison counties"		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	21	0	1	4	1	H5970_021_0	3	1			08/01/2019	2020.01	08/01/2019 05:08:56 PM Eastern Daylight Time	08/01/2019 04:48:12 PM Eastern Daylight Time	08/02/2019 01:18:52 PM Eastern Daylight Time			08/05/2019 11:17:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-021 (PPO)	1	4		1			H5970	21	0	2020	New York City and Long Island		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	22	0	1	4	1	H5970_022_0	3	1			07/15/2019	2020.01	07/15/2019 11:33:07 AM Eastern Daylight Time	08/01/2019 04:49:08 PM Eastern Daylight Time	08/02/2019 01:18:52 PM Eastern Daylight Time			08/05/2019 11:17:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-022 (PPO)	1	4		1			H5970	22	0	2020	New York City and Long Island		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	23	0	1	4	1	H5970_023_0	3	1			07/15/2019	2020.01	07/15/2019 11:34:46 AM Eastern Daylight Time	08/01/2019 04:50:04 PM Eastern Daylight Time	08/02/2019 01:18:52 PM Eastern Daylight Time			08/05/2019 11:17:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	HumanaChoice H5970-023 (PPO)	1	4		1			H5970	23	0	2020	New York City and Long Island		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H5970	801	0	1	4	1	H5970_801_0	1	1			05/29/2019	2020.01	05/29/2019 09:07:07 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5970	801	0	2020	State of New York		1	43533	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	802	0	1	4	1	H5970_802_0	1	1			05/29/2019	2020.01	05/29/2019 09:07:20 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5970	802	0	2020	State of New York		1	8909	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	805	0	2	4	1	H5970_805_0	1	1			05/29/2019	2020.01	05/29/2019 08:44:04 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		2	1		H5970	805	0	2020	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	806	0	2	4	1	H5970_806_0	1	1			05/29/2019	2020.01	05/29/2019 08:55:32 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		2	1		H5970	806	0	2020	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	816	0	1	4	1	H5970_816_0	1	1			05/29/2019	2020.01	05/29/2019 09:01:20 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5970	816	0	2020	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	817	0	1	4	1	H5970_817_0	1	1			05/29/2019	2020.01	05/29/2019 09:02:01 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5970	817	0	2020	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-	711	(711)-	711	(711)-	711	(711)-	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	818	0	1	4	1	H5970_818_0	1	1			05/29/2019	2020.01	05/29/2019 09:02:39 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5970	818	0	2020	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	819	0	1	4	1	H5970_819_0	1	1			05/29/2019	2020.01	05/29/2019 09:03:54 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5970	819	0	2020	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-	711	(711)-	711	(711)-	711	(711)-	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	820	0	1	4	1	H5970_820_0	1	1			05/29/2019	2020.01	05/29/2019 09:05:23 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5970	820	0	2020	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	(711)-	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5970	821	0	1	4	1	H5970_821_0	1	1			05/29/2019	2020.01	05/29/2019 09:06:37 AM Eastern Daylight Time					05/29/2019 02:22:50 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H5970	821	0	2020	State of New York		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-	711	(711)-	711	(711)-	711	(711)-	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H5978	1	0	1	20	8	H5978_001_0	1	1			05/20/2019	2020.01	05/20/2019 02:14:17 PM Eastern Daylight Time		05/20/2019 01:04:26 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"SENIOR LIFE LEHIGH VALLEY, INC."	"Senior LIFE Lehigh Valley, Inc."	www.seniorlifepa.com	Senior LIFE Lehigh Valley Dual Eligible (PACE)	8	20		1			H5978	1	0	2020	Northampton and Lehigh Counties		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5978	2	0	1	20	8	H5978_002_0	1	1			05/20/2019	2020.01	05/20/2019 02:14:26 PM Eastern Daylight Time		05/20/2019 01:04:24 PM Eastern Daylight Time			05/20/2019 02:21:51 PM Eastern Daylight Time	"SENIOR LIFE LEHIGH VALLEY, INC."	"Senior LIFE Lehigh Valley, Inc."	www.seniorlifepa.com	Senior LIFE Lehigh Valley Medicare Only (PACE)	8	20		1			H5978	2	0	2020	Northampton and Lehigh Counties		2		2			2						http://granerx.com/	NA										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000										(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000																
H5989	2	0	1	1	1	H5989_002_0	4	1		1	08/01/2019	2020.01	08/01/2019 09:29:12 AM Central Daylight Time	08/06/2019 10:53:43 AM Central Daylight Time	07/31/2019 05:05:48 PM Central Daylight Time			08/06/2019 03:39:32 PM Central Daylight Time	"CENTERLIGHT HEALTHCARE, INC."	CenterLight Healthcare	www.centerlighthealthcare.org	CenterLight Healthcare Direct Complete Plan (HMO I-SNP)	1	1		1			H5989	2	0	2020	"Counties NY, KNG, QNS, BRX, NAS, WC"		2	2083	2			1	1	3				www.centerlighthealthcare.org	www.centerlighthealthcare.org	www.centerlighthealthcare.org	(833)252-2737		(347)640-6000		(833)252-2737		(347)640-6000		(833)252-2737		(833)252-2737		(833)252-2737		(347)640-6280		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H5991	1	0	1	1	1	H5991_001_0	5	1	2	1	08/02/2019	2020.01	08/02/2019 04:34:02 PM US Eastern Daylight Time	08/06/2019 11:25:16 AM Eastern Daylight Time	07/31/2019 05:52:44 PM Eastern Daylight Time			08/06/2019 12:11:20 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/medicare	EmblemHealth VIP Dual Select (HMO D-SNP)	1	1		1			H5991	1	0	2020	"NYC, Nassau ,Orange, Rockland, Suffolk,Westchester"		2		2			1	3		1		1	www.emblemhealth.com/medicare	www.emblemhealth.com/medicare	www.emblemhealth.com/medicare	(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	2			
H5991	2	0	1	1	1	H5991_002_0	7	1	2	1	09/10/2019	2020.01	09/10/2019 04:10:00 PM Eastern Daylight Time	08/06/2019 11:27:40 AM Eastern Daylight Time	07/31/2019 05:58:20 PM Eastern Daylight Time			09/10/2019 05:10:04 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/medicare	EmblemHealth VIP Solutions (HMO D-SNP)	1	1		1			H5991	2	0	2020	"NYC, Nassau ,Orange, Rockland, Suffolk,Westchester"		2		2			1	3		2		2	www.emblemhealth.com/medicare	www.emblemhealth.com/medicare	www.emblemhealth.com/medicare	(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	2			
H5991	3	0	1	1	1	H5991_003_0	6	1			07/23/2019	2020.01	07/23/2019 10:14:51 AM US Eastern Daylight Time	08/01/2019 03:48:42 PM Eastern Daylight Time	07/31/2019 06:02:20 PM Eastern Daylight Time			08/05/2019 05:03:58 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/medicare	EmblemHealth VIP Passport (HMO)	1	1		1			H5991	3	0	2020	"Nassau,Orange, Rockland, Westchester"		2		2			2						www.emblemhealth.com/medicare	www.emblemhealth.com/medicare	www.emblemhealth.com/medicare	(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	2			
H5991	6	0	1	1	1	H5991_006_0	3	1			07/23/2019	2020.01	07/23/2019 10:15:41 AM US Eastern Daylight Time	08/02/2019 01:54:00 PM Eastern Daylight Time	08/01/2019 11:31:14 AM Eastern Daylight Time			08/05/2019 05:03:58 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/medicare	EmblemHealth VIP Passport NYC (HMO)	1	1		1			H5991	6	0	2020	"NY, Bronx, Queens, Kings, Richmond"		2		2			2						www.emblemhealth.com/medicare	www.emblemhealth.com/medicare	www.emblemhealth.com/medicare	(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	2			
H5991	7	0	1	1	1	H5991_007_0	5	1	2	1	08/02/2019	2020.01	08/02/2019 04:29:53 PM US Eastern Daylight Time	08/06/2019 11:29:28 AM Eastern Daylight Time	08/01/2019 11:41:46 AM Eastern Daylight Time			08/06/2019 12:11:20 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/medicare	EmblemHealth VIP Connect (HMO D-SNP)	1	1		1			H5991	7	0	2020	"New York City, Westchester and Long Island"		2		2			1	3		1		1	www.emblemhealth.com/medicare	www.emblemhealth.com/medicare	www.emblemhealth.com/medicare	(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	2			
H5991	8	0	1	1	1	H5991_008_0	4	1	2	1	08/02/2019	2020.01	08/02/2019 04:31:00 PM US Eastern Daylight Time	08/06/2019 11:31:20 AM Eastern Daylight Time	08/01/2019 11:47:20 AM Eastern Daylight Time			08/06/2019 12:11:20 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/medicare	EmblemHealth VIP Assist (HMO D-SNP)	1	1		1			H5991	8	0	2020	"New York City, Westchester and Long Island"		2		2			1	3		1		1	www.emblemhealth.com/medicare	www.emblemhealth.com/medicare	www.emblemhealth.com/medicare	(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	2			
H5992	7	0	1	1	1	H5992_007_0	4	1	2	1	08/01/2019	2020.01	08/01/2019 10:47:26 PM Eastern Daylight Time	08/01/2019 11:48:54 AM Eastern Daylight Time	08/01/2019 11:00:40 AM Eastern Daylight Time			08/05/2019 11:27:37 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 NHC (HMO D-SNP)	1	1		1			H5992	7	0	2020	"Counties: Ki, Qu, Brx, NY, Wes, and Na"		2	2316	2			1	3		2		1	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	2			
H5995	1	0	1	1	1	H5995_001_0	7	1	2	1	08/05/2019	2020.01	08/05/2019 09:17:35 AM Pacific Daylight Time	08/06/2019 01:01:52 PM Pacific Daylight Time	08/06/2019 01:59:36 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Special Needs Plan (Willamette) (HMO D-SNP)	1	1		1			H5995	1	0	2020	Marion and Polk Counties		2	39900	2			1	3		2		2	atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2	2			
H6059	1	0	1	20	8	H6059_001_0	1	1			05/21/2019	2020.01	05/21/2019 10:38:42 AM Eastern Daylight Time		05/19/2019 03:55:29 PM Eastern Daylight Time			05/21/2019 10:40:21 AM Eastern Daylight Time	"PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC."	PACE OF THE TRIAD	www.pacetriad.org	PACE of The Triad - Dual (PACE)	8	20		1			H6059	1	0	2020	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										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H6059	2	0	1	20	8	H6059_002_0	1	1			05/21/2019	2020.01	05/21/2019 10:38:57 AM Eastern Daylight Time		05/19/2019 03:56:17 PM Eastern Daylight Time			05/21/2019 10:40:21 AM Eastern Daylight Time	"PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC."	PACE OF THE TRIAD	www.pacetriad.org	PACE of The Triad - Medicare only (PACE)	8	20		1			H6059	2	0	2020	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										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H6079	1	0	1	20	8	H6079_001_0	1	1			05/16/2019	2020.01	05/16/2019 03:23:23 PM Mountain Daylight Time		05/16/2019 02:32:50 PM Mountain Daylight Time			05/16/2019 03:24:27 PM Mountain Daylight Time	"TOTAL LONGTERM CARE, INC."	InnovAge California PACE	www.MyInnovAge.com	InnovAge California PACE (PACE)	8	20		1			H6079	1	0	2020	San Bernardino and Riverside counties		2		2			2						www.granerx.com	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H6079	2	0	1	20	8	H6079_002_0	1	1			05/16/2019	2020.01	05/16/2019 03:23:37 PM Mountain Daylight Time		05/16/2019 02:32:51 PM Mountain Daylight Time			05/16/2019 03:24:27 PM Mountain Daylight Time	"TOTAL LONGTERM CARE, INC."	InnovAge California PACE	www.MyInnovAge.com	InnovAge California PACE (PACE)	8	20		1			H6079	2	0	2020	San Bernardino and Riverside counties		2		2			2						www.granerx.com	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H6080	1	0	1	48	5	H6080_001_0	4	1			06/20/2019	2020.01	06/20/2019 04:53:41 PM Eastern Daylight Time					06/20/2019 04:56:15 PM Eastern Daylight Time	"MERIDIAN HEALTH PLAN OF ILLINOIS, INC."	MeridianComplete	www.mhplan.com	MeridianComplete (Medicare-Medicaid Plan)	5	48		1			H6080	1	0	2020	Greater Chicago		2	83000	2			2						www.mhplan.com	www.mhplan.com	www.mhplan.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)-																
H6121	3	0	1	1	1	H6121_003_0	6	1			06/03/2019	2020.01	06/03/2019 08:52:33 AM Central Daylight Time	08/02/2019 04:26:04 PM Central Daylight Time	08/02/2019 04:42:39 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF ILLINOIS	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Assist (HMO)	1	1		1			H6121	3	0	2020	Cook and Kane Counties		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-7735		(844)221-7735		(833)412-6735		(833)412-6735		(844)221-7735		(844)221-7735		(833)412-6735		(833)412-6735		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6154	1	0	1	2	1	H6154_001_0	11	1			07/26/2019	2020.01	07/26/2019 02:49:33 PM Central Daylight Time	08/01/2019 09:45:06 AM Central Daylight Time	08/01/2019 09:47:05 AM Central Daylight Time			08/01/2019 11:39:37 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H6154-001 (HMO-POS)	1	2		1			H6154	1	0	2020	Minneapolis/St. Paul Metro Area		2		2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6154	2	0	1	2	1	H6154_002_0	10	1			07/26/2019	2020.01	07/26/2019 02:50:08 PM Central Daylight Time	08/01/2019 09:45:13 AM Central Daylight Time	08/01/2019 09:47:10 AM Central Daylight Time			08/01/2019 11:39:37 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H6154-002 (HMO-POS)	1	2		1			H6154	2	0	2020	Select Counties in MN		2		2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6154	3	0	1	1	1	H6154_003_0	2	1		1	05/30/2019	2020.01	05/30/2019 12:11:13 PM Central Daylight Time	08/01/2019 09:45:20 AM Central Daylight Time	08/01/2019 09:47:15 AM Central Daylight Time			08/02/2019 12:27:01 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution PartnerCare Premier (HMO I-SNP)	1	1		1			H6154	3	0	2020	Select counties in MN		2		2			1	1	3				medica.com/Members	medica.com/Members	medica.com/Members	(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7e1;7e2;7f;7g;7h1;7h2;	
H6154	4	0	1	1	1	H6154_004_0	2	1		1	05/30/2019	2020.01	05/30/2019 12:11:30 PM Central Daylight Time	08/01/2019 09:45:27 AM Central Daylight Time	08/01/2019 09:47:20 AM Central Daylight Time			08/02/2019 12:27:01 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution PartnerCare Focus (HMO I-SNP)	1	1		1			H6154	4	0	2020	Select counties in MN		2		2			1	1	3				medica.com/Members	medica.com/Members	medica.com/Members	(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	7e1;7e2;7f;7g;7h1;7h2;	
H6188	1	0	1	20	8	H6188_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:23:00 PM Eastern Daylight Time		05/22/2019 11:31:05 AM Eastern Daylight Time			05/22/2019 01:27:47 PM Eastern Daylight Time	"VIECARE ARMSTRONG, LLC"	LIFE Armstrong	www.lutheranseniorlife.org	"VieCare Armstrong, LLC dba LIFE Armstrong County (PACE)"	8	20		1			H6188	1	0	2020	Armstrong County		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)545-8000				(724)545-8000												(711)-				(711)-																
H6188	2	0	1	20	8	H6188_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:23:46 PM Eastern Daylight Time		05/22/2019 11:31:32 AM Eastern Daylight Time			05/22/2019 01:27:47 PM Eastern Daylight Time	"VIECARE ARMSTRONG, LLC"	LIFE Armstrong	www.lutheranseniorlife.org	"VieCare Armstrong, LLC dba LIFE Armstrong County (PACE)"	8	20		1			H6188	2	0	2020	Armstrong County		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)545-8000				(724)545-8000												(711)-				(711)-																
H6229	5	0	1	48	5	H6229_005_0	5	1			08/21/2019	2020.01	08/21/2019 01:37:27 PM Pacific Daylight Time					08/21/2019 01:42:52 PM Pacific Daylight Time	"BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC."	Anthem Blue Cross Cal MediConnect	duals.anthem.com	Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)	5	48		1			H6229	5	0	2020	Los Angeles County (Partial)		2	33208	2			2						duals.anthem.com	duals.anthem.com	duals.anthem.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)-																
H6229	6	0	1	48	5	H6229_006_0	4	1			08/21/2019	2020.01	08/21/2019 01:38:20 PM Pacific Daylight Time					08/21/2019 01:42:52 PM Pacific Daylight Time	"BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC."	Anthem Blue Cross Cal MediConnect	duals.anthem.com	Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)	5	48		1			H6229	6	0	2020	Santa Clara County		2	27029	2			2						duals.anthem.com	duals.anthem.com	duals.anthem.com	(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H6231	1	0	1	20	8	H6231_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:07:35 PM Central Daylight Time		05/22/2019 09:14:01 AM Central Daylight Time			05/22/2019 01:18:52 PM Central Daylight Time	"FRANCISCAN PACE, INC."	PACE Baton Rouge	www.ololrmc.com	"Franciscan PACE, Inc. (PACE)"	8	20		1			H6231	1	0	2020	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	2	0	1	20	8	H6231_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:08:35 PM Central Daylight Time		05/22/2019 09:13:51 AM Central Daylight Time			05/22/2019 01:18:52 PM Central Daylight Time	"FRANCISCAN PACE, INC."	PACE Baton Rouge	www.fmolhs.org	"Franciscan PACE, Inc. (PACE)"	8	20		1			H6231	2	0	2020	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	6	0	1	1	1	H6237_006_0	10	1			07/10/2019	2020.01	07/10/2019 04:24:38 PM Mountain Daylight Time	07/05/2019 02:50:43 PM Mountain Daylight Time				07/12/2019 11:13:26 AM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO No Rx (HMO)	1	1		1			H6237	6	0	2020	"Select Counties in Oregon/Clark County, WA"		2	1674	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										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H6237	7	1	1	1	1	H6237_007_1	10	1			07/01/2019	2020.01	07/01/2019 02:54:06 PM Mountain Daylight Time	08/05/2019 10:53:29 AM Mountain Daylight Time	07/31/2019 03:03:57 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	1	1		1			H6237	7	1	2020	"Select Counties in Oregon/Clark County, WA"	Metro	2	21930	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	2			
H6237	7	2	1	1	1	H6237_007_2	11	1			07/10/2019	2020.01	07/10/2019 04:20:06 PM Mountain Daylight Time	08/05/2019 10:54:40 AM Mountain Daylight Time	07/31/2019 03:06:25 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	1	1		1			H6237	7	2	2020	"Select Counties in Oregon/Clark County, WA"	Lane	2	24913	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	2			
H6237	7	3	1	1	1	H6237_007_3	11	1			07/10/2019	2020.01	07/10/2019 04:20:27 PM Mountain Daylight Time	08/05/2019 10:55:57 AM Mountain Daylight Time	07/31/2019 03:08:55 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	1	1		1			H6237	7	3	2020	"Select Counties in Oregon/Clark County, WA"	Deschutes	2	3487	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	2			
H6237	8	1	1	1	1	H6237_008_1	11	1			07/10/2019	2020.01	07/10/2019 04:21:00 PM Mountain Daylight Time	08/05/2019 10:57:12 AM Mountain Daylight Time	07/31/2019 03:14:24 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO Plus (HMO)	1	1		1			H6237	8	1	2020	"Select Counties in Oregon/Clark County, WA"	Metro	2	60968	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	2			
H6237	8	2	1	1	1	H6237_008_2	11	1			07/10/2019	2020.01	07/10/2019 04:21:27 PM Mountain Daylight Time	08/05/2019 10:58:29 AM Mountain Daylight Time	07/31/2019 03:19:36 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO Plus (HMO)	1	1		1			H6237	8	2	2020	"Select Counties in Oregon/Clark County, WA"	Lane	2	4969	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	2			
H6237	8	3	1	1	1	H6237_008_3	11	1			07/10/2019	2020.01	07/10/2019 04:21:45 PM Mountain Daylight Time	08/05/2019 10:59:40 AM Mountain Daylight Time	07/31/2019 03:24:54 PM Mountain Daylight Time			08/06/2019 01:37:40 PM Mountain Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO Plus (HMO)	1	1		1			H6237	8	3	2020	"Select Counties in Oregon/Clark County, WA"	Deschutes	2	613	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	2			
H6306	5	0	1	1	1	H6306_005_0	3	1			06/03/2019	2020.01	06/03/2019 04:39:40 PM Pacific Daylight Time	07/31/2019 12:46:31 PM Pacific Daylight Time	07/31/2019 09:14:44 AM Pacific Daylight Time			08/02/2019 01:16:31 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct smartHMO (HMO)	1	1		1			H6306	5	0	2020	Wake County		2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)499-5630		(844)499-5630		(855)903-5154		(855)903-5154		(844)499-5630		(844)499-5630		(855)903-5154		(855)903-5154		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	10	0	1	1	1	H6306_010_0	5	1			08/05/2019	2020.01	08/05/2019 05:21:59 PM Pacific Daylight Time	08/05/2019 02:47:47 PM Pacific Daylight Time	08/05/2019 03:07:19 PM Pacific Daylight Time			08/05/2019 05:31:31 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct HMO Prime (HMO)	1	1		1			H6306	10	0	2020	Western North Carolina		2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	11	1	1	1	1	H6306_011_1	5	1			07/18/2019	2020.01	07/18/2019 09:43:59 AM Pacific Daylight Time	08/05/2019 02:30:53 PM Pacific Daylight Time	07/31/2019 10:33:41 AM Pacific Daylight Time			08/05/2019 05:31:31 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct HMO Plus (HMO)	1	1		1			H6306	11	1	2020	North Carolina	South Central North Carolina	2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	11	2	1	1	1	H6306_011_2	5	1			07/18/2019	2020.01	07/18/2019 09:44:14 AM Pacific Daylight Time	08/05/2019 02:32:17 PM Pacific Daylight Time	07/31/2019 10:35:20 AM Pacific Daylight Time			08/05/2019 05:31:31 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct HMO Plus (HMO)	1	1		1			H6306	11	2	2020	North Carolina	Eastern North Carolina	2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	11	3	1	1	1	H6306_011_3	5	1			07/18/2019	2020.01	07/18/2019 09:44:29 AM Pacific Daylight Time	08/05/2019 02:49:04 PM Pacific Daylight Time	07/31/2019 10:39:08 AM Pacific Daylight Time			08/05/2019 05:31:31 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct HMO Plus (HMO)	1	1		1			H6306	11	3	2020	North Carolina	Western North Carolina	2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	12	1	1	1	1	H6306_012_1	5	1			07/18/2019	2020.01	07/18/2019 09:44:46 AM Pacific Daylight Time	08/05/2019 02:35:49 PM Pacific Daylight Time	07/31/2019 10:58:52 AM Pacific Daylight Time			08/05/2019 05:31:31 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct HMO Standard (HMO)	1	1		1			H6306	12	1	2020	North Carolina	South Central North Carolina	2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6306	12	4	1	1	1	H6306_012_4	5	1			07/18/2019	2020.01	07/18/2019 09:45:18 AM Pacific Daylight Time	08/05/2019 02:37:13 PM Pacific Daylight Time	07/31/2019 10:59:56 AM Pacific Daylight Time			08/05/2019 05:31:31 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct HMO Standard (HMO)	1	1		1			H6306	12	4	2020	North Carolina	Eastern North Carolina	2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6316	1	0	1	1	1	H6316_001_0	4	1			07/16/2019	2020.01	07/16/2019 12:27:52 PM Eastern Daylight Time	08/02/2019 08:25:06 AM Eastern Daylight Time	07/30/2019 11:09:56 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"MISSOURI CARE, INCORPORATED"	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H6316	1	0	2020	Select counties in MO		2	7723	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6316	2	0	1	1	1	H6316_002_0	4	1	2	1	07/12/2019	2020.01	07/12/2019 03:11:05 PM Eastern Daylight Time	08/02/2019 08:26:44 AM Eastern Daylight Time	07/30/2019 11:10:33 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"MISSOURI CARE, INCORPORATED"	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H6316	2	0	2020	Select counties in MO		2	213	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6316	3	0	1	1	1	H6316_003_0	4	1	2	1	07/12/2019	2020.01	07/12/2019 03:14:07 PM Eastern Daylight Time	08/02/2019 08:28:20 AM Eastern Daylight Time	07/30/2019 11:11:08 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"MISSOURI CARE, INCORPORATED"	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H6316	3	0	2020	Select counties in MO		2	1721	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6316	4	0	1	1	1	H6316_004_0	4	1			07/11/2019	2020.01	07/11/2019 02:57:59 PM Eastern Daylight Time	08/02/2019 08:29:59 AM Eastern Daylight Time	07/30/2019 11:11:44 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"MISSOURI CARE, INCORPORATED"	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H6316	4	0	2020	Select counties in MO		2	278	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6328	1	0	1	4	1	H6328_001_0	5	1			07/17/2019	2020.01	07/17/2019 03:25:21 PM Eastern Daylight Time	08/05/2019 04:42:59 PM Eastern Daylight Time	07/31/2019 02:25:20 PM Eastern Daylight Time			08/05/2019 04:52:22 PM Eastern Daylight Time	"CARE N' CARE INSURANCE COMPANY, INC."	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice Premium (PPO)	1	4		1			H6328	1	0	2020	Dallas/Fort Worth Metro Area		2	14800	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			
H6328	2	0	1	4	1	H6328_002_0	6	1			07/18/2019	2020.01	07/18/2019 05:41:40 PM Eastern Daylight Time	07/31/2019 02:18:02 PM Eastern Daylight Time	07/31/2019 02:26:26 PM Eastern Daylight Time			08/05/2019 04:52:22 PM Eastern Daylight Time	"CARE N' CARE INSURANCE COMPANY, INC."	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice Plus (PPO)	1	4		1			H6328	2	0	2020	Dallas/Fort Worth Metro Area		2	45500	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			
H6328	3	0	1	4	1	H6328_003_0	6	1			07/18/2019	2020.01	07/18/2019 05:41:59 PM Eastern Daylight Time	07/31/2019 02:19:51 PM Eastern Daylight Time	07/31/2019 02:27:35 PM Eastern Daylight Time			08/05/2019 04:52:22 PM Eastern Daylight Time	"CARE N' CARE INSURANCE COMPANY, INC."	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice (PPO)	1	4		1			H6328	3	0	2020	Dallas/Fort Worth Metro Area		2	84700	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			
H6328	5	0	1	4	1	H6328_005_0	5	1			07/18/2019	2020.01	07/18/2019 05:43:17 PM Eastern Daylight Time	06/02/2019 06:54:22 PM Eastern Daylight Time				07/18/2019 05:44:26 PM Eastern Daylight Time	"CARE N' CARE INSURANCE COMPANY, INC."	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice MA-Only (PPO)	1	4		1			H6328	5	0	2020	Dallas/Fort Worth Metro Area		2	4400	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						2			
H6328	801	0	1	4	1	H6328_801_0	1	1			05/28/2019	2020.01	05/28/2019 01:30:55 PM Eastern Daylight Time					06/03/2019 12:56:04 PM Eastern Daylight Time	"CARE N' CARE INSURANCE COMPANY, INC."	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice CY - MAPD (PPO)	1	4		1			H6328	801	0	2020	Nationwide		1	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)-		2					2						2			
H6328	802	0	1	4	1	H6328_802_0	1	1			05/28/2019	2020.01	05/28/2019 01:35:21 PM Eastern Daylight Time					06/03/2019 12:56:04 PM Eastern Daylight Time	"CARE N' CARE INSURANCE COMPANY, INC."	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice NCY - MAPD (PPO)	1	4		1			H6328	802	0	2020	Nationwide		1	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)-		2					2						2			
H6328	803	0	1	4	1	H6328_803_0	1	1			05/28/2019	2020.01	05/28/2019 02:30:23 PM Eastern Daylight Time					06/03/2019 12:56:04 PM Eastern Daylight Time	"CARE N' CARE INSURANCE COMPANY, INC."	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice CY - MA-Only (PPO)	1	4		1			H6328	803	0	2020	Nationwide		1	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)-										2					2						2			
H6328	804	0	1	4	1	H6328_804_0	1	1			05/28/2019	2020.01	05/28/2019 02:36:32 PM Eastern Daylight Time					06/03/2019 12:56:04 PM Eastern Daylight Time	"CARE N' CARE INSURANCE COMPANY, INC."	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Choice NCY - MA-Only (PPO)	1	4		1			H6328	804	0	2020	Nationwide		1	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)-										2					2						2			
H6342	1	0	1	20	8	H6342_001_0	1	1			05/17/2019	2020.01	05/17/2019 11:08:44 AM Central Daylight Time		05/17/2019 11:11:42 AM Central Daylight Time			05/17/2019 11:18:30 AM Central Daylight Time	COMPLETE HEALTH WITH PACE	Complete Health with PACE	www.completehealthwithpace.org	Complete Health with PACE (PACE)	8	20		1			H6342	1	0	2020	Central Arkansas		2		2			2						www.CareKinesis.com	https://www.completehealthwithpace.org												(501)376-8852				(501)376-8852												(501)688-7462				(501)688-7462																
H6342	2	0	1	20	8	H6342_002_0	1	1			05/17/2019	2020.01	05/17/2019 11:09:07 AM Central Daylight Time		05/17/2019 11:12:04 AM Central Daylight Time			05/17/2019 11:18:30 AM Central Daylight Time	COMPLETE HEALTH WITH PACE	Complete Health with PACE	www.completehealthwithpace.org	Complete Health with PACE (PACE)	8	20		1			H6342	2	0	2020	Central Arkansas		2		2			2						www.CareKinesis.com	https://www.completehealthwithpace.org												(501)376-8852				(501)376-8852												(501)688-7462				(501)688-7462																
H6345	1	0	1	1	1	H6345_001_0	3	1		1	05/31/2019	2020.01	05/31/2019 04:19:27 PM Central Daylight Time	08/05/2019 12:21:18 PM Central Daylight Time	08/01/2019 09:33:34 AM Central Daylight Time			08/05/2019 04:53:44 PM Central Daylight Time	"PRUITTHEALTH PREMIER NORTH CAROLINA, LLC"	PruittHealth Premier	www.pruitthealthpremier.com	PruittHealth Premier (HMO I-SNP)	1	1		1			H6345	1	0	2020	NC (Partial)		2	3468	2			1	1	3				www.pruitthealthpremier.com	www.pruitthealthpremier.com	www.pruitthealthpremier.com	(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6345	2	0	1	1	1	H6345_002_0	3	1		1	08/05/2019	2020.01	08/05/2019 03:17:09 PM Central Daylight Time	08/05/2019 12:22:33 PM Central Daylight Time	08/01/2019 09:34:44 AM Central Daylight Time			08/05/2019 04:53:44 PM Central Daylight Time	"PRUITTHEALTH PREMIER NORTH CAROLINA, LLC"	PruittHealth Premier	www.pruitthealthpremier.com	PruittHealth Premier (HMO I-SNP)	1	1		1			H6345	2	0	2020	South Carolina (partial)		2	5904	2			1	1	3				www.pruitthealthpremier.com	www.pruitthealthpremier.com	www.pruitthealthpremier.com	(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(844)224-3659		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6348	1	0	1	4	1	H6348_001_0	5	1			08/01/2019	2020.01	08/01/2019 09:55:23 AM US Mountain Standard Time	08/05/2019 04:21:12 PM Central Daylight Time	08/05/2019 03:30:22 PM Central Daylight Time			08/06/2019 10:34:40 AM Central Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (PPO)	1	4		1			H6348	1	0	2020	Central Indiana		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6348	2	0	1	4	1	H6348_002_0	4	1			08/01/2019	2020.01	08/01/2019 09:57:56 AM US Mountain Standard Time	08/05/2019 04:21:18 PM Central Daylight Time	08/05/2019 03:30:25 PM Central Daylight Time			08/06/2019 10:34:40 AM Central Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (PPO)	1	4		1			H6348	2	0	2020	Northern Indiana		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6348	3	0	1	4	1	H6348_003_0	4	1			08/01/2019	2020.01	08/01/2019 09:58:59 AM US Mountain Standard Time	08/05/2019 04:21:01 PM Central Daylight Time	08/05/2019 03:30:16 PM Central Daylight Time			08/06/2019 10:34:40 AM Central Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (PPO)	1	4		1			H6348	3	0	2020	Southwest Indiana		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6348	4	0	1	4	1	H6348_004_0	3	1			08/01/2019	2020.01	08/01/2019 10:00:02 AM US Mountain Standard Time	08/05/2019 04:21:05 PM Central Daylight Time	08/05/2019 03:30:19 PM Central Daylight Time			08/06/2019 10:34:40 AM Central Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Medicare (PPO)	1	4		1			H6348	4	0	2020	Northwest Indiana		2		2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6348	801	0	1	4	1	H6348_801_0	2	1			05/13/2019	2020.01	05/13/2019 09:19:34 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Group (PPO)	1	4		1			H6348	801	0	2020	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H6348	802	0	1	4	1	H6348_802_0	2	1			05/10/2019	2020.01	05/10/2019 04:07:11 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Group (PPO)	1	4		1			H6348	802	0	2020	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H6348	803	0	1	4	1	H6348_803_0	2	1			05/10/2019	2020.01	05/10/2019 04:24:12 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	COORDINATED CARE CORPORATION	Allwell	allwell.mhsindiana.com	Allwell Group (PPO)	1	4		1			H6348	803	0	2020	Indiana		1	100	2			2						allwell.mhsindiana.com/findadoctor	allwell.mhsindiana.com/formulary	allwell.mhsindiana.com/findadoctor	(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(855)766-1541		(855)766-1541		(877)891-6093		(877)891-6093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H6351	1	0	1	1	1	H6351_001_0	4	1		1	08/01/2019	2020.01	08/01/2019 06:45:48 PM Central Daylight Time	08/05/2019 01:53:22 PM Central Daylight Time	07/31/2019 02:25:50 PM Central Daylight Time			08/06/2019 10:12:46 AM Central Daylight Time	"LIBERTY ADVANTAGE, LLC"	Liberty Advantage	www.libertyadvantageplan.com	Liberty Advantage (HMO I-SNP)	1	1		1			H6351	1	0	2020	North Carolina (partial)		2	15818	2			1	1	3				www.libertyadvantageplan.com	www.libertyadvantageplan.com	www.libertyadvantageplan.com	(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6351	2	0	1	1	1	H6351_002_0	4	1		1	05/30/2019	2020.01	05/30/2019 08:00:48 PM Central Daylight Time	08/01/2019 04:15:38 PM Central Daylight Time	07/31/2019 02:27:34 PM Central Daylight Time			08/06/2019 10:12:46 AM Central Daylight Time	"LIBERTY ADVANTAGE, LLC"	Liberty Advantage	www.libertyadvantageplan.com	Liberty Advantage Gold (HMO I-SNP)	1	1		1			H6351	2	0	2020	North Carolina (partial)		2	644	2			1	1	3				www.libertyadvantageplan.com	www.libertyadvantageplan.com	www.libertyadvantageplan.com	(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6351	3	0	1	1	1	H6351_003_0	4	1		1	05/30/2019	2020.01	05/30/2019 08:01:05 PM Central Daylight Time	08/01/2019 04:17:12 PM Central Daylight Time	07/31/2019 02:28:24 PM Central Daylight Time			08/06/2019 10:12:46 AM Central Daylight Time	"LIBERTY ADVANTAGE, LLC"	Liberty Advantage	www.libertyadvantageplan.com	Liberty at Home (HMO I-SNP)	1	1		1			H6351	3	0	2020	North Carolina (partial)		2	240	2			1	1	3				www.libertyadvantageplan.com	www.libertyadvantageplan.com	www.libertyadvantageplan.com	(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(844)854-6884		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6371	1	0	1	20	8	H6371_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:15:07 PM Eastern Daylight Time		05/21/2019 05:35:23 PM Eastern Daylight Time			05/22/2019 01:18:47 PM Eastern Daylight Time	"LUTHERAN SENIOR HEALTHCARE, INC."	Lutheran Senior LIFE	www.lifelsmnj.org	Lutheran Senior Healthcare (PACE)	8	20		1			H6371	1	0	2020	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	2	0	1	20	8	H6371_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:15:30 PM Eastern Daylight Time		05/21/2019 05:35:07 PM Eastern Daylight Time			05/22/2019 01:18:47 PM Eastern Daylight Time	"LUTHERAN SENIOR HEALTHCARE, INC."	Lutheran Senior LIFE	www.lifelsmnj.org	Lutheran Senior Healthcare (PACE)	8	20		1			H6371	2	0	2020	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																
H6379	1	0	1	1	1	H6379_001_0	6	1			07/03/2019	2020.01	07/03/2019 11:20:10 AM Central Daylight Time	08/06/2019 02:11:21 PM Central Daylight Time	08/06/2019 02:11:30 PM Central Daylight Time			08/06/2019 02:39:04 PM Central Daylight Time	"CLEAR SPRING HEALTH (CO), INC."	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (HMO)	1	1		1			H6379	1	0	2020	Select Counties		2	7564	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)384-1241		(877)384-1241		(877)384-1241		(877)384-1241		(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6396	1	0	1	1	1	H6396_001_0	7	1			08/02/2019	2020.01	08/02/2019 11:59:36 AM Eastern Daylight Time	08/01/2019 02:59:40 PM Eastern Daylight Time	08/01/2019 03:12:32 PM Eastern Daylight Time			08/06/2019 11:22:13 AM Eastern Daylight Time	CARESOURCE	CareSource	www.caresource.com/medicare	CareSource Advantage (HMO)	1	1		1			H6396	1	0	2020	Ohio		2	47956	2			2						http:\\caresource.com	www.caresource.com/medicare	https://memberportal.caresource.com/App/OH/FindADoctor/MA	(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(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	2			
H6396	4	0	1	1	1	H6396_004_0	8	1			08/01/2019	2020.01	08/01/2019 01:33:15 PM Eastern Daylight Time	08/01/2019 09:16:22 AM Eastern Daylight Time	08/01/2019 10:05:36 AM Eastern Daylight Time			08/06/2019 11:22:13 AM Eastern Daylight Time	CARESOURCE	CareSource	www.caresource.com/medicare	CareSource Advantage Zero Premium (HMO)	1	1		1			H6396	4	0	2020	Ohio		2	20419	2			2						http:\\caresource.com	www.caresource.com/medicare	https://memberportal.caresource.com/App/OH/FindADoctor/MA	(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(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	2			
H6396	5	0	1	1	1	H6396_005_0	9	1	2	1	08/01/2019	2020.01	08/01/2019 01:36:23 PM Eastern Daylight Time	08/01/2019 09:18:08 AM Eastern Daylight Time	08/01/2019 10:07:14 AM Eastern Daylight Time			08/06/2019 11:22:13 AM Eastern Daylight Time	CARESOURCE	CareSource	caresource.com	CareSource DSNP (HMO D-SNP)	1	1		1			H6396	5	0	2020	OH DSNP		2	12705	2			1	3		1		1	http:\\caresource.com	http:\\caresource.com	https://memberportal.caresource.com/App/OH/FindADoctor/MA	(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(844)607-2827		(844)607-2827		(844)607-2830		(844)607-2830		(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	2			
H6425	1	0	1	20	8	H6425_001_0	1	1			05/31/2019	2020.01	05/31/2019 09:31:16 AM Central Daylight Time		05/28/2019 10:51:50 AM Central Daylight Time			05/31/2019 09:36:01 AM Central Daylight Time	WASHINGTON REGIONAL MEDICORP	PACE of the Ozarks	www.wregional.com	Washington Regional Medicorp PACE of the Ozarks (PACE)	8	20		1			H6425	1	0	2020	Northwest Arkansas		2		2			2						www.carekinesis.com	N/A												(479)463-6600				(479)463-6600												(711)-				(711)-																
H6425	2	0	1	20	8	H6425_002_0	1	1			05/31/2019	2020.01	05/31/2019 09:31:36 AM Central Daylight Time		05/28/2019 10:52:32 AM Central Daylight Time			05/31/2019 09:36:01 AM Central Daylight Time	WASHINGTON REGIONAL MEDICORP	PACE of the Ozarks	www.wregional.com	Washington Regional Medicorp PACE of the Ozarks (PACE)	8	20		1			H6425	2	0	2020	Northwest Arkansas		2		2			2						www.carekinesis.com	N/A												(479)463-6600				(479)463-6600												(711)-				(711)-																
H6439	2	0	1	1	1	H6439_002_0	5	1			07/11/2019	2020.01	07/11/2019 03:09:39 PM Eastern Daylight Time	08/02/2019 08:31:34 AM Eastern Daylight Time	07/30/2019 11:12:20 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH PLANS OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H6439	2	0	2020	Select counties in Arizona		2	31652	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6439	3	0	1	1	1	H6439_003_0	5	1			07/11/2019	2020.01	07/11/2019 03:09:24 PM Eastern Daylight Time	08/02/2019 08:33:09 AM Eastern Daylight Time	07/30/2019 11:12:55 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH PLANS OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Compass (HMO)	1	1		1			H6439	3	0	2020	Select counties in Arizona		2	2093	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6439	4	0	1	1	1	H6439_004_0	5	1			07/16/2019	2020.01	07/16/2019 12:30:08 PM Eastern Daylight Time	08/02/2019 08:34:45 AM Eastern Daylight Time	07/30/2019 11:13:31 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	"WELLCARE HEALTH PLANS OF ARIZONA, INC."	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H6439	4	0	2020	Select counties in Arizona		2	2624	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6446	1	0	1	1	1	H6446_001_0	3	1			08/01/2019	2020.01	08/01/2019 12:48:22 PM Pacific Daylight Time	08/05/2019 04:04:31 PM Central Daylight Time	08/05/2019 03:30:55 PM Central Daylight Time			08/06/2019 10:41:48 AM Central Daylight Time	"SILVERSUMMIT HEALTHPLAN, INC."	Allwell	allwell.silversummithealthplan.com	Allwell Medicare (HMO)	1	1		1			H6446	1	0	2020	Clark and Nye Counties		2		2			2						allwell.silversummithealthplan.com/findadoctor	allwell.silversummithealthplan.com/formulary	allwell.silversummithealthplan.com/findadoctor	(833)854-4766		(833)854-4766		(800)606-3604		(800)606-3604		(833)854-4766		(833)854-4766		(800)606-3604		(800)606-3604		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	5	0	1	1	1	H6453_005_0	9	1			07/23/2019	2020.01	07/23/2019 10:46:49 AM Central Daylight Time	08/06/2019 09:19:40 AM Central Daylight Time	08/06/2019 09:47:06 AM Central Daylight Time			08/06/2019 12:02:30 PM Central Daylight Time	"HMO LOUISIANA, INC."	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	1	1		1			H6453	5	0	2020	Northwest Parishes		2	7596	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	6	0	1	1	1	H6453_006_0	9	1			07/23/2019	2020.01	07/23/2019 10:47:12 AM Central Daylight Time	08/06/2019 09:24:58 AM Central Daylight Time	08/06/2019 09:49:10 AM Central Daylight Time			08/06/2019 12:02:30 PM Central Daylight Time	"HMO LOUISIANA, INC."	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	1	1		1			H6453	6	0	2020	Northeast Parishes		2	6264	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	7	1	1	1	1	H6453_007_1	9	1			07/23/2019	2020.01	07/23/2019 10:39:56 AM Central Daylight Time	08/06/2019 09:26:40 AM Central Daylight Time	08/06/2019 09:51:16 AM Central Daylight Time			08/06/2019 12:02:30 PM Central Daylight Time	"HMO LOUISIANA, INC."	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	1	1		1			H6453	7	1	2020	Baton Rouge	"Ascension, East Baton Rouge"	2	26568	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	7	2	1	1	1	H6453_007_2	9	1			07/23/2019	2020.01	07/23/2019 10:40:41 AM Central Daylight Time	08/06/2019 09:27:56 AM Central Daylight Time	08/06/2019 09:53:38 AM Central Daylight Time			08/06/2019 12:02:30 PM Central Daylight Time	"HMO LOUISIANA, INC."	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	1	1		1			H6453	7	2	2020	Baton Rouge	"West Baton Rouge Parishes, Select Parishes"	2	5784	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	8	1	1	1	1	H6453_008_1	9	1			07/23/2019	2020.01	07/23/2019 10:41:50 AM Central Daylight Time	08/06/2019 09:30:38 AM Central Daylight Time	08/06/2019 09:54:42 AM Central Daylight Time			08/06/2019 12:02:30 PM Central Daylight Time	"HMO LOUISIANA, INC."	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	1	1		1			H6453	8	1	2020	Greater New Orleans	"Terrebonne, Lafourche, Greater New Orleans"	2	31068	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	8	2	1	1	1	H6453_008_2	9	1			07/23/2019	2020.01	07/23/2019 10:42:34 AM Central Daylight Time	08/06/2019 09:33:18 AM Central Daylight Time	08/06/2019 09:55:42 AM Central Daylight Time			08/06/2019 12:02:30 PM Central Daylight Time	"HMO LOUISIANA, INC."	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	1	1		1			H6453	8	2	2020	Greater New Orleans	"Assumption, Plaquemines, Select Parishes"	2	10632	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	9	1	1	1	1	H6453_009_1	9	1			07/23/2019	2020.01	07/23/2019 10:43:20 AM Central Daylight Time	08/06/2019 09:11:42 AM Central Daylight Time	08/06/2019 09:57:48 AM Central Daylight Time			08/06/2019 12:02:30 PM Central Daylight Time	"HMO LOUISIANA, INC."	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	1	1		1			H6453	9	1	2020	North Shore	"St. Tammany, Tangipahoa"	2	35172	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	9	2	1	1	1	H6453_009_2	9	1			07/23/2019	2020.01	07/23/2019 10:44:55 AM Central Daylight Time	08/06/2019 09:13:12 AM Central Daylight Time	08/06/2019 09:41:20 AM Central Daylight Time			08/06/2019 12:02:30 PM Central Daylight Time	"HMO LOUISIANA, INC."	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	1	1		1			H6453	9	2	2020	North Shore	Washington	2	4524	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	10	1	1	1	1	H6453_010_1	9	1			07/23/2019	2020.01	07/23/2019 10:45:45 AM Central Daylight Time	08/06/2019 09:18:26 AM Central Daylight Time	08/06/2019 09:48:16 AM Central Daylight Time			08/06/2019 12:02:30 PM Central Daylight Time	"HMO LOUISIANA, INC."	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	1	1		1			H6453	10	1	2020	Acadiana	"Rapides, Calcasieu, Greater Lafayette Parishes"	2	32016	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	10	2	1	1	1	H6453_010_2	9	1			07/23/2019	2020.01	07/23/2019 10:46:18 AM Central Daylight Time	08/06/2019 09:23:14 AM Central Daylight Time	08/06/2019 09:50:20 AM Central Daylight Time			08/06/2019 12:02:30 PM Central Daylight Time	"HMO LOUISIANA, INC."	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	1	1		1			H6453	10	2	2020	Acadiana	"Avoyelles, Grant, St. Mary, Southwest Parishes"	2	6600	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6453	801	0	1	1	1	H6453_801_0	6	1			06/13/2019	2020.01	06/13/2019 05:14:38 PM Central Daylight Time					06/18/2019 03:41:48 PM Central Daylight Time	"HMO LOUISIANA, INC."	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	1	1		1			H6453	801	0	2020	State of Louisiana		1	3293	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;	2		1					1				
H6453	802	0	1	1	1	H6453_802_0	6	1			06/13/2019	2020.01	06/13/2019 05:02:58 PM Central Daylight Time					06/18/2019 03:41:48 PM Central Daylight Time	"HMO LOUISIANA, INC."	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	1	1		1			H6453	802	0	2020	State of Louisiana		1	1	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;15;	2		1					1				
H6453	803	0	1	1	1	H6453_803_0	6	1			06/13/2019	2020.01	06/13/2019 05:07:16 PM Central Daylight Time					06/18/2019 03:41:48 PM Central Daylight Time	"HMO LOUISIANA, INC."	Blue Cross and Blue Shield of Louisiana HMO	www.bcbsla.com/blueadvantage	Blue Advantage (HMO)	1	1		1			H6453	803	0	2020	State of Louisiana		1	1	2			2						www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	www.bcbsla.com/blueadvantage	(866)508-7145		(866)508-7145		(800)363-9152		(800)363-9152										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;	2		1					1				
H6502	1	0	1	4	1	H6502_001_0	16	1			07/17/2019	2020.01	07/17/2019 01:45:59 PM Central Daylight Time	08/06/2019 09:31:49 AM Central Daylight Time	08/06/2019 09:32:08 AM Central Daylight Time			08/06/2019 09:35:27 AM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Cross and Blue Shield of Kansas City (Blue KC	www.MedicareBlueKC.com	Blue Medicare Advantage Access (PPO)	1	4		1			H6502	1	0	2020	Kansas City Area		2		2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6502	2	0	1	4	1	H6502_002_0	16	1			07/17/2019	2020.01	07/17/2019 01:46:19 PM Central Daylight Time	08/06/2019 09:31:49 AM Central Daylight Time	08/06/2019 09:32:09 AM Central Daylight Time			08/06/2019 09:35:27 AM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Cross and Blue Shield of Kansas City (Blue KC	www.BlueKCMA.com	Blue Medicare Advantage Essential (PPO)	1	4		1			H6502	2	0	2020	Kansas City Area		2		2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6502	801	0	1	4	1	H6502_801_0	3	1			05/30/2019	2020.01	05/30/2019 07:07:56 PM Central Daylight Time					06/03/2019 01:51:23 PM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Cross and Blue Shield of Kansas City (Blue KC	www.MedicareBlueKC.com	Blue Medicare Advantage Employer Group MA-CY (PPO)	1	4		1			H6502	801	0	2020	Kansas City Area		1	13200	2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7e;7g;7h;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H6502	802	0	1	4	1	H6502_802_0	3	1			05/30/2019	2020.01	05/30/2019 07:11:31 PM Central Daylight Time					06/03/2019 01:51:23 PM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Cross and Blue Shield of Kansas City (Blue KC	www.MedicareBlueKC.com	Blue Medicare Advantage Employer Group MAPD - CY (PPO)	1	4		1			H6502	802	0	2020	Kansas City Area		1	13200	2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7e;7g;7h;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H6502	803	0	1	4	1	H6502_803_0	3	1			05/30/2019	2020.01	05/30/2019 07:14:26 PM Central Daylight Time					06/03/2019 01:51:23 PM Central Daylight Time	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Blue Cross and Blue Shield of Kansas City (Blue KC	www.MedicareBlueKC.com	Blue Medicare Advantage Employer Group MAPD - BY (PPO)	1	4		1			H6502	803	0	2020	Kansas City Area		1	13200	2			2						www.BlueKCMA.com	www.BlueKCMA.com	www.BlueKCMA.com	(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(866)508-7140		(866)508-7140		(855)208-8246		(816)395-3152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7e;7g;7h;7k;8a;8b1;8b2;9a1;9a2;9b;9c;10a;11a;11b;11c;15;	2		1									
H6526	1	0	1	1	1	H6526_001_0	2	1			07/12/2019	2020.01	07/12/2019 09:26:15 AM Central Daylight Time	08/02/2019 11:01:24 AM Central Daylight Time	07/30/2019 09:54:31 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW MEXICO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H6526	1	0	2020	"Bernalillo, Sandoval, and Valencia counties"		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6526	2	0	1	1	1	H6526_002_0	3	1			07/12/2019	2020.01	07/12/2019 09:26:26 AM Central Daylight Time	08/02/2019 11:02:07 AM Central Daylight Time	07/30/2019 09:55:05 PM Central Daylight Time			08/06/2019 09:10:37 AM Central Daylight Time	"UNITEDHEALTHCARE OF NEW MEXICO, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage (HMO)	1	1		1			H6526	2	0	2020	Santa Fe Metro area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6528	6	0	1	4	1	H6528_006_0	3	1			08/02/2019	2020.01	08/02/2019 11:57:57 AM Central Daylight Time	08/02/2019 11:19:24 AM Central Daylight Time	07/30/2019 09:55:37 PM Central Daylight Time			08/06/2019 09:57:12 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 1 (PPO)	1	4		1			H6528	6	0	2020	"Barrow, Forsyth, Gwinnett, and Hall Counties"		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6550	1	0	1	1	1	H6550_001_0	3	1			08/01/2019	2020.01	08/01/2019 12:44:24 PM Pacific Daylight Time	08/05/2019 04:21:59 PM Central Daylight Time	08/05/2019 03:31:48 PM Central Daylight Time			08/06/2019 10:49:17 AM Central Daylight Time	"SUNFLOWER STATE HEALTH PLAN, INC."	Allwell	allwell.sunflowerhealthplan.com	Allwell Medicare (HMO)	1	1		1			H6550	1	0	2020	"Counties: JO, LV, MM, WY, DO, LN"		2		2			2						allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	3	0	1	1	1	H6550_003_0	2	1			08/01/2019	2020.01	08/01/2019 12:45:09 PM Pacific Daylight Time	08/05/2019 04:21:50 PM Central Daylight Time	08/05/2019 03:31:42 PM Central Daylight Time			08/06/2019 10:49:17 AM Central Daylight Time	"SUNFLOWER STATE HEALTH PLAN, INC."	Allwell	allwell.sunflowerhealthplan.com	Allwell Medicare (HMO)	1	1		1			H6550	3	0	2020	"Counties: AN, BO, BU, CH, CW, HV, SG, SR, WO"		2		2			2						allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	4	0	1	1	1	H6550_004_0	3	1	2	1	08/01/2019	2020.01	08/01/2019 12:47:18 PM Pacific Daylight Time	08/05/2019 04:21:54 PM Central Daylight Time	08/05/2019 03:31:45 PM Central Daylight Time			08/06/2019 10:49:17 AM Central Daylight Time	"SUNFLOWER STATE HEALTH PLAN, INC."	Allwell	allwell.sunflowerhealthplan.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H6550	4	0	2020	Kansas City and Wichita Metro Areas		2		2			1	3		1		1	allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6550	801	0	1	1	1	H6550_801_0	2	1			05/03/2019	2020.01	05/03/2019 02:22:57 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"SUNFLOWER STATE HEALTH PLAN, INC."	Allwell	allwell.sunflowerhealthplan.com	Allwell Group (HMO)	1	1		1			H6550	801	0	2020	Kansas		1	100	2			2						allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6550	802	0	1	1	1	H6550_802_0	2	1			05/03/2019	2020.01	05/03/2019 02:23:14 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"SUNFLOWER STATE HEALTH PLAN, INC."	Allwell	allwell.sunflowerhealthplan.com	Allwell Group (HMO)	1	1		1			H6550	802	0	2020	Kansas		1	100	2			2						allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6550	803	0	1	1	1	H6550_803_0	2	1			05/03/2019	2020.01	05/03/2019 02:24:19 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"SUNFLOWER STATE HEALTH PLAN, INC."	Allwell	allwell.sunflowerhealthplan.com	Allwell Group (HMO)	1	1		1			H6550	803	0	2020	Kansas		1	100	2			2						allwell.sunflowerhealthplan.com/findadoctor	allwell.sunflowerhealthplan.com/formulary	allwell.sunflowerhealthplan.com/findadoctor	(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(855)565-9519		(855)565-9519		(877)891-6094		(877)891-6094		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6551	1	0	1	20	8	H6551_001_0	1	1			05/22/2019	2020.01	05/22/2019 12:36:41 PM Eastern Daylight Time		05/22/2019 12:23:29 PM Eastern Daylight Time			05/22/2019 12:40:47 PM Eastern Daylight Time	LIFE ST. MARY	LIFE St. Mary	http://www.lifestmary.org/	LIFE St. Mary (PACE)	8	20		1			H6551	1	0	2020	Bucks County and Partial Montgomery County		2		2			2						stmaryhealthcare.org	stmaryhealthcare.org										(267)991-7600		(267)991-7600		(267)991-7601		(267)991-7601										(267)991-7600		(267)991-7600		(267)991-7601		(267)991-7601																
H6551	2	0	1	20	8	H6551_002_0	1	1			05/22/2019	2020.01	05/22/2019 12:37:13 PM Eastern Daylight Time		05/22/2019 12:19:37 PM Eastern Daylight Time			05/22/2019 12:40:47 PM Eastern Daylight Time	LIFE ST. MARY	LIFE St. Mary	www.lifestmary.org	LIFE St. Mary (PACE)	8	20		1			H6551	2	0	2020	Bucks County and Partical Montgomery County		2		2			2						stmaryhealthcare.org	stmaryhealthcare.org										(267)991-7600		(267)991-7600		(267)991-7601		(267)991-7601										(267)991-7600		(267)991-7600		(267)991-7601		(267)991-7601																
H6595	1	0	1	1	1	H6595_001_0	4	1	2	1	08/06/2019	2020.01	08/06/2019 09:36:56 AM Central Daylight Time	08/02/2019 11:08:31 AM Central Daylight Time	07/30/2019 09:56:13 PM Central Daylight Time			08/06/2019 03:47:42 PM Central Daylight Time	"UNITEDHEALTHCARE OF KENTUCKY, LTD."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H6595	1	0	2020	Select Counties in Kentucky		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)855-9774		(844)855-9774		(888)834-3721		(888)834-3721		(844)855-9774		(844)855-9774		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6596	1	0	1	20	8	H6596_001_0	1	1			06/03/2019	2020.01	06/03/2019 11:47:21 PM Eastern Daylight Time		06/03/2019 11:46:39 PM Eastern Daylight Time			06/03/2019 11:47:55 PM Eastern Daylight Time	"FALLON HEALTH WEINBERG, INC."	Fallon Health Weinberg-PACE	fallonweinberg.org	Fallon Health Weinberg-PACE (PACE)	8	20		1			H6596	1	0	2020	Erie County		2	2080	2			2						Not applicable	fallonweinberg.org	fallonweinberg.org									(855)665-1113		(716)810-1895		(855)665-1113		(716)810-1895										(711)-		(711)-		(711)-		(711)-																
H6596	2	0	1	20	8	H6596_002_0	1	1			06/03/2019	2020.01	06/03/2019 11:47:28 PM Eastern Daylight Time		06/03/2019 11:46:32 PM Eastern Daylight Time			06/03/2019 11:47:55 PM Eastern Daylight Time	"FALLON HEALTH WEINBERG, INC."	Fallon Health Weinberg-PACE	fallonweinberg.org	Fallon Health Weinberg-PACE (PACE)	8	20		1			H6596	2	0	2020	Erie County		2	17	2			2						Not applicable	fallonweinberg.org	fallonweinberg.org									(855)665-1113		(716)810-1895		(855)665-1113		(716)810-1895										(711)-		(711)-		(711)-		(711)-																
H6622	1	0	1	1	1	H6622_001_0	3	1			08/01/2019	2020.01	08/01/2019 03:38:21 PM Eastern Daylight Time	08/04/2019 02:57:57 PM Eastern Daylight Time	08/02/2019 01:18:52 PM Eastern Daylight Time			08/05/2019 11:17:32 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-001 (HMO)	1	1		1			H6622	1	0	2020	Green Bay area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	2	0	1	1	1	H6622_002_0	3	1			07/15/2019	2020.01	07/15/2019 11:57:42 AM Eastern Daylight Time	08/04/2019 02:59:09 PM Eastern Daylight Time	08/02/2019 01:18:52 PM Eastern Daylight Time			08/05/2019 11:17:32 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-002 (HMO)	1	1		1			H6622	2	0	2020	Milwaukee area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	4	0	1	1	1	H6622_004_0	4	1			08/02/2019	2020.01	08/02/2019 06:19:44 PM Eastern Daylight Time	08/04/2019 04:35:43 PM Eastern Daylight Time	08/02/2019 01:18:52 PM Eastern Daylight Time			08/05/2019 11:15:31 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-004 (HMO)	1	1		1			H6622	4	0	2020	Richmond Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	5	0	1	1	1	H6622_005_0	4	1			08/01/2019	2020.01	08/01/2019 07:26:17 PM Eastern Daylight Time	08/04/2019 04:36:31 PM Eastern Daylight Time	08/02/2019 01:18:52 PM Eastern Daylight Time			08/05/2019 11:15:31 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-005 (HMO)	1	1		1			H6622	5	0	2020	Tidewater Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	7	0	1	1	1	H6622_007_0	4	1			07/15/2019	2020.01	07/15/2019 03:01:51 PM Eastern Daylight Time	08/04/2019 03:05:19 PM Eastern Daylight Time	08/02/2019 01:18:52 PM Eastern Daylight Time			08/05/2019 11:23:48 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-007 (HMO)	1	1		1			H6622	7	0	2020	Select Counties in Montana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	8	0	1	1	1	H6622_008_0	6	1	2	1	07/19/2019	2020.01	07/19/2019 03:14:45 PM Eastern Daylight Time	08/04/2019 03:11:25 PM Eastern Daylight Time	08/02/2019 01:18:53 PM Eastern Daylight Time			08/05/2019 11:23:48 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-008 (HMO D-SNP)	1	1		1			H6622	8	0	2020	Select Counties in Montana		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	10	0	1	1	1	H6622_010_0	4	1			08/01/2019	2020.01	08/01/2019 07:27:36 PM Eastern Daylight Time	08/04/2019 04:39:46 PM Eastern Daylight Time	08/02/2019 01:18:53 PM Eastern Daylight Time			08/05/2019 11:15:31 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-010 (HMO)	1	1		1			H6622	10	0	2020	"Kent, New Castle and Sussex Counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	11	0	1	1	1	H6622_011_0	3	1			07/15/2019	2020.01	07/15/2019 01:41:51 PM Eastern Daylight Time	08/04/2019 02:39:30 PM Eastern Daylight Time	08/02/2019 01:18:53 PM Eastern Daylight Time			08/05/2019 10:59:57 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-011 (HMO)	1	1		1			H6622	11	0	2020	Cleveland Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	13	0	1	1	1	H6622_013_0	3	1			08/01/2019	2020.01	08/01/2019 06:19:47 PM Eastern Daylight Time	08/04/2019 02:43:19 PM Eastern Daylight Time	08/02/2019 01:18:53 PM Eastern Daylight Time			08/05/2019 11:24:16 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-013 (HMO)	1	1		1			H6622	13	0	2020	Columbus Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	14	0	1	1	1	H6622_014_0	3	1			08/01/2019	2020.01	08/01/2019 06:21:31 PM Eastern Daylight Time	08/04/2019 02:44:05 PM Eastern Daylight Time	08/02/2019 01:18:53 PM Eastern Daylight Time			08/05/2019 11:24:16 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-014 (HMO)	1	1		1			H6622	14	0	2020	Canton-Akron Metro Areas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	15	0	1	1	1	H6622_015_0	6	1	2	1	07/19/2019	2020.01	07/19/2019 03:47:52 PM Eastern Daylight Time	08/04/2019 02:44:50 PM Eastern Daylight Time	08/02/2019 01:18:53 PM Eastern Daylight Time			08/05/2019 11:24:16 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP)	1	1		1			H6622	15	0	2020	Select counties in Ohio		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	16	0	1	1	1	H6622_016_0	3	1			08/01/2019	2020.01	08/01/2019 06:24:26 PM Eastern Daylight Time	08/04/2019 02:46:20 PM Eastern Daylight Time	08/02/2019 01:18:53 PM Eastern Daylight Time			08/05/2019 11:24:16 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-016 (HMO)	1	1		1			H6622	16	0	2020	Select Counties in Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	17	0	1	1	1	H6622_017_0	3	1		1	07/15/2019	2020.01	07/15/2019 01:08:54 PM Eastern Daylight Time	08/04/2019 02:47:51 PM Eastern Daylight Time	08/02/2019 01:18:53 PM Eastern Daylight Time			08/05/2019 11:24:16 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	1	1		1			H6622	17	0	2020	Cincinnati and Columbus area		2		2			1	4			10		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	18	0	1	1	1	H6622_018_0	7	1	2	1	07/19/2019	2020.01	07/19/2019 03:40:46 PM Eastern Daylight Time	08/04/2019 02:49:22 PM Eastern Daylight Time	08/02/2019 01:18:53 PM Eastern Daylight Time			08/05/2019 11:24:16 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-018 (HMO D-SNP)	1	1		1			H6622	18	0	2020	Northern Kentucky Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	19	0	1	1	1	H6622_019_0	3	1			07/15/2019	2020.01	07/15/2019 01:12:07 PM Eastern Daylight Time	08/04/2019 02:55:23 PM Eastern Daylight Time	08/02/2019 01:18:54 PM Eastern Daylight Time			08/05/2019 11:34:35 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-019 (HMO)	1	1		1			H6622	19	0	2020	Select Counties in Ohio and Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	21	1	1	1	1	H6622_021_1	3	1			08/01/2019	2020.01	08/01/2019 06:27:28 PM Eastern Daylight Time	08/04/2019 02:53:07 PM Eastern Daylight Time	08/02/2019 01:18:54 PM Eastern Daylight Time			08/05/2019 11:34:35 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-021 (HMO)	1	1		1			H6622	21	1	2020	Select KY counties in Cincinnati Metro Area	Select KY counties in Cincinnati Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	21	2	1	1	1	H6622_021_2	3	1			08/01/2019	2020.01	08/01/2019 06:28:50 PM Eastern Daylight Time	08/04/2019 02:53:52 PM Eastern Daylight Time	08/02/2019 01:18:54 PM Eastern Daylight Time			08/05/2019 11:34:35 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-021 (HMO)	1	1		1			H6622	21	2	2020	Select KY counties in Cincinnati Metro Area	Select OH counties in Cincinnati Metro Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	22	0	1	1	1	H6622_022_0	4	1			08/01/2019	2020.01	08/01/2019 02:46:19 PM Eastern Daylight Time	08/04/2019 02:58:23 PM Eastern Daylight Time	08/02/2019 01:18:54 PM Eastern Daylight Time			08/05/2019 10:59:57 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-022 (HMO)	1	1		1			H6622	22	0	2020	Select counties in Cleveland		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	23	0	1	1	1	H6622_023_0	4	1			08/01/2019	2020.01	08/01/2019 06:33:26 PM Eastern Daylight Time	08/04/2019 03:03:37 PM Eastern Daylight Time	08/02/2019 01:18:54 PM Eastern Daylight Time			08/05/2019 10:59:57 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Cleveland Clinic Preferred (HMO)	1	1		1			H6622	23	0	2020	Select counties in Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	25	0	1	1	1	H6622_025_0	3	1			08/01/2019	2020.01	08/01/2019 06:55:48 PM Eastern Daylight Time	08/04/2019 04:45:38 PM Eastern Daylight Time	08/02/2019 01:18:54 PM Eastern Daylight Time			08/05/2019 11:22:57 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-025 (HMO)	1	1		1			H6622	25	0	2020	Western North Carolina Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	26	0	1	1	1	H6622_026_0	3	1			07/15/2019	2020.01	07/15/2019 12:52:45 PM Eastern Daylight Time	08/04/2019 04:42:26 PM Eastern Daylight Time	08/02/2019 01:18:54 PM Eastern Daylight Time			08/05/2019 11:22:57 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-026 (HMO)	1	1		1			H6622	26	0	2020	Western North Carolina Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	27	0	1	1	1	H6622_027_0	2	1	2	1	06/01/2019	2020.01	06/01/2019 02:08:18 PM Eastern Daylight Time	08/04/2019 04:43:13 PM Eastern Daylight Time	08/02/2019 01:18:54 PM Eastern Daylight Time			08/05/2019 11:22:57 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-027 (HMO D-SNP)	1	1		1			H6622	27	0	2020	Western North Carolina Area		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	28	0	1	1	1	H6622_028_0	5	1			08/01/2019	2020.01	08/01/2019 04:21:44 PM Eastern Daylight Time	08/03/2019 10:18:24 AM Eastern Daylight Time	08/02/2019 01:18:55 PM Eastern Daylight Time			08/05/2019 11:18:38 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-028 (HMO)	1	1		1			H6622	28	0	2020	Clark and Nye (partial) counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	29	0	1	1	1	H6622_029_0	4	1		1	08/01/2019	2020.01	08/01/2019 04:29:34 PM Eastern Daylight Time	08/03/2019 10:14:57 AM Eastern Daylight Time	08/02/2019 01:18:55 PM Eastern Daylight Time			08/05/2019 11:18:38 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus - Diabetes and Heart (HMO C-SNP)	1	1		1			H6622	29	0	2020	Clark and Nye (partial) counties		2		2			1	4			10		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	30	0	1	1	1	H6622_030_0	4	1		1	08/01/2019	2020.01	08/01/2019 04:35:33 PM Eastern Daylight Time	08/03/2019 10:16:49 AM Eastern Daylight Time	08/02/2019 01:18:55 PM Eastern Daylight Time			08/05/2019 11:18:38 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus Lung (HMO C-SNP)	1	1		1			H6622	30	0	2020	Clark and Nye (partial) counties		2		2			1	4			100000000		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	31	0	1	1	1	H6622_031_0	9	1		1	08/01/2019	2020.01	08/01/2019 04:44:22 PM Eastern Daylight Time		08/02/2019 01:18:55 PM Eastern Daylight Time		08/04/2019 10:31:50 AM Eastern Daylight Time	08/05/2019 11:18:38 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Kidney Care (HMO C-SNP)	1	1		1			H6622	31	0	2020	Clark and Nye (partial) counties		2		2			1	4			1E+11		https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	32	0	1	1	1	H6622_032_0	3	1			08/01/2019	2020.01	08/01/2019 02:42:20 PM Eastern Daylight Time	08/02/2019 10:06:56 AM Eastern Daylight Time	08/02/2019 01:18:55 PM Eastern Daylight Time			08/05/2019 11:14:25 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-032 (HMO)	1	1		1			H6622	32	0	2020	Select Counties in Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	33	0	1	1	1	H6622_033_0	2	1			08/01/2019	2020.01	08/01/2019 02:47:28 PM Eastern Daylight Time	08/02/2019 10:08:51 AM Eastern Daylight Time	08/02/2019 01:18:55 PM Eastern Daylight Time			08/05/2019 11:14:25 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-033 (HMO)	1	1		1			H6622	33	0	2020	Select Counties in Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	34	0	1	1	1	H6622_034_0	3	1			08/01/2019	2020.01	08/01/2019 03:38:58 PM Eastern Daylight Time	08/04/2019 03:22:02 PM Eastern Daylight Time	08/02/2019 01:18:55 PM Eastern Daylight Time			08/05/2019 11:17:32 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-034 (HMO)	1	1		1			H6622	34	0	2020	Milwaukee area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	35	0	1	1	1	H6622_035_0	3	1			08/02/2019	2020.01	08/02/2019 04:54:32 PM Eastern Daylight Time	08/04/2019 06:36:16 PM Eastern Daylight Time	08/02/2019 01:18:55 PM Eastern Daylight Time			08/05/2019 11:27:24 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-035 (HMO)	1	1		1			H6622	35	0	2020	Central-Western Pennsylvania area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	36	0	1	1	1	H6622_036_0	3	1			08/01/2019	2020.01	08/01/2019 07:35:54 PM Eastern Daylight Time	08/04/2019 06:38:06 PM Eastern Daylight Time	08/02/2019 01:18:55 PM Eastern Daylight Time			08/05/2019 11:27:24 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-036 (HMO)	1	1		1			H6622	36	0	2020	Northeast Pennsylvania Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	37	0	1	1	1	H6622_037_0	3	1			08/01/2019	2020.01	08/01/2019 07:08:38 PM Eastern Daylight Time	08/04/2019 06:39:52 PM Eastern Daylight Time	08/02/2019 01:18:56 PM Eastern Daylight Time			08/05/2019 11:27:24 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-037 (HMO)	1	1		1			H6622	37	0	2020	Greater Philadelphia Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	38	0	1	1	1	H6622_038_0	2	1	2	1	05/30/2019	2020.01	05/30/2019 04:37:50 PM Eastern Daylight Time	08/04/2019 06:57:02 PM Eastern Daylight Time	08/02/2019 01:18:56 PM Eastern Daylight Time			08/05/2019 11:27:24 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-038 (HMO D-SNP)	1	1		1			H6622	38	0	2020	Select counties in Pennsylvania		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	40	0	1	1	1	H6622_040_0	3	1			08/01/2019	2020.01	08/01/2019 03:46:51 PM Eastern Daylight Time	08/04/2019 03:24:15 PM Eastern Daylight Time	08/02/2019 01:18:56 PM Eastern Daylight Time			08/05/2019 11:17:32 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-040 (HMO)	1	1		1			H6622	40	0	2020	Milwaukee area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	41	0	1	1	1	H6622_041_0	2	1			08/01/2019	2020.01	08/01/2019 07:28:23 PM Eastern Daylight Time	08/04/2019 04:47:14 PM Eastern Daylight Time	08/02/2019 01:18:56 PM Eastern Daylight Time			08/05/2019 11:15:31 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-041 (HMO)	1	1		1			H6622	41	0	2020	Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	47	0	1	1	1	H6622_047_0	4	1			08/01/2019	2020.01	08/01/2019 12:30:23 PM Eastern Daylight Time	08/03/2019 11:31:59 AM Eastern Daylight Time	08/02/2019 01:18:56 PM Eastern Daylight Time			08/05/2019 11:17:46 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-047 (HMO)	1	1		1			H6622	47	0	2020	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	48	0	1	1	1	H6622_048_0	6	1	2	1	08/01/2019	2020.01	08/01/2019 12:31:37 PM Eastern Daylight Time	08/03/2019 11:29:59 AM Eastern Daylight Time	08/02/2019 01:18:56 PM Eastern Daylight Time			08/05/2019 11:17:46 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-048 (HMO D-SNP)	1	1		1			H6622	48	0	2020	Select Counties in Mississippi		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	49	0	1	1	1	H6622_049_0	3	1			07/15/2019	2020.01	07/15/2019 10:56:58 AM Eastern Daylight Time	08/02/2019 10:23:34 AM Eastern Daylight Time	08/02/2019 01:18:56 PM Eastern Daylight Time			08/05/2019 11:14:25 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Value Plus H6622-049 (HMO)	1	1		1			H6622	49	0	2020	Select Counties in Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	50	1	1	1	1	H6622_050_1	4	1			08/02/2019	2020.01	08/02/2019 12:10:26 PM Eastern Daylight Time	08/04/2019 04:51:15 PM Eastern Daylight Time	08/02/2019 01:18:56 PM Eastern Daylight Time			08/05/2019 11:15:31 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-050 (HMO)	1	1		1			H6622	50	1	2020	Richmond - Tidewater Area	Richmond	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	50	2	1	1	1	H6622_050_2	2	1			08/01/2019	2020.01	08/01/2019 07:29:11 PM Eastern Daylight Time	08/04/2019 04:52:03 PM Eastern Daylight Time	08/02/2019 01:18:57 PM Eastern Daylight Time			08/05/2019 11:15:31 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-050 (HMO)	1	1		1			H6622	50	2	2020	Richmond - Tidewater Area	Richmond - Tidewater Area	2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	51	0	1	1	1	H6622_051_0	2	1	2	1	06/01/2019	2020.01	06/01/2019 02:18:11 PM Eastern Daylight Time	08/04/2019 04:50:28 PM Eastern Daylight Time	08/02/2019 01:18:57 PM Eastern Daylight Time			08/05/2019 11:15:31 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H6622-051 (HMO D-SNP)	1	1		1			H6622	51	0	2020	"Kent, New Castle and Sussex Counties"		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	52	0	1	1	1	H6622_052_0	3	1			08/01/2019	2020.01	08/01/2019 06:27:53 PM Eastern Daylight Time	08/04/2019 07:20:16 PM Eastern Daylight Time	08/02/2019 01:18:57 PM Eastern Daylight Time			08/05/2019 11:34:27 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-052 (HMO)	1	1		1			H6622	52	0	2020	Guthrie		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	54	0	1	1	1	H6622_054_0	3	1			08/01/2019	2020.01	08/01/2019 06:30:26 PM Eastern Daylight Time	08/04/2019 07:14:24 PM Eastern Daylight Time	08/02/2019 01:18:57 PM Eastern Daylight Time			08/05/2019 11:34:27 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-054 (HMO)	1	1		1			H6622	54	0	2020	Pittsburgh		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	55	0	1	1	1	H6622_055_0	3	1			08/01/2019	2020.01	08/01/2019 06:31:40 PM Eastern Daylight Time	08/04/2019 03:09:37 PM Eastern Daylight Time	08/02/2019 01:18:57 PM Eastern Daylight Time			08/05/2019 11:34:35 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-055 (HMO)	1	1		1			H6622	55	0	2020	Select counties in Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	56	0	1	1	1	H6622_056_0	3	1			08/01/2019	2020.01	08/01/2019 04:55:02 PM Eastern Daylight Time	08/03/2019 10:48:52 AM Eastern Daylight Time	08/02/2019 01:18:57 PM Eastern Daylight Time			08/05/2019 11:18:38 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-056 (HMO)	1	1		1			H6622	56	0	2020	Clark and Nye (partial) counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	57	0	1	1	1	H6622_057_0	3	1			07/15/2019	2020.01	07/15/2019 12:54:54 PM Eastern Daylight Time	08/04/2019 05:04:04 PM Eastern Daylight Time	08/02/2019 01:18:57 PM Eastern Daylight Time			08/05/2019 11:22:57 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-057 (HMO)	1	1		1			H6622	57	0	2020	Charlotte Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	58	0	1	1	1	H6622_058_0	3	1			08/01/2019	2020.01	08/01/2019 07:01:30 PM Eastern Daylight Time	08/04/2019 05:04:52 PM Eastern Daylight Time	08/02/2019 01:18:57 PM Eastern Daylight Time			08/05/2019 11:22:57 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-058 (HMO)	1	1		1			H6622	58	0	2020	Charlotte Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	59	0	1	1	1	H6622_059_0	4	1			07/15/2019	2020.01	07/15/2019 01:25:55 PM Eastern Daylight Time	08/03/2019 11:53:31 AM Eastern Daylight Time	08/02/2019 01:18:58 PM Eastern Daylight Time			08/05/2019 11:17:46 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-059 (HMO)	1	1		1			H6622	59	0	2020	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	60	0	1	1	1	H6622_060_0	3	1			08/01/2019	2020.01	08/01/2019 07:31:13 PM Eastern Daylight Time	08/04/2019 05:06:29 PM Eastern Daylight Time	08/02/2019 01:18:58 PM Eastern Daylight Time			08/05/2019 11:13:56 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-060 (HMO)	1	1		1			H6622	60	0	2020	Triangle Perimeter		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)233-8364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	61	0	1	1	1	H6622_061_0	3	1			08/01/2019	2020.01	08/01/2019 07:32:49 PM Eastern Daylight Time	08/04/2019 05:07:17 PM Eastern Daylight Time	08/02/2019 01:18:58 PM Eastern Daylight Time			08/05/2019 11:13:56 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-061 (HMO)	1	1		1			H6622	61	0	2020	Wilmington		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)233-8364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	62	0	1	2	1	H6622_062_0	5	1			07/15/2019	2020.01	07/15/2019 12:37:12 PM Eastern Daylight Time	08/04/2019 03:34:07 PM Eastern Daylight Time	08/02/2019 01:18:58 PM Eastern Daylight Time			08/05/2019 11:17:32 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-062 (HMO-POS)	1	2		1			H6622	62	0	2020	Select Counties in Minnesota		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	63	0	1	1	1	H6622_063_0	3	1			08/01/2019	2020.01	08/01/2019 04:11:32 PM Eastern Daylight Time	08/01/2019 05:05:01 PM Eastern Daylight Time	08/02/2019 01:18:58 PM Eastern Daylight Time			08/05/2019 11:33:12 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-063 (HMO)	1	1		1			H6622	63	0	2020	Bergen and Hudson counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	64	0	1	1	1	H6622_064_0	2	1			05/31/2019	2020.01	05/31/2019 02:03:31 PM Eastern Daylight Time	08/03/2019 10:10:17 AM Eastern Daylight Time	08/02/2019 01:18:58 PM Eastern Daylight Time			08/05/2019 11:18:38 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Value Plus H6622-064 (HMO)	1	1		1			H6622	64	0	2020	Clark and Nye (partial) counties		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	66	0	1	1	1	H6622_066_0	3	1			08/02/2019	2020.01	08/02/2019 10:41:50 AM Eastern Daylight Time	08/04/2019 07:45:20 PM Eastern Daylight Time	08/02/2019 01:18:58 PM Eastern Daylight Time			08/05/2019 11:31:37 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-066 (HMO)	1	1		1			H6622	66	0	2020	Southern New Jersey		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	69	0	1	1	1	H6622_069_0	3	1			07/15/2019	2020.01	07/15/2019 01:20:32 PM Eastern Daylight Time	08/04/2019 03:14:53 PM Eastern Daylight Time	08/02/2019 01:18:58 PM Eastern Daylight Time			08/05/2019 11:34:35 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-069 (HMO)	1	1		1			H6622	69	0	2020	Columbus Metro Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	70	0	1	1	1	H6622_070_0	3	1			07/15/2019	2020.01	07/15/2019 01:21:37 PM Eastern Daylight Time	08/04/2019 03:15:38 PM Eastern Daylight Time	08/02/2019 01:18:58 PM Eastern Daylight Time			08/05/2019 11:34:35 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Gold Plus H6622-070 (HMO)	1	1		1			H6622	70	0	2020	Canton-Akron Metro Areas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6622	801	0	1	1	1	H6622_801_0	1	1			05/29/2019	2020.01	05/29/2019 10:57:41 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H6622	801	0	2020	Select counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6622	802	0	1	1	1	H6622_802_0	1	1			05/29/2019	2020.01	05/29/2019 10:58:09 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H6622	802	0	2020	Select counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6622	804	0	1	1	1	H6622_804_0	1	1			05/29/2019	2020.01	05/29/2019 12:53:42 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H6622	804	0	2020	Select counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H6622	805	0	1	1	1	H6622_805_0	1	1			05/29/2019	2020.01	05/29/2019 12:55:29 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H6622	805	0	2020	Select counties in Multi States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H6672	1	0	1	1	1	H6672_001_0	6	1	2	1	08/02/2019	2020.01	08/02/2019 01:20:35 PM Central Daylight Time	08/05/2019 12:03:25 PM Central Daylight Time	08/05/2019 12:04:22 PM Central Daylight Time			08/05/2019 12:18:43 PM Central Daylight Time	"EON HEALTH, INC. (GA)"	Eon Health	www.eonhealthplan.com	EON DELUXE (HMO D-SNP)	1	1		1			H6672	1	0	2020	Select Georgia Counties		2	6648	2			1	3		1		1	www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6672	3	0	1	1	1	H6672_003_0	6	1		1	08/02/2019	2020.01	08/02/2019 01:09:29 PM Central Daylight Time	08/05/2019 12:03:25 PM Central Daylight Time	08/05/2019 12:04:23 PM Central Daylight Time			08/05/2019 12:18:43 PM Central Daylight Time	"EON HEALTH, INC. (GA)"	Eon Health	www.eonhealthplan.com	EON SILVER (HMO C-SNP)	1	1		1			H6672	3	0	2020	Select Georgia Counties		2	4947	2			1	4			10		www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6672	4	0	1	1	1	H6672_004_0	7	1			08/02/2019	2020.01	08/02/2019 01:11:32 PM Central Daylight Time	08/05/2019 12:03:25 PM Central Daylight Time	08/05/2019 12:04:23 PM Central Daylight Time			08/05/2019 12:18:43 PM Central Daylight Time	"EON HEALTH, INC. (GA)"	Eon Health	www.eonhealthplan.com	EON SELECT (HMO)	1	1		1			H6672	4	0	2020	Select Georgia Counties		2	11103	2			2						www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	1	1	1	1	1	H6723_001_1	11	1			07/17/2019	2020.01	07/17/2019 09:09:10 AM Eastern Daylight Time	07/31/2019 06:44:44 PM Eastern Daylight Time	07/31/2019 05:10:30 PM Eastern Daylight Time			08/06/2019 02:05:01 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/maplaninfo	MedMutual Advantage Classic (HMO)	1	1		1			H6723	1	1	2020	Ohio Regions	Region 1	2	167481	2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	Provider.medmutual.com	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	1	2	1	1	1	H6723_001_2	11	1			07/17/2019	2020.01	07/17/2019 09:11:30 AM Eastern Daylight Time	07/31/2019 06:45:38 PM Eastern Daylight Time	07/31/2019 05:11:02 PM Eastern Daylight Time			08/06/2019 02:05:01 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/maplaninfo	MedMutual Advantage Classic (HMO)	1	1		1			H6723	1	2	2020	Ohio Regions	Region 2	2	56770	2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	Provider.medmutual.com	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	2	1	1	1	1	H6723_002_1	11	1			07/17/2019	2020.01	07/17/2019 09:18:37 AM Eastern Daylight Time	07/31/2019 06:46:28 PM Eastern Daylight Time	07/31/2019 05:11:34 PM Eastern Daylight Time			08/06/2019 02:05:01 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/maplaninfo	MedMutual Advantage Choice (HMO)	1	1		1			H6723	2	1	2020	Ohio Regions	Region 1	2	63360	2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	Provider.medmutual.com	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	2	2	1	1	1	H6723_002_2	11	1			07/17/2019	2020.01	07/17/2019 09:13:05 AM Eastern Daylight Time	07/31/2019 06:47:16 PM Eastern Daylight Time	07/31/2019 05:12:06 PM Eastern Daylight Time			08/06/2019 02:05:01 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/maplaninfo	MedMutual Advantage Choice (HMO)	1	1		1			H6723	2	2	2020	Ohio Regions	Region 2	2	4912	2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	Provider.medmutual.com	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	3	1	1	1	1	H6723_003_1	11	1			07/17/2019	2020.01	07/17/2019 09:14:05 AM Eastern Daylight Time	07/31/2019 06:48:04 PM Eastern Daylight Time	07/31/2019 05:12:38 PM Eastern Daylight Time			08/06/2019 02:05:01 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/maplaninfo	MedMutual Advantage Plus (HMO)	1	1		1			H6723	3	1	2020	Ohio Regions	Region 1	2	23953	2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	Provider.medmutual.com	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	3	2	1	1	1	H6723_003_2	11	1			07/17/2019	2020.01	07/17/2019 09:14:49 AM Eastern Daylight Time	07/31/2019 06:48:54 PM Eastern Daylight Time	07/31/2019 05:13:10 PM Eastern Daylight Time			08/06/2019 02:05:01 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/maplaninfo	MedMutual Advantage Plus (HMO)	1	1		1			H6723	3	2	2020	Ohio Regions	Region 2	2	972	2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	Provider.medmutual.com	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	4	0	1	1	1	H6723_004_0	12	1			07/17/2019	2020.01	07/17/2019 09:16:24 AM Eastern Daylight Time	07/31/2019 06:49:42 PM Eastern Daylight Time	07/31/2019 05:13:42 PM Eastern Daylight Time			08/06/2019 02:05:01 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/maplaninfo	MedMutual Advantage Secure (HMO)	1	1		1			H6723	4	0	2020	Ohio Regions		2	9168	2			2						medmutual.com/maplaninfo	medmutual.com/maplaninfo	Provider.medmutual.com	(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(800)982-3117		(800)982-3117		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6723	801	0	1	1	1	H6723_801_0	7	1			05/17/2019	2020.01	05/17/2019 11:25:35 AM Eastern Daylight Time					06/03/2019 01:58:35 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/magroup	MedMutual Advantage EGWP (Calendar Year) (HMO)	1	1		1			H6723	801	0	2020	Ohio Regions		1	5500	2			2						medmutual.com/magroup	medmutual.com/magroup	Provider.medmutual.com	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;	2		1					1				
H6723	802	0	1	1	1	H6723_802_0	7	1			05/17/2019	2020.01	05/17/2019 11:25:52 AM Eastern Daylight Time					06/03/2019 01:58:35 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/magroup	MedMutual Advantage EGWP (Non-Calendar Year) (HMO)	1	1		1			H6723	802	0	2020	Ohio Regions		1	125	2			2						medmutual.com/magroup	medmutual.com/magroup	Provider.medmutual.com	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;	2		1					1				
H6723	803	0	1	1	1	H6723_803_0	7	1			05/17/2019	2020.01	05/17/2019 11:26:07 AM Eastern Daylight Time					06/03/2019 01:58:35 PM Eastern Daylight Time	MEDICAL MUTUAL OF OHIO	Medical Mutual of Ohio	medmutual.com/magroup	MedMutual Advantage EGWP (MA-Only) (HMO)	1	1		1			H6723	803	0	2020	Ohio Regions		1	125	2			2						medmutual.com/magroup	medmutual.com/magroup	Provider.medmutual.com	(800)801-4823		(800)801-4823		(866)406-8777		(866)406-8777										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;6;8a;8b1;8b2;9a1;9b;10a;11a;11b;	2		1					1				
H6743	1	0	1	4	1	H6743_001_0	7	1			05/30/2019	2020.01	05/30/2019 12:35:15 PM Pacific Daylight Time	08/06/2019 01:01:51 PM Pacific Daylight Time	08/06/2019 01:59:35 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Bronze Rx (Basin) (PPO)	1	4		1			H6743	1	0	2020	Klamath County		2	24087	2			2						atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H6743	7	0	1	4	1	H6743_007_0	7	1			05/24/2019	2020.01	05/24/2019 04:13:01 PM Pacific Daylight Time	08/06/2019 01:01:51 PM Pacific Daylight Time	08/06/2019 01:59:35 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Bronze Rx (Umpqua) (PPO)	1	4		1			H6743	7	0	2020	Douglas County		2	44008	2			2						atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H6743	18	1	1	4	1	H6743_018_1	7	1			05/24/2019	2020.01	05/24/2019 04:10:30 PM Pacific Daylight Time	08/06/2019 01:01:51 PM Pacific Daylight Time	08/06/2019 01:59:35 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Bronze Rx (Rogue) (PPO)	1	4		1			H6743	18	1	2020	Jackson and Josephine Counties	Jackson County	2	12616	2			2						atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H6743	18	3	1	4	1	H6743_018_3	7	1			05/24/2019	2020.01	05/24/2019 04:29:49 PM Pacific Daylight Time	08/06/2019 01:01:51 PM Pacific Daylight Time	08/06/2019 01:59:35 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Bronze Rx (Rogue) (PPO)	1	4		1			H6743	18	3	2020	Jackson and Josephine Counties	Josephine County	2	12616	2			2						atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H6743	19	2	1	4	1	H6743_019_2	5	1			05/24/2019	2020.01	05/24/2019 04:16:00 PM Pacific Daylight Time	07/26/2019 11:03:17 AM Pacific Daylight Time				07/26/2019 12:31:04 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Silver (PPO)	1	4		1			H6743	19	2	2020	Douglas and Klamath counties	Douglas County	2	2864	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2						2			
H6743	19	4	1	4	1	H6743_019_4	5	1			06/02/2019	2020.01	06/02/2019 10:21:30 AM Pacific Daylight Time	07/26/2019 11:03:17 AM Pacific Daylight Time				07/26/2019 12:31:04 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Silver (PPO)	1	4		1			H6743	19	4	2020	Douglas and Klamath counties	Klamath County	2	2864	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2						2			
H6743	20	1	1	4	1	H6743_020_1	7	1			05/25/2019	2020.01	05/25/2019 10:01:26 PM Pacific Daylight Time	08/06/2019 01:01:51 PM Pacific Daylight Time	08/06/2019 01:59:35 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Silver Rx (PPO)	1	4		1			H6743	20	1	2020	"Douglas, Jackson, Josephine, and Klamath counties"	Jackson County	2	6549	2			2						atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H6743	20	2	1	4	1	H6743_020_2	7	1			05/27/2019	2020.01	05/27/2019 08:50:11 PM Pacific Daylight Time	08/06/2019 01:01:52 PM Pacific Daylight Time	08/06/2019 01:59:35 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Silver Rx (PPO)	1	4		1			H6743	20	2	2020	"Douglas, Jackson, Josephine, and Klamath counties"	Douglas County	2	15559	2			2						atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H6743	20	3	1	4	1	H6743_020_3	7	1			05/25/2019	2020.01	05/25/2019 10:10:25 PM Pacific Daylight Time	08/06/2019 01:01:52 PM Pacific Daylight Time	08/06/2019 01:59:35 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Silver Rx (PPO)	1	4		1			H6743	20	3	2020	"Douglas, Jackson, Josephine, and Klamath counties"	Josephine County	2	6549	2			2						atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H6743	20	4	1	4	1	H6743_020_4	7	1			05/27/2019	2020.01	05/27/2019 08:50:45 PM Pacific Daylight Time	08/06/2019 01:01:52 PM Pacific Daylight Time	08/06/2019 01:59:35 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Silver Rx (PPO)	1	4		1			H6743	20	4	2020	"Douglas, Jackson, Josephine, and Klamath counties"	Klamath County	2	15559	2			2						atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H6743	21	2	1	4	1	H6743_021_2	7	1			05/24/2019	2020.01	05/24/2019 04:26:36 PM Pacific Daylight Time	08/06/2019 01:01:52 PM Pacific Daylight Time	08/06/2019 01:59:36 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Gold Rx (PPO)	1	4		1			H6743	21	2	2020	Douglas and Klamath counties	Douglas County	2	14309	2			2						atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H6743	21	4	1	4	1	H6743_021_4	7	1			05/24/2019	2020.01	05/24/2019 04:27:18 PM Pacific Daylight Time	08/06/2019 01:01:52 PM Pacific Daylight Time	08/06/2019 01:59:36 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Gold Rx (PPO)	1	4		1			H6743	21	4	2020	Douglas and Klamath counties	Klamath County	2	14309	2			2						atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H6743	22	1	1	4	1	H6743_022_1	5	1			05/24/2019	2020.01	05/24/2019 04:30:25 PM Pacific Daylight Time	07/26/2019 11:03:18 AM Pacific Daylight Time				07/26/2019 12:31:04 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Bronze (PPO)	1	4		1			H6743	22	1	2020	"Douglas, Jackson, and Klamath counties"	Jackson County	2	12616	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2						2			
H6743	22	2	1	4	1	H6743_022_2	5	1			05/24/2019	2020.01	05/24/2019 04:07:08 PM Pacific Daylight Time	07/26/2019 11:03:18 AM Pacific Daylight Time				07/26/2019 12:31:04 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Bronze (PPO)	1	4		1			H6743	22	2	2020	"Douglas, Jackson, and Klamath counties"	Douglas County	2	5768	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2						2			
H6743	22	4	1	4	1	H6743_022_4	5	1			06/02/2019	2020.01	06/02/2019 10:24:15 AM Pacific Daylight Time	07/26/2019 11:03:18 AM Pacific Daylight Time				07/26/2019 12:31:04 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Bronze (PPO)	1	4		1			H6743	22	4	2020	"Douglas, Jackson, and Klamath counties"	Klamath County	2	5768	2			2						atriohp.com	atriohp.com	atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2						2			
H6750	5	0	1	1	1	H6750_005_0	4	1			07/13/2019	2020.01	07/13/2019 01:52:10 AM Eastern Daylight Time	07/31/2019 03:27:54 PM Eastern Daylight Time	07/31/2019 10:27:06 AM Eastern Daylight Time			08/06/2019 05:52:50 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 Basic Rx (HMO)	1	1		1			H6750	5	0	2020	New Hampshire		2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	6	0	1	1	1	H6750_006_0	4	1			07/13/2019	2020.01	07/13/2019 01:41:22 AM Eastern Daylight Time	07/31/2019 03:30:32 PM Eastern Daylight Time	07/31/2019 10:29:36 AM Eastern Daylight Time			08/06/2019 05:52:50 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 Basic Rx (HMO)	1	1		1			H6750	6	0	2020	Barnstable County MA		2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	7	0	1	1	1	H6750_007_0	4	1			07/13/2019	2020.01	07/13/2019 01:51:57 AM Eastern Daylight Time	07/31/2019 03:33:30 PM Eastern Daylight Time	07/31/2019 10:31:26 AM Eastern Daylight Time			08/06/2019 05:52:50 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)	1	1		1			H6750	7	0	2020	Barnstable County MA		2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	8	0	1	1	1	H6750_008_0	4	1			08/06/2019	2020.01	08/06/2019 03:30:45 PM Eastern Daylight Time	07/31/2019 03:35:48 PM Eastern Daylight Time	07/31/2019 10:33:14 AM Eastern Daylight Time			08/06/2019 05:52:50 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)	1	1		1			H6750	8	0	2020	Barnstable County MA		2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	9	0	1	1	1	H6750_009_0	4	1			08/06/2019	2020.01	08/06/2019 03:31:31 PM Eastern Daylight Time	08/01/2019 04:05:26 PM Eastern Daylight Time	07/31/2019 10:34:50 AM Eastern Daylight Time			08/06/2019 05:52:50 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 Gain Rx (HMO)	1	1		1			H6750	9	0	2020	New Hampshire		2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	10	1	1	1	1	H6750_010_1	4	1			07/13/2019	2020.01	07/13/2019 02:07:10 AM Eastern Daylight Time	07/31/2019 03:21:48 PM Eastern Daylight Time	07/31/2019 10:49:36 AM Eastern Daylight Time			08/06/2019 05:52:50 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)	1	1		1			H6750	10	1	2020	New Hampshire	"Strafford County, NH"	2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	10	2	1	1	1	H6750_010_2	4	1			07/13/2019	2020.01	07/13/2019 02:11:14 AM Eastern Daylight Time	07/31/2019 03:24:42 PM Eastern Daylight Time	07/31/2019 10:25:14 AM Eastern Daylight Time			08/06/2019 05:52:50 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)	1	1		1			H6750	10	2	2020	New Hampshire	Most New Hampshire Counties	2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	11	1	1	2	1	H6750_011_1	4	1			07/13/2019	2020.01	07/13/2019 02:17:07 AM Eastern Daylight Time	08/05/2019 04:53:50 PM Eastern Daylight Time	08/05/2019 05:04:58 PM Eastern Daylight Time			08/06/2019 05:52:50 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 Choice Rx (HMO-POS)	1	2		1			H6750	11	1	2020	New Hampshire	"Strafford County, NH"	2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	11	2	1	2	1	H6750_011_2	4	1			07/13/2019	2020.01	07/13/2019 02:22:46 AM Eastern Daylight Time	08/05/2019 04:56:20 PM Eastern Daylight Time	08/05/2019 05:07:50 PM Eastern Daylight Time			08/06/2019 05:52:50 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 Choice Rx (HMO-POS)	1	2		1			H6750	11	2	2020	New Hampshire	Most New Hampshire Counties	2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	12	1	1	1	1	H6750_012_1	4	1			07/13/2019	2020.01	07/13/2019 02:27:02 AM Eastern Daylight Time	07/31/2019 03:16:18 PM Eastern Daylight Time	07/31/2019 10:47:44 AM Eastern Daylight Time			08/06/2019 05:52:50 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)	1	1		1			H6750	12	1	2020	New Hampshire	"Strafford County, NH"	2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	12	2	1	1	1	H6750_012_2	4	1			07/13/2019	2020.01	07/13/2019 02:30:47 AM Eastern Daylight Time	07/31/2019 03:19:00 PM Eastern Daylight Time	07/31/2019 10:22:20 AM Eastern Daylight Time			08/06/2019 05:52:50 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)	1	1		1			H6750	12	2	2020	New Hampshire	Most New Hampshire Counties	2		2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	801	0	1	1	1	H6750_801_0	3	1			07/13/2019	2020.01	07/13/2019 02:46:14 AM Eastern Daylight Time					07/13/2019 04:01:02 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)	1	1		1			H6750	801	0	2020	New Hampshire		1	1200	2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	802	0	1	1	1	H6750_802_0	3	1			07/13/2019	2020.01	07/13/2019 02:46:22 AM Eastern Daylight Time					07/13/2019 04:01:02 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)	1	1		1			H6750	802	0	2020	Barnstable County MA		1	1200	2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	803	0	1	1	1	H6750_803_0	3	1			07/13/2019	2020.01	07/13/2019 02:46:39 AM Eastern Daylight Time					07/13/2019 04:01:02 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)	1	1		1			H6750	803	0	2020	New Hampshire		1	1200	2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	804	0	1	1	1	H6750_804_0	3	1			07/13/2019	2020.01	07/13/2019 02:46:55 AM Eastern Daylight Time					07/13/2019 04:01:02 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)	1	1		1			H6750	804	0	2020	Barnstable County MA		1	1200	2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6750	805	0	1	2	1	H6750_805_0	3	1			07/13/2019	2020.01	07/13/2019 02:47:14 AM Eastern Daylight Time					07/13/2019 04:01:02 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 Choice Rx (HMO-POS)	1	2		1			H6750	805	0	2020	New Hampshire		1	12	2			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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6776	1	0	1	1	1	H6776_001_0	5	1		1	08/05/2019	2020.01	08/05/2019 11:45:47 AM Eastern Daylight Time	07/31/2019 06:34:50 PM Eastern Daylight Time	08/01/2019 02:34:40 PM Eastern Daylight Time			08/05/2019 04:03:04 PM Eastern Daylight Time	"ELDERSERVE HEALTH, INC."	RiverSpring Health Plans	riverspringstar.org	RiverSpring Star (HMO I-SNP)	1	1		1			H6776	1	0	2020	"Counties: Brx, Ki, Na, NY, Qu, Ri, Wes"		2	4530	2			1	1	3				riverspringstar.org	riverspringstar.org	riverspringstar.org	(800)580-7000		(800)580-7000		(800)580-7000		(800)580-7000		(855)898-1482		(855)898-1482		(855)898-1482		(855)898-1482		(711)-		(711)-		(711)-		(711)-		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					1					1	2			
H6776	2	0	1	1	1	H6776_002_0	6	1	2	1	08/05/2019	2020.01	08/05/2019 11:47:02 AM Eastern Daylight Time	07/31/2019 06:38:34 PM Eastern Daylight Time	08/01/2019 02:28:09 PM Eastern Daylight Time			08/05/2019 04:03:04 PM Eastern Daylight Time	"ELDERSERVE HEALTH, INC."	RiverSpring Health Plans	riverspringMAP.org	RiverSpring MAP (HMO D-SNP)	1	1		1			H6776	2	0	2020	"Counties: Brx, Ki, Na, NY, Qu, Ri, Wes"		2	2250	2			1	3		2		1	riverspringMAP.org	riverspringMAP.org	riverspringMAP.org	(800)362-2266		(800)362-2266		(800)362-2266		(800)362-2266		(855)898-1482		(855)898-1482		(855)898-1482		(855)898-1482		(711)-		(711)-		(711)-		(711)-		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					1					1	2			
H6786	2	0	1	4	1	H6786_002_0	7	1			06/25/2019	2020.01	06/25/2019 05:26:08 PM Eastern Daylight Time	08/07/2019 04:06:26 PM Eastern Daylight Time	07/30/2019 07:50:09 PM Eastern Daylight Time			08/07/2019 05:33:01 PM Eastern Daylight Time	"ANTHEM HEALTH PLANS OF MAINE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access (PPO)	1	4		1			H6786	2	0	2020	State of Maine		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)304-1785		(855)304-1785		(800)797-6458		(800)797-6458		(855)304-1785		(855)304-1785		(844)373-7114		(844)373-7114		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H6786	804	0	1	4	1	H6786_804_0	2	1			05/30/2019	2020.01	05/30/2019 04:52:07 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF MAINE, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/me/medicare	Anthem MediBlue Preferred (PPO)	1	4		1			H6786	804	0	2020	National		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H6787	1	0	1	20	8	H6787_001_0	1	1			05/28/2019	2020.01	05/28/2019 09:41:36 AM Eastern Daylight Time		05/28/2019 09:32:43 AM Eastern Daylight Time			05/28/2019 09:44:12 AM 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)	8	20		1			H6787	1	0	2020	"Ingham, Eaton, and Clinton Counties"		2		2			2						http://seniorcommunitycaremi.org	http://seniorcommunitycaremi.org										(517)319-0700		(517)319-0700		(517)319-0700		(517)319-0700										(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000																
H6787	2	0	1	20	8	H6787_002_0	1	1			05/28/2019	2020.01	05/28/2019 09:42:07 AM Eastern Daylight Time		05/28/2019 09:32:48 AM Eastern Daylight Time			05/28/2019 09:44:12 AM 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)	8	20		1			H6787	2	0	2020	"Eaton, Ingham and Clinton County"		2		2			2						http://seniorcommunitycaremi.org	http://seniorcommunitycaremi.org										(517)319-0700		(517)319-0700		(517)319-0700		(517)319-0700										(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000																
H6815	3	1	1	1	1	H6815_003_1	4	1			08/01/2019	2020.01	08/01/2019 10:10:56 AM US Mountain Standard Time	08/05/2019 04:05:37 PM Central Daylight Time	08/05/2019 03:32:55 PM Central Daylight Time			08/06/2019 10:59:48 AM Central Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	"Health Net Health Plan of Oregon, Inc."	or.healthnetadvantage.com	Health Net Ruby (HMO)	1	1		1			H6815	3	1	2020	"OR Counties BE, CK, LA, LN, ML, MN, PK, WA, YM"	"Clackamas, Multnomah and Washington Counties"	2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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					2	2			
H6815	3	2	1	1	1	H6815_003_2	4	1			08/01/2019	2020.01	08/01/2019 10:12:40 AM US Mountain Standard Time	08/05/2019 04:05:42 PM Central Daylight Time	08/05/2019 03:32:57 PM Central Daylight Time			08/06/2019 10:59:48 AM Central Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	"Health Net Health Plan of Oregon, Inc."	or.healthnetadvantage.com	Health Net Ruby (HMO)	1	1		1			H6815	3	2	2020	"OR Counties BE, CK, LA, LN, ML, MN, PK, WA, YM"	"Benton, Linn, Marion, Polk and Yamhill Counties"	2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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					2	2			
H6815	3	3	1	1	1	H6815_003_3	4	1			08/01/2019	2020.01	08/01/2019 10:13:24 AM US Mountain Standard Time	08/05/2019 04:05:46 PM Central Daylight Time	08/05/2019 03:32:46 PM Central Daylight Time			08/06/2019 10:59:48 AM Central Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	"Health Net Health Plan of Oregon, Inc."	or.healthnetadvantage.com	Health Net Ruby (HMO)	1	1		1			H6815	3	3	2020	"OR Counties BE, CK, LA, LN, ML, MN, PK, WA, YM"	Lane County	2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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					2	2			
H6815	5	0	1	1	1	H6815_005_0	4	1			08/01/2019	2020.01	08/01/2019 10:13:54 AM US Mountain Standard Time	08/05/2019 04:05:30 PM Central Daylight Time	08/05/2019 03:32:49 PM Central Daylight Time			08/06/2019 11:08:34 AM Central Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	"Health Net Health Plan of Oregon, Inc."	or.healthnetadvantage.com	Health Net Ruby (HMO)	1	1		1			H6815	5	0	2020	"Douglas, Jackson, Josephine"		2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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					2	2			
H6815	6	0	1	1	1	H6815_006_0	3	1			08/01/2019	2020.01	08/01/2019 10:14:59 AM US Mountain Standard Time	08/05/2019 04:05:33 PM Central Daylight Time	08/05/2019 03:32:52 PM Central Daylight Time			08/06/2019 11:08:34 AM Central Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	"Health Net Health Plan of Oregon, Inc."	or.healthnetadvantage.com	Health Net Ruby (HMO)	1	1		1			H6815	6	0	2020	"Coos, Crook, Deschutes and Jefferson counties"		2		2			2						or.healthnetadvantage.com/findadoctor	or.healthnetadvantage.com/formulary	or.healthnetadvantage.com/findadoctor	(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					2	2			
H6815	801	0	1	1	1	H6815_801_0	2	1			05/13/2019	2020.01	05/13/2019 02:17:11 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	"Health Net Health Plan of Oregon, Inc."	or.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	1	1		1			H6815	801	0	2020	Oregon and California		1	100	2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(800)275-4737		(800)275-4737		(800)949-6192		(800)949-6192		(800)275-4737		(800)275-4737		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6815	802	0	1	1	1	H6815_802_0	2	1			05/10/2019	2020.01	05/10/2019 11:18:35 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	"Health Net Health Plan of Oregon, Inc."	or.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	1	1		1			H6815	802	0	2020	Oregon and California		1	100	2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(800)275-4737		(800)275-4737		(800)949-6192		(800)949-6192										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6815	803	0	1	1	1	H6815_803_0	2	1			05/10/2019	2020.01	05/10/2019 11:18:53 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	"Health Net Health Plan of Oregon, Inc."	or.healthnetadvantage.com	Health Net Seniority Plus Employer (HMO)	1	1		1			H6815	803	0	2020	Oregon and California		1	100	2			2						or.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy	or.healthnetadvantage.com/prescription-drugs-formulary/formulary	or.healthnetadvantage.com/find-doctor1	(800)275-4737		(800)275-4737		(800)949-6192		(800)949-6192		(800)275-4737		(800)275-4737		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H6821	1	0	1	1	1	H6821_001_0	5	1			08/02/2019	2020.01	08/02/2019 08:50:04 AM Central Daylight Time	08/01/2019 12:03:42 PM Central Daylight Time	08/01/2019 12:09:51 PM Central Daylight Time			08/03/2019 06:34:30 AM Central Daylight Time	MUTUAL OF OMAHA MEDICARE ADVANTAGE COMPANY	Mutual of Omaha Medicare Advantage	www.mutualofomahacareadvantage.com	Mutual of Omaha CareAdvantage Complete (HMO)	1	1		1			H6821	1	0	2020	Bexar county		2		2			2						www.mutualofomahacareadvantage.com	www.mutualofomahacareadvantage.com	https://www.mutualofomahacareadvantage.com/	(866)488-0249		(866)488-0249		(877)603-0787		(877)603-0787		(866)488-0249		(866)488-0249		(877)603-0787		(877)603-0787		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6821	2	0	1	1	1	H6821_002_0	5	1			05/22/2019	2020.01	05/22/2019 03:57:11 PM Central Daylight Time	08/01/2019 01:33:18 PM Central Daylight Time	08/01/2019 01:35:07 PM Central Daylight Time			08/03/2019 06:34:30 AM Central Daylight Time	MUTUAL OF OMAHA MEDICARE ADVANTAGE COMPANY	Mutual of Omaha Medicare Advantage	www.mutualofomahacareadvantage.com	Mutual of Omaha CareAdvantage Plus (HMO)	1	1		1			H6821	2	0	2020	Cincinnati Metro area		2		2			2						www.mutualofomahacareadvantage.com	www.mutualofomahacareadvantage.com	https://www.mutualofomahacareadvantage.com/	(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6821	3	0	1	1	1	H6821_003_0	5	1			08/02/2019	2020.01	08/02/2019 08:44:20 AM Central Daylight Time	08/01/2019 01:42:15 PM Central Daylight Time	08/01/2019 01:46:57 PM Central Daylight Time			08/03/2019 06:34:30 AM Central Daylight Time	MUTUAL OF OMAHA MEDICARE ADVANTAGE COMPANY	Mutual of Omaha Medicare Advantage	www.mutualofomahacareadvantage.com	Mutual of Omaha CareAdvantage Complete (HMO)	1	1		1			H6821	3	0	2020	"Ohio- Butler, Clermont, Hamilton & Warren counties"		2		2			2						www.mutualofomahacareadvantage.com	www.mutualofomahacareadvantage.com	https://www.mutualofomahacareadvantage.com/	(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6821	4	0	1	1	1	H6821_004_0	5	1			08/02/2019	2020.01	08/02/2019 08:39:10 AM Central Daylight Time	08/01/2019 12:33:11 PM Central Daylight Time	08/01/2019 12:38:24 PM Central Daylight Time			08/03/2019 06:34:30 AM Central Daylight Time	MUTUAL OF OMAHA MEDICARE ADVANTAGE COMPANY	Mutual of Omaha Medicare Advantage	www.mutualofomahacareadvantage.com	Mutual of Omaha CareAdvantage Complete (HMO)	1	1		1			H6821	4	0	2020	"Kentucky - Boone, Campbell and Kenton counties"		2		2			2						www.mutualofomahacareadvantage.com	www.mutualofomahacareadvantage.com	https://www.mutualofomahacareadvantage.com/	(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6821	801	0	1	1	1	H6821_801_0	2	1			05/16/2019	2020.01	05/16/2019 11:28:38 AM Central Daylight Time					05/30/2019 02:34:10 PM Central Daylight Time	MUTUAL OF OMAHA MEDICARE ADVANTAGE COMPANY	Mutual of Omaha Medicare Advantage	www.mutualofomaha.com	MAPD EGWP Calendar year (HMO)	1	1		1			H6821	801	0	2020	"Cincinnati Metro area and Bexar County, Texas"		1	300	2			2						www.mutualofomahacareadvantage.com	www.mutualofomahacareadvantage.com	https://www.mutualofomahacareadvantage.com/	(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;17a;18a;	1					1				
H6821	802	0	1	1	1	H6821_802_0	2	1			05/21/2019	2020.01	05/21/2019 12:05:23 PM Central Daylight Time					05/30/2019 02:34:10 PM Central Daylight Time	MUTUAL OF OMAHA MEDICARE ADVANTAGE COMPANY	Mutual of Omaha Medicare Advantage	www.mutualofomaha.com	MAPD EGWP non Calendar year (HMO)	1	1		1			H6821	802	0	2020	"Cincinnati Metro area and Bexar County, Texas"		1	300	2			2						www.mutualofomahacareadvantage.com	www.mutualofomahacareadvantage.com	https://www.mutualofomahacareadvantage.com/	(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(877)603-0785		(877)603-0785		(866)314-0918		(866)314-0918		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;17a;18a;	1					1				
H6832	1	0	1	1	1	H6832_001_0	4	1		1	06/27/2019	2020.01	06/27/2019 02:26:38 PM Mountain Daylight Time	07/31/2019 08:51:15 PM Eastern Daylight Time	07/31/2019 09:01:32 PM Eastern Daylight Time			08/06/2019 11:55:36 AM Eastern Daylight Time	"ALIGN SENIOR CARE MI, LLC"	Align Senior Care	www.alignseniorcare.com	Align Thrive (HMO I-SNP)	1	1		1			H6832	1	0	2020	Michigan (partial)		2	2737	2			1	1	3				www.PLACEHOLDER.com	www.PLACEHOLDER.com	www.alignseniorcare.com			(804)396-6412				(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		2					2					2	2			
H6832	2	0	1	1	1	H6832_002_0	6	1		1	07/17/2019	2020.01	07/17/2019 03:56:20 PM Mountain Daylight Time	07/31/2019 08:49:06 PM Eastern Daylight Time	07/31/2019 08:58:35 PM Eastern Daylight Time			08/06/2019 11:55:36 AM Eastern Daylight Time	"ALIGN SENIOR CARE MI, LLC"	Align Senior Care	www.alignseniorcare.com	Align Connect (HMO C-SNP)	1	1		1			H6832	2	0	2020	Michigan (partial)		2	2737	2			1	4			1E+14		www.PLACEHOLDER.com	www.PLACEHOLDER.com	www.alignseniorcare.com			(804)396-6412				(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		(804)396-6412		2					2					2	2			
H6846	1	0	1	20	8	H6846_001_0	3	1			06/01/2019	2020.01	06/01/2019 09:41:26 AM Eastern Daylight Time		07/17/2019 06:20:30 PM Eastern Daylight Time			07/17/2019 06:27:58 PM Eastern Daylight Time	"MISSION HOSPITAL, INC."	CarePartners PACE	https://missionhealth.org/services-treatments	"Mission Hospital, Inc. (PACE)"	8	20		1			H6846	1	0	2020	Buncombe and Henderson Counties		2		2			2						http://www.missionpardeehealthcampus.org/services/	www.carepartners.org										(800)000-0000		(828)213-8442		(800)000-0000		(828)213-8442										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H6846	2	0	1	20	8	H6846_002_0	3	1			06/01/2019	2020.01	06/01/2019 09:41:40 AM Eastern Daylight Time		07/17/2019 06:20:31 PM Eastern Daylight Time			07/17/2019 06:27:58 PM Eastern Daylight Time	"MISSION HOSPITAL, INC."	CarePartners PACE	https://missionhealth.org/services-treatments	"Mission Hospital, Inc. (PACE)"	8	20		1			H6846	2	0	2020	Buncombe and Henderson Counties		2		2			2						http://www.missionpardeehealthcampus.org/services/	www.carepartners.org										(800)000-0000		(828)213-8442		(800)000-0000		(828)213-8442										(800)735-2962		(800)735-2962		(800)735-2962		(800)735-2962																
H6870	1	0	1	48	5	H6870_001_0	4	1			08/20/2019	2020.01	08/20/2019 04:11:21 PM Central Daylight Time					08/20/2019 04:38:23 PM Pacific Daylight Time	"SUPERIOR HEALTH PLAN, INC."	Superior HealthPlan	mmp.superiorhealthplan.com	Superior HealthPlan STAR+PLUS Medicare-Medicaid (Medicare-Medicaid Plan)	5	48		1			H6870	1	0	2020	"Bexar, Dallas and Hidalgo Counties"		2	95000	2			2						mmp.superiorhealthplan.com/findadoctor	mmp.superiorhealthplan.com/formulary	mmp.superiorhealthplan.com/findadoctor	(866)896-1844		(866)896-1844		(866)896-1844		(866)896-1844		(866)896-1844		(866)896-1844		(866)896-1844		(866)896-1844		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H6887	1	0	1	20	8	H6887_001_0	1	1			05/28/2019	2020.01	05/28/2019 11:38:08 AM Eastern Daylight Time		05/28/2019 10:03:52 AM Eastern Daylight Time			05/28/2019 11:40:58 AM Eastern Daylight Time	"INSPIRA HEALTH NETWORK LIFE, INC."	Inspira Health Network LIFE	http://www.inspirahealthnetwork.org/life-center	Inspira Health Network LIFE (PACE)	8	20		1			H6887	1	0	2020	Inspira Health Network LIFE		2		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)632-4516																
H6887	2	0	1	20	8	H6887_002_0	1	1			05/28/2019	2020.01	05/28/2019 11:38:41 AM Eastern Daylight Time		05/28/2019 10:04:09 AM Eastern Daylight Time			05/28/2019 11:40:58 AM Eastern Daylight Time	"INSPIRA HEALTH NETWORK LIFE, INC."	Inspira Health Network LIFE	http://www.inspirahealthnetwork.org/life-center	Inspira Health Network LIFE (PACE)	8	20		1			H6887	2	0	2020	Inspira Health Network LIFE		2		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																
H6910	1	0	1	1	1	H6910_001_0	9	1			07/03/2019	2020.01	07/03/2019 01:48:47 PM Eastern Daylight Time	08/05/2019 01:42:03 PM Eastern Daylight Time	08/05/2019 01:42:03 PM Eastern Daylight Time			08/05/2019 01:55:27 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN OF IDAHO, INC."	MediGold	www.MediGold.com	MediGold Essential Care (HMO)	1	1		1			H6910	1	0	2020	Greater Boise Idaho		2		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	2			
H6910	2	0	1	1	1	H6910_002_0	9	1			07/03/2019	2020.01	07/03/2019 01:49:23 PM Eastern Daylight Time	08/05/2019 01:42:04 PM Eastern Daylight Time	08/05/2019 01:42:04 PM Eastern Daylight Time			08/05/2019 01:55:27 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN OF IDAHO, INC."	MediGold	www.MediGold.com	MediGold True Advantage (HMO)	1	1		1			H6910	2	0	2020	Greater Boise Idaho		2		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	2			
H6910	3	0	1	1	1	H6910_003_0	9	1			07/03/2019	2020.01	07/03/2019 01:50:12 PM Eastern Daylight Time	08/05/2019 01:42:04 PM Eastern Daylight Time	08/05/2019 01:42:04 PM Eastern Daylight Time			08/05/2019 01:55:27 PM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN OF IDAHO, INC."	MediGold	www.MediGold.com	MediGold Classic Preferred (HMO)	1	1		1			H6910	3	0	2020	Greater Boise Idaho		2		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	2			
H6910	4	0	1	1	1	H6910_004_0	5	1			07/03/2019	2020.01	07/03/2019 01:51:02 PM Eastern Daylight Time	07/03/2019 03:03:42 PM Eastern Daylight Time				07/18/2019 11:46:33 AM Eastern Daylight Time	"MOUNT CARMEL HEALTH PLAN OF IDAHO, INC."	MediGold	www.MediGold.com	MediGold Medical Only (HMO)	1	1		1			H6910	4	0	2020	Greater Boise Idaho		2		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)-										2					2					2	2			
H6936	3	0	1	1	1	H6936_003_0	9	1			07/11/2019	2020.01	07/11/2019 01:52:55 PM US Mountain Standard Time	08/06/2019 03:56:45 PM US Mountain Standard Time	08/06/2019 11:51:28 AM US Mountain Standard Time			08/06/2019 05:02:40 PM US Mountain Standard Time	"BLUE CROSS & BLUE SHIELD OF ARIZONA, INC."	Blue Cross Blue Shield of Arizona	azbluemedicare.com	BluePathway Plan 2 (HMO)	1	1		1			H6936	3	0	2020	Maricopa County		2		2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6936	4	0	1	1	1	H6936_004_0	8	1			07/11/2019	2020.01	07/11/2019 01:52:44 PM US Mountain Standard Time	08/06/2019 04:05:36 PM US Mountain Standard Time	08/06/2019 11:51:28 AM US Mountain Standard Time			08/06/2019 05:02:40 PM US Mountain Standard Time	"BLUE CROSS & BLUE SHIELD OF ARIZONA, INC."	Blue Cross Blue Shield of Arizona	azbluemedicare.com	BluePathway Plan 3 (HMO)	1	1		1			H6936	4	0	2020	Maricopa County		2	24672	2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6936	5	0	1	1	1	H6936_005_0	9	1			07/11/2019	2020.01	07/11/2019 01:52:39 PM US Mountain Standard Time	08/06/2019 04:09:04 PM US Mountain Standard Time	08/06/2019 11:51:28 AM US Mountain Standard Time			08/06/2019 05:02:40 PM US Mountain Standard Time	"BLUE CROSS & BLUE SHIELD OF ARIZONA, INC."	Blue Cross Blue Shield of Arizona	azbluemedicare.com	BluePathway Plan 2 (HMO)	1	1		1			H6936	5	0	2020	Pima County		2	17460	2			2						azbluemedicare.com	azbluemedicare.com	azbluemedicare.com	(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(800)446-8331		(800)446-8331		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6941	1	0	1	20	8	H6941_001_0	1	1			05/23/2019	2020.01	05/23/2019 09:05:49 AM Central Daylight Time		05/23/2019 09:12:32 AM Central Daylight Time			05/23/2019 09:13:42 AM Central Daylight Time	LIFE PACE	"LIFE PACE, INC."	www.lifepace.org	LIFE PACE Dual Eligible 001 (PACE)	8	20		1			H6941	1	0	2020	Tulsa County		2		2			2						www.carekinesis.com	www.lifepace.org										(844)664-4440		(918)949-9969		(844)664-4440		(918)949-9969										(844)664-4440		(918)949-9969		(844)664-4440		(918)949-9969																
H6941	2	0	1	20	8	H6941_002_0	1	1			05/23/2019	2020.01	05/23/2019 09:06:18 AM Central Daylight Time		05/23/2019 09:11:54 AM Central Daylight Time			05/23/2019 09:13:42 AM Central Daylight Time	LIFE PACE	"LIFE PACE, INC."	www.lifepace.org	LIFE PACE Medicare Only 002 (PACE)	8	20		1			H6941	2	0	2020	Tulsa County		2		2			2						www.carekinesis.com	www.lifepace.org										(844)664-4440		(918)949-9969		(844)664-4440		(918)949-9969										(844)664-4440		(918)949-9969		(844)664-4440		(918)949-9969																
H6959	1	0	1	1	1	H6959_001_0	4	1		1	08/02/2019	2020.01	08/02/2019 07:33:43 AM Central Daylight Time	08/01/2019 06:23:38 PM Central Daylight Time	08/01/2019 06:13:54 PM Central Daylight Time			08/06/2019 10:05:30 AM Central Daylight Time	"ISNP VENTURES, LLC"	KeyCare Advantage	www.keycareadvantage.com	KeyCare Advantage (HMO I-SNP)	1	1		1			H6959	1	0	2020	Maryland (partial)		2	3804	2			1	1	1				www.keycareadvantage.com	www.keycareadvantage.com	www.keycareadvantage.com	(844)206-1205		(844)206-1205		(844)206-1205		(844)206-1205		(844)206-1205		(844)206-1205		(844)206-1205		(844)206-1205		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6975	1	0	1	1	1	H6975_001_0	6	1			07/15/2019	2020.01	07/15/2019 12:42:33 PM Eastern Daylight Time	08/02/2019 08:36:18 AM Eastern Daylight Time	07/30/2019 11:14:07 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"WELLCARE OF ALABAMA, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H6975	1	0	2020	Selected Counties in AL		2	431	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H6988	1	0	1	1	1	H6988_001_0	13	1			08/09/2019	2020.01	08/09/2019 02:23:59 PM Eastern Daylight Time	08/06/2019 08:22:42 PM Eastern Daylight Time	08/06/2019 08:22:42 PM Eastern Daylight Time			08/09/2019 02:27:29 PM Eastern Daylight Time	"CENTERS PLAN FOR HEALTHY LIVING, LLC"	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Medicare Advantage Care (HMO)	1	1		1			H6988	1	0	2020	"NYC Metro Area, ERIE, NASS, NIAG, ROCK Counties"		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		(888)807-5717		(888)807-5717		(877)940-9330		(877)940-9330		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		2					2					2	2			
H6988	2	0	1	1	1	H6988_002_0	14	1	2	1	08/09/2019	2020.01	08/09/2019 02:24:24 PM Eastern Daylight Time	08/06/2019 08:22:42 PM Eastern Daylight Time	08/12/2019 04:45:08 PM Eastern Daylight Time			08/12/2019 04:52:36 PM Eastern Daylight Time	"CENTERS PLAN FOR HEALTHY LIVING, LLC"	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Dual Coverage Care (HMO D-SNP)	1	1		1			H6988	2	0	2020	"Kings,Queens,Bronx,Manhattan and Richmond Counties"		2		2			1	3		2		2	www.centersplan.com	www.centersplan.com	www.centersplan.com	(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(888)807-5717		(888)807-5717		(877)940-9330		(877)940-9330		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		2					2					2	2			
H6988	3	0	1	1	1	H6988_003_0	14	1		1	08/06/2019	2020.01	08/06/2019 08:35:02 PM Eastern Daylight Time	08/06/2019 09:50:14 PM Eastern Daylight Time	08/06/2019 08:24:08 PM Eastern Daylight Time			08/06/2019 09:54:13 PM Eastern Daylight Time	"CENTERS PLAN FOR HEALTHY LIVING, LLC"	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Nursing Home Care (HMO I-SNP)	1	1		1			H6988	3	0	2020	"NYC Metro, ER, NA, SU, RO, MO, WE, NI, WA Counties"		2	287	2			1	1	1				www.centersplan.com	www.centersplan.com	www.centersplan.com	(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(888)807-5717		(888)807-5717		(877)940-9330		(877)940-9330		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		2					2					2	2			
H6988	4	0	1	1	1	H6988_004_0	12	1	2	1	08/06/2019	2020.01	08/06/2019 07:54:00 PM Eastern Daylight Time	08/06/2019 08:24:08 PM Eastern Daylight Time	08/06/2019 08:24:08 PM Eastern Daylight Time			08/06/2019 08:37:19 PM Eastern Daylight Time	"CENTERS PLAN FOR HEALTHY LIVING, LLC"	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Medicaid Advantage Plus (HMO D-SNP)	1	1		1			H6988	4	0	2020	"NYC Metro Area, NASS, ROCK County"		2		2			1	3		1		2	www.centersplan.com	www.centersplan.com	www.centersplan.com	(833)274-5627		(833)274-5627		(833)274-5627		(833)274-5627		(888)807-5717		(888)807-5717		(833)274-5627		(833)274-5627		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		2					2					2	2			
H6988	801	0	1	1	1	H6988_801_0	10	1			05/30/2019	2020.01	05/30/2019 01:56:29 PM Eastern Daylight Time					06/03/2019 05:51:06 PM Eastern Daylight Time	"CENTERS PLAN FOR HEALTHY LIVING, LLC"	Centers Plan for Healthy Living	www.centersplan.com	Centers Plan for Employer Groups (HMO)	1	1		1			H6988	801	0	2020	"NYC Metro Area, ERIE, NASS, NIAG, ROCK Counties"		1	63	2			2						www.centersplan.com	www.centersplan.com	www.centersplan.com	(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(888)807-5717		(888)807-5717		(877)940-9330		(877)940-9330		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		(800)421-1220		(711)-		2					2					2	2			
H7003	1	0	1	20	8	H7003_001_0	1	1			05/30/2019	2020.01	05/30/2019 11:46:31 AM Central Daylight Time		05/22/2019 07:02:26 AM Central Daylight Time			05/30/2019 11:47:47 AM Central Daylight Time	PACE NEBRASKA	Immanuel Pathways Omaha	Immanuel.com	PACE Nebraska (PACE)	8	20		1			H7003	1	0	2020	"Select Zip Codes in DO, SA, and W, DG, C, and SU"		2		2			2						http://www.immanuelpathways.org/	"www.immanuelpathways,org"												(402)991-0330				(402)991-0330												(402)991-0330				(402)991-0330																
H7003	2	0	1	20	8	H7003_002_0	1	1			05/30/2019	2020.01	05/30/2019 11:46:49 AM Central Daylight Time		05/22/2019 07:02:26 AM Central Daylight Time			05/30/2019 11:47:47 AM Central Daylight Time	PACE NEBRASKA	Immanuel Pathways Omaha	immanuelpathways.org	PACE Nebraska (PACE)	8	20		1			H7003	2	0	2020	"Select Zip Codes in DO, SA, and W, DG, C, and SU"		2		2			2						http://www.immanuelpathways.org/	"www.immanuelpathways,org"												(402)991-0330				(402)991-0330												(402)991-0330				(402)991-0330																
H7006	1	0	1	4	1	H7006_001_0	7	1			05/24/2019	2020.01	05/24/2019 04:25:18 PM Pacific Daylight Time	08/06/2019 01:01:52 PM Pacific Daylight Time	08/06/2019 01:59:36 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Gold Rx (Willamette) (PPO)	1	4		1			H7006	1	0	2020	Marion and Polk Counties		2	17303	2			2						atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H7006	3	0	1	4	1	H7006_003_0	7	1			06/02/2019	2020.01	06/02/2019 10:20:34 AM Pacific Daylight Time	08/06/2019 01:01:52 PM Pacific Daylight Time	08/06/2019 01:59:36 PM Pacific Daylight Time			08/06/2019 02:03:36 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	atriohp.com	ATRIO Silver Rx (Willamette) (PPO)	1	4		1			H7006	3	0	2020	Marion and Polk Counties		2	27303	2			2						atriohp.com	atriohp.com	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		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2						2			
H7020	4	0	1	1	1	H7020_004_0	4	1			07/08/2019	2020.01	07/08/2019 04:17:38 PM Central Daylight Time	07/31/2019 05:36:34 PM Central Daylight Time	07/30/2019 04:26:50 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF SOUTH CAROLINA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H7020	4	0	2020	South Carolina		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7020	5	0	1	1	1	H7020_005_0	3	1			07/08/2019	2020.01	07/08/2019 04:18:22 PM Central Daylight Time	05/30/2019 10:17:14 AM Central Daylight Time				07/11/2019 09:31:32 PM Central Daylight Time	"CIGNA HEALTHCARE OF SOUTH CAROLINA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	1	1		1			H7020	5	0	2020	Select South Carolina Counties		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7020	6	0	1	1	1	H7020_006_0	4	1			07/08/2019	2020.01	07/08/2019 04:19:02 PM Central Daylight Time	07/31/2019 05:36:54 PM Central Daylight Time	07/30/2019 04:27:03 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF SOUTH CAROLINA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus (HMO)	1	1		1			H7020	6	0	2020	South Carolina		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7020	7	0	1	1	1	H7020_007_0	4	1			07/08/2019	2020.01	07/08/2019 04:19:47 PM Central Daylight Time	07/31/2019 05:37:15 PM Central Daylight Time	07/30/2019 04:27:17 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF SOUTH CAROLINA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Part B Savings (HMO)	1	1		1			H7020	7	0	2020	South Carolina		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7020	801	0	1	1	1	H7020_801_0	2	1			04/18/2019	2020.01	04/18/2019 02:24:53 PM Central Daylight Time					05/30/2019 06:10:28 PM Central Daylight Time	"CIGNA HEALTHCARE OF SOUTH CAROLINA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	1	1		1			H7020	801	0	2020	South Carolina		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H7063	1	0	1	4	1	H7063_001_0	8	1			08/08/2019	2020.01	08/08/2019 09:10:34 PM Central Daylight Time	08/06/2019 04:35:49 PM Central Daylight Time	08/06/2019 04:35:51 PM Central Daylight Time			08/08/2019 09:35:21 PM Central Daylight Time	"BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC."	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare	Blue Medicare Advantage (PPO)	1	4		1			H7063	1	0	2020	"Topeka Region (DG, JA, JF, OS, PT, SN, WB)"		2		2			2						www.bcbsks.com/medicare	www.bcbsks.com/medicare	www.bcbsks.com/medicare			(800)222-7645				(800)752-6650		(866)230-7265		(866)230-7265		(800)752-6650		(800)752-6650		(711)-		(711)-		(800)766-3777		(800)766-3777		(711)-		(711)-		(800)766-3777		(800)766-3777		2					2						2			
H7063	2	0	1	4	1	H7063_002_0	8	1			08/08/2019	2020.01	08/08/2019 04:12:51 PM Central Daylight Time	08/06/2019 04:35:54 PM Central Daylight Time	08/06/2019 04:35:55 PM Central Daylight Time			08/08/2019 09:35:21 PM Central Daylight Time	"BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC."	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare	Blue Medicare Advantage Comprehensive (PPO)	1	4		1			H7063	2	0	2020	"Topeka Region (DG, JA, JF, OS, PT, SN, WB)"		2		2			2						www.bcbsks.com/medicare	www.bcbsks.com/medicare	www.bcbsks.com/medicare			(800)222-7645				(800)752-6650		(866)230-7265		(866)230-7265		(800)752-6650		(800)752-6650		(711)-		(711)-		(800)766-3777		(800)766-3777		(711)-		(711)-		(800)766-3777		(800)766-3777		2					2						2			
H7063	6	0	1	4	1	H7063_006_0	8	1			08/08/2019	2020.01	08/08/2019 04:11:28 PM Central Daylight Time	08/06/2019 04:35:58 PM Central Daylight Time	08/06/2019 04:35:59 PM Central Daylight Time			08/08/2019 09:35:21 PM Central Daylight Time	"BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC."	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare	Blue Medicare Advantage (PPO)	1	4		1			H7063	6	0	2020	"Wichita Region (BU, CL, HV, KM, RN, SG, SU)"		2		2			2						www.bcbsks.com/medicare	www.bcbsks.com/medicare	www.bcbsks.com/medicare			(800)222-7645				(800)752-6650		(866)230-7265		(866)230-7265		(800)752-6650		(800)752-6650		(711)-		(711)-		(800)766-3777		(800)766-3777		(711)-		(711)-		(800)766-3777		(800)766-3777		2					2						2			
H7063	7	0	1	4	1	H7063_007_0	8	1			08/08/2019	2020.01	08/08/2019 04:10:01 PM Central Daylight Time	08/06/2019 04:36:01 PM Central Daylight Time	08/06/2019 04:36:03 PM Central Daylight Time			08/08/2019 09:35:21 PM Central Daylight Time	"BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC."	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare	Blue Medicare Advantage Comprehensive (PPO)	1	4		1			H7063	7	0	2020	"Wichita Region (BU, CL, HV, KM, RN, SG, SU)"		2		2			2						www.bcbsks.com/medicare	www.bcbsks.com/medicare	www.bcbsks.com/medicare			(800)222-7645				(800)752-6650		(866)230-7265		(866)230-7265		(800)752-6650		(800)752-6650		(711)-		(711)-		(800)766-3777		(800)766-3777		(711)-		(711)-		(800)766-3777		(800)766-3777		2					2						2			
H7063	801	0	1	4	1	H7063_801_0	2	1			05/30/2019	2020.01	05/30/2019 03:52:16 PM Central Daylight Time					06/03/2019 11:31:20 AM Central Daylight Time	"BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC."	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare	MAPD Group Plan Non Calendar Year (PPO)	1	4		1			H7063	801	0	2020	Nationwide		1	0	2			2						www.bcbsks.com/medicare	www.bcbsks.com/medicare	www.bcbsks.com/medicare			(800)222-7645				(800)752-6650		(866)230-7265		(866)230-7265		(800)752-6650		(800)752-6650		(711)-		(711)-		(800)766-3777		(800)766-3777		(711)-		(711)-		(800)766-3777		(800)766-3777		1	1	1a;1b;2;7e;7h;11c;	2		1									
H7063	802	0	1	4	1	H7063_802_0	2	1			05/30/2019	2020.01	05/30/2019 03:54:21 PM Central Daylight Time					06/03/2019 11:31:20 AM Central Daylight Time	"BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC."	Blue Cross and Blue Shield of Kansas	www.bcbsks.com/medicare	MAPD Group Plan Calendar Year (PPO)	1	4		1			H7063	802	0	2020	Nationwide		1	0	2			2						www.bcbsks.com/medicare	www.bcbsks.com/medicare	www.bcbsks.com/medicare			(800)222-7645				(800)752-6650		(866)230-7265		(866)230-7265		(800)752-6650		(800)752-6650		(711)-		(711)-		(800)766-3777		(800)766-3777		(711)-		(711)-		(800)766-3777		(800)766-3777		1	1	1a;1b;2;7e;7h;11c;	2		1									
H7114	1	0	1	20	8	H7114_001_0	2	1			05/23/2019	2020.01	05/23/2019 12:40:12 PM Central Daylight Time		06/03/2019 04:04:10 PM Central Daylight Time			06/03/2019 04:07:12 PM Central Daylight Time	VALIR PACE FOUNDATION	Valir PACE Foundation	www.valirpace.org	Dual (PACE)	8	20		1			H7114	1	0	2020	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	2	0	1	20	8	H7114_002_0	2	1			05/23/2019	2020.01	05/23/2019 12:40:31 PM Central Daylight Time		06/03/2019 04:03:59 PM Central Daylight Time			06/03/2019 04:07:12 PM Central Daylight Time	VALIR PACE FOUNDATION	Valir PACE Foundation	www.valirpace.org	Medicare Only (PACE)	8	20		1			H7114	2	0	2020	Oklahoma County		2	0	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	1	0	1	1	1	H7115_001_0	7	1			08/02/2019	2020.01	08/02/2019 05:31:42 PM Central Daylight Time	08/05/2019 05:43:14 PM Central Daylight Time	08/05/2019 05:37:22 PM Central Daylight Time			08/06/2019 10:35:27 AM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	1	1		1			H7115	1	0	2020	"Texas Counties - Harris, Montgomery, Fort Bend"		2	72000	2			2						healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808		(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7115	805	0	1	1	1	H7115_805_0	5	1			05/28/2019	2020.01	05/28/2019 11:42:18 AM Central Daylight Time					06/03/2019 01:22:25 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	1	1		1			H7115	805	0	2020	"Texas Counties - Harris, Montgomery, Fort Bend"		1	14400	2			2						healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808		(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7115	806	0	1	1	1	H7115_806_0	5	1			05/28/2019	2020.01	05/28/2019 10:00:30 AM Central Daylight Time					06/03/2019 01:22:25 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	1	1		1			H7115	806	0	2020	"Texas Counties - Harris, Montgomery, Fort Bend"		1	14400	2			2						healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808		(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7115	807	0	1	1	1	H7115_807_0	5	1			05/28/2019	2020.01	05/28/2019 10:00:16 AM Central Daylight Time					06/03/2019 01:22:25 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org/medicare	Memorial Hermann Advantage (HMO)	1	1		1			H7115	807	0	2020	"Texas Counties - Harris, Montgomery, Fort Bend"		1	14400	2			2						healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	healthplan.memorialhermann.org/medicare	(855)645-8448		(855)645-8448		(888)801-4808		(888)801-4808										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7119	1	0	1	1	1	H7119_001_0	20	1		1	08/06/2019	2020.01	08/06/2019 10:47:57 AM Eastern Daylight Time	08/06/2019 12:47:42 AM Eastern Daylight Time	08/06/2019 12:47:42 AM Eastern Daylight Time			08/06/2019 11:04:13 AM Eastern Daylight Time	PROVIDER PARTNERS HEALTH PLAN OF OHIO	Provider Partners Ohio Advantage Plan	pphealthplan.com	Provider Partners Health Plan of Ohio (HMO I-SNP)	1	1		1			H7119	1	0	2020	"Central, Southern, Northeastern"		2	7800	2			1	1	1				pphealthplan.com	pphealthplan.com	pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7123	1	0	1	1	1	H7123_001_0	9	1	2	1	08/06/2019	2020.01	08/06/2019 01:31:24 PM Eastern Daylight Time	08/05/2019 11:42:26 PM Eastern Daylight Time	07/31/2019 03:38:42 PM Eastern Daylight Time			08/06/2019 03:54:26 PM Eastern Daylight Time	"UPMC HEALTH COVERAGE, INC."	UPMC for Life Dual	www.upmchealthplan.com/snp	UPMC for Life Dual (HMO D-SNP)	1	1		1			H7123	1	0	2020	"Bucks, Chester, Delaware, Montgomery, Philadelphia"		2	6425	2			1	3		1		1	www.upmchealthplan.com/medicare/documents-and-forms	www.upmchealthplan.com/medicare/documents-and-forms	http://www.upmchealthplan.com/snp	(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7149	1	0	1	1	1	H7149_001_0	5	1			08/01/2019	2020.01	08/01/2019 02:14:17 PM Central Daylight Time	08/01/2019 03:28:38 PM Central Daylight Time	07/31/2019 03:33:33 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Advantra (HMO)	1	1		1			H7149	1	0	2020	Partial State of Nebraska		2	63456	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7149	4	0	1	1	1	H7149_004_0	4	1			08/01/2019	2020.01	08/01/2019 02:14:43 PM Central Daylight Time	08/01/2019 03:32:13 PM Central Daylight Time	07/31/2019 03:34:44 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime (HMO)	1	1		1			H7149	4	0	2020	Douglas and Sarpy Counties Nebraska		2	13248	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7149	6	0	1	1	1	H7149_006_0	4	1	2	1	07/03/2019	2020.01	07/03/2019 05:48:21 PM Eastern Daylight Time	07/31/2019 02:03:15 PM Central Daylight Time	07/31/2019 03:35:57 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Assure Premier (HMO D-SNP)	1	1		1			H7149	6	0	2020	"Douglas, Lancaster and Sarpy counties"		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7149	801	0	1	1	1	H7149_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:55:44 AM Eastern Daylight Time					05/30/2019 07:05:44 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (HMO)	1	1		1			H7149	801	0	2020	Nebraska		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H7149	802	0	1	1	1	H7149_802_0	2	1			05/31/2019	2020.01	05/31/2019 12:05:33 PM Eastern Daylight Time					05/31/2019 12:18:23 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (HMO)	1	1		1			H7149	802	0	2020	Nebraska		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H7149	804	0	1	1	1	H7149_804_0	1	1			05/24/2019	2020.01	05/24/2019 09:56:08 AM Eastern Daylight Time					05/30/2019 07:05:44 PM Eastern Daylight Time	AETNA HEALTH INC. (PA)	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (HMO)	1	1		1			H7149	804	0	2020	Nebraska		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H7165	1	0	1	1	1	H7165_001_0	6	1			07/09/2019	2020.01	07/09/2019 10:59:25 AM Eastern Daylight Time	08/01/2019 03:07:09 PM Eastern Daylight Time	08/01/2019 03:08:53 PM Eastern Daylight Time			08/01/2019 03:21:31 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx20	BlueCross Secure (HMO)	1	1		1			H7165	1	0	2020	Greenville County		2		2			2						www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7165	2	0	1	1	1	H7165_002_0	7	1			07/09/2019	2020.01	07/09/2019 11:00:39 AM Eastern Daylight Time	08/01/2019 03:07:14 PM Eastern Daylight Time	08/01/2019 03:08:56 PM Eastern Daylight Time			08/01/2019 03:21:31 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx20	BlueCross Secure (HMO)	1	1		1			H7165	2	0	2020	Richland County		2		2			2						www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7165	805	0	1	1	1	H7165_805_0	1	1			05/24/2019	2020.01	05/24/2019 01:56:42 PM Eastern Daylight Time					05/31/2019 05:30:06 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx20	BlueCross MAPD Calendar Year (HMO) (HMO)	1	1		1			H7165	805	0	2020	Nationwide		1	120	2			2						www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H7165	806	0	1	1	1	H7165_806_0	1	1			05/23/2019	2020.01	05/23/2019 01:36:43 PM Eastern Daylight Time					05/31/2019 05:30:06 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx20	BlueCross MAPD Non-Calendar Year (HMO) (HMO)	1	1		1			H7165	806	0	2020	Nationwide		1	1000	2			2						www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1				
H7172	1	0	1	48	5	H7172_001_0	4	1			08/20/2019	2020.01	08/20/2019 02:03:45 PM Central Daylight Time					08/20/2019 02:03:53 PM Central 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)"	5	48		1			H7172	1	0	2020	Ohio		2	343086	2			2						www.aetnabetterhealth.com/ohio	www.aetnabetterhealth.com/ohio	www.aetnabetterhealth.com/ohio	(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)-																
H7173	1	0	1	1	1	H7173_001_0	4	1	2	1	08/01/2019	2020.01	08/01/2019 12:33:23 PM Eastern Daylight Time	08/05/2019 04:24:27 PM Central Daylight Time	08/05/2019 03:36:35 PM Central Daylight Time			08/06/2019 11:18:33 AM Central Daylight Time	"PEACH STATE HEALTH PLAN, INC."	Allwell	allwell.pshpgeorgia.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H7173	1	0	2020	"Metro Atl, N. GA, Counties: CE, HS, HE, SP, TP"		2		2			1	3		2		2	allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(877)725-7748		(877)725-7748		(877)826-3693		(877)826-3693		(877)725-7748		(877)725-7748		(877)826-3693		(877)826-3693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7173	2	0	1	1	1	H7173_002_0	4	1			08/01/2019	2020.01	08/01/2019 12:33:59 PM Eastern Daylight Time	08/05/2019 04:24:31 PM Central Daylight Time	08/05/2019 03:36:41 PM Central Daylight Time			08/06/2019 11:18:33 AM Central Daylight Time	"PEACH STATE HEALTH PLAN, INC."	Allwell	allwell.pshpgeorgia.com	Allwell Medicare (HMO)	1	1		1			H7173	2	0	2020	"CY, DA, DO, FY, FU, GW, HY, PA, RO, SP, TP"		2		2			2						allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7173	7	0	1	1	1	H7173_007_0	3	1			08/01/2019	2020.01	08/01/2019 12:34:26 PM Eastern Daylight Time	08/05/2019 04:24:19 PM Central Daylight Time	08/05/2019 03:36:20 PM Central Daylight Time			08/06/2019 11:18:33 AM Central Daylight Time	"PEACH STATE HEALTH PLAN, INC."	Allwell	allwell.pshpgeorgia.com	Allwell Medicare Premier (HMO)	1	1		1			H7173	7	0	2020	"Counties: DA, FU, GE, GW, ME"		2		2			2						allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7173	8	0	1	1	1	H7173_008_0	3	1			08/01/2019	2020.01	08/01/2019 12:34:44 PM Eastern Daylight Time	08/05/2019 04:24:23 PM Central Daylight Time	08/05/2019 03:36:27 PM Central Daylight Time			08/06/2019 11:18:33 AM Central Daylight Time	"PEACH STATE HEALTH PLAN, INC."	Allwell	allwell.pshpgeorgia.com	Allwell Medicare (HMO)	1	1		1			H7173	8	0	2020	Cobb County		2		2			2						allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7173	801	0	1	1	1	H7173_801_0	1	1			05/03/2019	2020.01	05/30/2019 11:58:45 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"PEACH STATE HEALTH PLAN, INC."	Allwell	allwell.pshpgeorgia.com	Allwell Group (HMO)	1	1		1			H7173	801	0	2020	Statewide		1	100	2			2						allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H7173	802	0	1	1	1	H7173_802_0	1	1			05/03/2019	2020.01	05/03/2019 02:29:29 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"PEACH STATE HEALTH PLAN, INC."	Allwell	allwell.pshpgeorgia.com	Allwell Group (HMO)	1	1		1			H7173	802	0	2020	Statewide		1	100	2			2						allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H7173	803	0	1	1	1	H7173_803_0	1	1			05/03/2019	2020.01	05/30/2019 11:58:46 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"PEACH STATE HEALTH PLAN, INC."	Allwell	allwell.pshpgeorgia.com	Allwell Group (HMO)	1	1		1			H7173	803	0	2020	Statewide		1	100	2			2						allwell.pshpgeorgia.com/findadoctor	allwell.pshpgeorgia.com/formulary	allwell.pshpgeorgia.com/findadoctor	(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(844)890-2326		(844)890-2326		(877)826-3693		(877)826-3693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H7175	1	0	1	4	1	H7175_001_0	8	1			07/16/2019	2020.01	07/16/2019 01:48:16 PM Eastern Daylight Time	08/02/2019 08:37:58 AM Eastern Daylight Time	07/30/2019 11:14:43 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC."	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H7175	1	0	2020	Select counties in NC		2	2337	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7175	2	0	1	4	1	H7175_002_0	8	1	2	1	07/11/2019	2020.01	07/11/2019 02:01:05 PM Eastern Daylight Time	08/02/2019 08:39:36 AM Eastern Daylight Time	07/30/2019 11:15:20 PM Eastern Daylight Time			08/05/2019 04:10:32 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC."	WellCare	www.wellcare.com/medicare	WellCare Imperial (PPO D-SNP)	1	4		1			H7175	2	0	2020	Select counties in NC		2	1409	2			1	3		2		2	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7195	1	0	1	20	8	H7195_001_0	1	1			05/28/2019	2020.01	05/28/2019 10:57:30 AM Central Daylight Time		05/28/2019 10:48:07 AM Central Daylight Time			05/28/2019 10:59:00 AM Central Daylight Time	NORTHLAND PACE PROGRAM	Northland PACE Senior Care Services	http://www.northlandpace.com	Northland PACE - Dual (PACE)	8	20		1			H7195	1	0	2020	"Burleigh, Morton, Stark and Ward Counties"		2		2			2						http://www.pharmastarpbm.com/	n/a										(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	2	0	1	20	8	H7195_002_0	1	1			05/28/2019	2020.01	05/28/2019 10:57:55 AM Central Daylight Time		05/28/2019 10:48:08 AM Central Daylight Time			05/28/2019 10:59:00 AM Central Daylight Time	NORTHLAND PACE PROGRAM	Northland PACE Senior Care Services	http://www.northlandpace.com	Northland PACE - Medicare Only (PACE)	8	20		1			H7195	2	0	2020	"Burleigh, Morton, Stark and Ward Counties"		2		2			2						http://www.pharmastarpbm.com/	n/a										(888)883-8959		(701)751-3050		(888)883-8959		(701)751-3050										(888)838-8959		(701)751-3050		(888)838-8959		(701)751-3050																
H7220	2	0	1	1	1	H7220_002_0	3	1			07/19/2019	2020.01	07/19/2019 04:03:09 PM Eastern Daylight Time	06/03/2019 09:03:20 AM Eastern Daylight Time				07/19/2019 04:21:22 PM Eastern Daylight Time	"INDIANA UNIVERSITY HEALTH PLANS NFP, INC."	Indiana University Health Plans - Medicare	www.iuhealthplans.org	IU Health Plans Medicare Select (HMO)	1	1		1			H7220	2	0	2020	State of Indiana - 31 counties		2		2			2						www.iuhealthplans.org	www.iuhealthplans.org	www.iuhealthplans.org	(800)455-9776		(317)963-9700		(866)327-7497		(866)327-7497										(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333										2					2					2	2			
H7220	4	0	1	2	1	H7220_004_0	5	1			08/01/2019	2020.01	08/01/2019 04:41:31 PM Eastern Daylight Time	08/05/2019 12:53:48 PM Eastern Daylight Time	08/05/2019 12:53:48 PM Eastern Daylight Time			08/06/2019 09:46:59 AM Eastern Daylight Time	"INDIANA UNIVERSITY HEALTH PLANS NFP, INC."	Indiana University Health Plans - Medicare	www.iuhealthplans.org	IU Health Plans Medicare Choice (HMO-POS)	1	2		1			H7220	4	0	2020	State of Indiana - 25 counties		2		2			2						www.iuhealthplans.org	www.iuhealthplans.org	www.iuhealthplans.org	(800)455-9776		(317)963-9700		(866)327-7497		(866)327-7497		(844)432-0695		(844)432-0695		(866)327-7497		(866)327-7497		(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	2			
H7220	9	1	1	1	1	H7220_009_1	4	1			08/01/2019	2020.01	08/01/2019 04:42:15 PM Eastern Daylight Time	08/05/2019 12:53:49 PM Eastern Daylight Time	08/05/2019 12:53:49 PM Eastern Daylight Time			08/06/2019 09:46:59 AM Eastern Daylight Time	"INDIANA UNIVERSITY HEALTH PLANS NFP, INC."	Indiana University Health Plans - Medicare	www.iuhealthplans.org	IU Health Plans Medicare Select Plus (HMO)	1	1		1			H7220	9	1	2020	Indianapolis Metro Area and Surrounding Counties	State of Indiana - 34 counties	2		2			2						www.iuhealthplans.org	www.iuhealthplans.org	www.iuhealthplans.org	(800)455-9776		(317)963-9700		(866)327-7497		(866)327-7497		(844)432-0695		(844)432-0695		(866)327-7497		(866)327-7497		(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	1	1	7a;	
H7220	9	2	1	1	1	H7220_009_2	4	1			08/01/2019	2020.01	08/01/2019 04:42:28 PM Eastern Daylight Time	08/05/2019 12:53:49 PM Eastern Daylight Time	08/05/2019 12:53:49 PM Eastern Daylight Time			08/06/2019 09:46:59 AM Eastern Daylight Time	"INDIANA UNIVERSITY HEALTH PLANS NFP, INC."	Indiana University Health Plans - Medicare	www.iuhealthplans.org	IU Health Plans Medicare Select Plus (HMO)	1	1		1			H7220	9	2	2020	Indianapolis Metro Area and Surrounding Counties	Indianapolis Metro Area	2		2			2						www.iuhealthplans.org	www.iuhealthplans.org	www.iuhealthplans.org	(800)455-9776		(317)963-9700		(866)327-7497		(866)327-7497		(844)432-0695		(844)432-0695		(866)327-7497		(866)327-7497		(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	1	1	7a;	
H7220	9	3	1	1	1	H7220_009_3	4	1			08/01/2019	2020.01	08/01/2019 04:42:44 PM Eastern Daylight Time	08/05/2019 12:53:49 PM Eastern Daylight Time	08/05/2019 12:53:49 PM Eastern Daylight Time			08/06/2019 09:46:59 AM Eastern Daylight Time	"INDIANA UNIVERSITY HEALTH PLANS NFP, INC."	Indiana University Health Plans - Medicare	www.iuhealthplans.org	IU Health Plans Medicare Select Plus (HMO)	1	1		1			H7220	9	3	2020	Indianapolis Metro Area and Surrounding Counties	Ft. Wayne Area	2		2			2						www.iuhealthplans.org	www.iuhealthplans.org	www.iuhealthplans.org	(800)455-9776		(317)963-9700		(866)327-7497		(866)327-7497		(844)432-0695		(844)432-0695		(866)327-7497		(866)327-7497		(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	1	1	7a;	
H7245	1	0	1	1	1	H7245_001_0	7	1			07/16/2019	2020.01	07/16/2019 02:00:26 PM Pacific Daylight Time	08/01/2019 10:00:12 AM Pacific Daylight Time	08/01/2019 10:36:18 AM Pacific Daylight Time			08/02/2019 02:43:20 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage (HMO)	1	1		1			H7245	1	0	2020	Various Counties in Eastern and Western WA		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(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	2			
H7245	2	0	1	1	1	H7245_002_0	9	1			07/16/2019	2020.01	07/16/2019 09:33:41 AM Pacific Daylight Time	08/01/2019 10:01:18 AM Pacific Daylight Time	08/01/2019 10:36:56 AM Pacific Daylight Time			08/02/2019 02:43:20 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Classic (HMO)	1	1		1			H7245	2	0	2020	Various Counties in Western WA		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(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	1	11	18a;	18a1;
H7245	3	0	1	1	1	H7245_003_0	7	1			07/16/2019	2020.01	07/16/2019 11:20:37 AM Pacific Daylight Time	08/01/2019 10:34:08 AM Pacific Daylight Time	08/01/2019 10:37:34 AM Pacific Daylight Time			08/02/2019 02:43:20 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Classic Plus (HMO)	1	1		1			H7245	3	0	2020	Various Counties in Western WA		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(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	2			
H7245	5	0	1	1	1	H7245_005_0	7	1			07/16/2019	2020.01	07/16/2019 11:21:22 AM Pacific Daylight Time	08/01/2019 10:02:58 AM Pacific Daylight Time	08/01/2019 10:38:12 AM Pacific Daylight Time			08/02/2019 02:43:20 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Total Health (HMO)	1	1		1			H7245	5	0	2020	Various Counties in Eastern WA		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(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	1	11	18a;	18a1;
H7245	6	0	1	1	1	H7245_006_0	7	1			07/16/2019	2020.01	07/16/2019 02:02:11 PM Pacific Daylight Time	08/01/2019 10:03:54 AM Pacific Daylight Time	08/01/2019 10:38:50 AM Pacific Daylight Time			08/02/2019 02:43:20 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Core (HMO)	1	1		1			H7245	6	0	2020	Various Counties in Eastern and Western WA		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(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	2			
H7245	8	0	1	1	1	H7245_008_0	7	1			07/16/2019	2020.01	07/16/2019 11:22:16 AM Pacific Daylight Time	08/01/2019 10:05:02 AM Pacific Daylight Time	08/01/2019 10:39:28 AM Pacific Daylight Time			08/02/2019 02:43:20 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Core Plus (HMO)	1	1		1			H7245	8	0	2020	Various Counties in Eastern and Western WA		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(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	1	11	18a;	18a1;
H7262	1	0	1	20	8	H7262_001_0	1	1			05/20/2019	2020.01	05/20/2019 09:34:29 AM Mountain Daylight Time		05/20/2019 07:58:20 AM Mountain Daylight Time			05/20/2019 09:35:05 AM Mountain Daylight Time	TRU COMMUNITY CARE	TRU PACE	www.pace.trucare.org	TRU Community Care (PACE)	8	20		1			H7262	1	0	2020	Boulder and Southwest Weld Counties		2		2			2						TBD	www.trucare.org												(303)665-0115				(303)665-0115												(800)659-2656				(800)659-2656																
H7262	2	0	1	20	8	H7262_002_0	1	1			05/20/2019	2020.01	05/20/2019 09:34:36 AM Mountain Daylight Time		05/20/2019 07:58:18 AM Mountain Daylight Time			05/20/2019 09:35:05 AM Mountain Daylight Time	TRU COMMUNITY CARE	TRU PACE	www.pace.trucare.org	TRU Community Care (PACE)	8	20		1			H7262	2	0	2020	Boulder and Southwest Weld Counties		2		2			2						TBD	www.trucare.org												(303)665-0115				(303)665-0115												(800)659-2656				(800)659-2656																
H7284	1	0	1	4	1	H7284_001_0	3	1			07/16/2019	2020.01	07/16/2019 01:27:32 PM Eastern Daylight Time	08/04/2019 05:17:10 PM Eastern Daylight Time	08/02/2019 01:18:59 PM Eastern Daylight Time			08/05/2019 11:15:45 AM Eastern Daylight Time	"HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC."	Humana	www.humana.com/medicare	HumanaChoice Florida H7284-001 (PPO)	1	4		1			H7284	1	0	2020	"Lake, Marion, Seminole and Sumter counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7284	2	0	1	4	1	H7284_002_0	3	1			07/16/2019	2020.01	07/16/2019 01:31:22 PM Eastern Daylight Time	08/04/2019 05:18:32 PM Eastern Daylight Time	08/02/2019 01:18:59 PM Eastern Daylight Time			08/05/2019 11:15:45 AM Eastern Daylight Time	"HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC."	Humana	www.humana.com/medicare	HumanaChoice Florida H7284-002 (PPO)	1	4		1			H7284	2	0	2020	"Charlotte, Collier and Lee counties"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7284	3	0	1	4	1	H7284_003_0	2	1	2	1	05/30/2019	2020.01	05/30/2019 04:36:49 PM Eastern Daylight Time	08/04/2019 05:19:51 PM Eastern Daylight Time	08/02/2019 01:18:59 PM Eastern Daylight Time			08/05/2019 11:26:46 AM Eastern Daylight Time	"HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC."	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H7284-003 (PPO D-SNP)	1	4		1			H7284	3	0	2020	North Florida Rural Counties		2		2			1	3		2		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	2	0	1	4	1	H7301_002_0	6	1			07/03/2019	2020.01	07/03/2019 06:08:31 PM Eastern Daylight Time	08/07/2019 10:02:35 AM Eastern Daylight Time	07/31/2019 04:37:07 AM Eastern Daylight Time			08/07/2019 12:00:24 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF ILLINOIS, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Advantra (PPO)	1	4		1			H7301	2	0	2020	Northern/Northwestern Illinois		2	122424	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	6	0	1	4	1	H7301_006_0	5	1			07/31/2019	2020.01	07/31/2019 01:20:50 PM Eastern Daylight Time	08/07/2019 10:04:22 AM Eastern Daylight Time	07/31/2019 04:38:20 AM Eastern Daylight Time			08/07/2019 12:00:24 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF ILLINOIS, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Advantra (PPO)	1	4		1			H7301	6	0	2020	Northern/Northwestern Illinois		2	43632	2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	7	0	1	4	1	H7301_007_0	4	1			08/01/2019	2020.01	08/01/2019 10:25:55 AM Central Daylight Time	08/02/2019 07:37:54 AM Central Daylight Time	07/31/2019 03:39:31 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	"COVENTRY HEALTH CARE OF ILLINOIS, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Advantra (PPO)	1	4		1			H7301	7	0	2020	Illinois		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	9	0	1	4	1	H7301_009_0	4	1			07/03/2019	2020.01	07/03/2019 05:07:09 PM Central Daylight Time	08/02/2019 07:38:59 AM Central Daylight Time	07/31/2019 03:40:42 AM Central Daylight Time			08/02/2019 03:28:09 PM Central Daylight Time	"COVENTRY HEALTH CARE OF ILLINOIS, INC."	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Advantra (PPO)	1	4		1			H7301	9	0	2020	Illinois		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7301	801	0	1	4	1	H7301_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:56:25 AM Eastern Daylight Time					05/30/2019 07:07:40 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF ILLINOIS, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx (PPO)	1	4		1			H7301	801	0	2020	Illinois		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H7301	803	0	1	4	1	H7301_803_0	2	1			05/31/2019	2020.01	05/31/2019 11:47:26 AM Eastern Daylight Time					05/31/2019 12:20:30 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF ILLINOIS, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan (PPO)	1	4		1			H7301	803	0	2020	Illinois		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H7301	807	0	1	4	1	H7301_807_0	1	1			05/24/2019	2020.01	05/24/2019 09:56:49 AM Eastern Daylight Time					05/30/2019 07:07:40 PM Eastern Daylight Time	"COVENTRY HEALTH CARE OF ILLINOIS, INC."	Aetna Medicare	https://www.aetnamedicare.com	Aetna Medicare Plan w/Rx SH (PPO)	1	4		1			H7301	807	0	2020	Illinois		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H7317	1	0	1	1	1	H7317_001_0	6	1			08/02/2019	2020.01	08/02/2019 04:06:19 AM Hawaiian Standard Time	08/02/2019 03:52:26 AM Hawaiian Standard Time	07/30/2019 11:32:58 AM Hawaiian Standard Time			08/02/2019 09:39:04 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	HMSA Essential Advantage	www.hmsa.com/advantage	HMSA Essential Advantage (HMO)	1	1		1			H7317	1	0	2020	Honolulu County		2	8220	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7317	801	0	1	1	1	H7317_801_0	2	1			05/24/2019	2020.01	05/24/2019 12:41:53 PM Hawaiian Standard Time					05/30/2019 11:06:30 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	Essential Advantage	www.hmsa.com/advantage	HMSA Essential Advantage EGWP with Drug CY (HMO)	1	1		1			H7317	801	0	2020	Honolulu County		1	0	2			2						www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(800)660-4672		(808)948-6000		(800)693-4672		(808)948-6235		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;12;14a;15;	1	1a;1b;2;3-1;3-2;3-3;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;9a1;9b;9c;9d;12;14d;14e6;16b;17a;18a;	2					2				
H7322	1	0	1	1	1	H7322_001_0	5	1			07/15/2019	2020.01	07/15/2019 11:35:07 AM Eastern Daylight Time	08/01/2019 10:42:36 AM Eastern Daylight Time	08/01/2019 08:17:33 PM Eastern Daylight Time			08/04/2019 12:32:06 PM Eastern Daylight Time	"OSCAR HEALTH PLAN OF NEW YORK, INC."	Oscar	www.hioscar.com/medicare	Montefiore + Oscar Easy Care (HMO)	1	1		1			H7322	1	0	2020	Bronx County		2	5232	2			2						www.hioscar.com/search	www.hioscar.com/search	www.hioscar.com/search	(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		2					2					2	2			
H7322	2	0	1	1	1	H7322_002_0	5	1			07/15/2019	2020.01	07/15/2019 11:35:56 AM Eastern Daylight Time	08/01/2019 10:46:45 AM Eastern Daylight Time	08/01/2019 08:19:20 PM Eastern Daylight Time			08/04/2019 12:32:06 PM Eastern Daylight Time	"OSCAR HEALTH PLAN OF NEW YORK, INC."	Oscar	www.hioscar.com/medicare	Oscar Easy Care (HMO)	1	1		1			H7322	2	0	2020	"Orange, Rockland and Westchester Counties"		2	6768	2			2						www.hioscar.com/search	www.hioscar.com/search	www.hioscar.com/search	(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		(855)672-2720		(855)672-2720		(855)672-2710		(855)672-2710		2					2					2	2			
H7323	1	0	1	4	1	H7323_001_0	5	1			07/17/2019	2020.01	07/17/2019 10:45:38 AM Eastern Daylight Time	08/02/2019 08:41:13 AM Eastern Daylight Time	07/30/2019 11:15:56 PM Eastern Daylight Time			08/05/2019 04:03:16 PM Eastern Daylight Time	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	WellCare	www.wellcare.com/medicare	WellCare Prime (PPO)	1	4		1			H7323	1	0	2020	Select counties in TX		2	2391	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7323	2	0	1	4	1	H7323_002_0	5	1			07/17/2019	2020.01	07/17/2019 10:47:43 AM Eastern Daylight Time	08/02/2019 08:42:48 AM Eastern Daylight Time	07/30/2019 11:16:32 PM Eastern Daylight Time			08/05/2019 04:03:16 PM Eastern Daylight Time	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H7323	2	0	2020	Select counties in TX		2	2391	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7323	3	0	1	4	1	H7323_003_0	5	1			07/17/2019	2020.01	07/17/2019 10:48:21 AM Eastern Daylight Time	08/02/2019 08:44:25 AM Eastern Daylight Time	07/30/2019 11:17:08 PM Eastern Daylight Time			08/05/2019 04:03:16 PM Eastern Daylight Time	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H7323	3	0	2020	Select counties in TX		2	5940	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7323	4	0	1	4	1	H7323_004_0	5	1			07/17/2019	2020.01	07/17/2019 10:48:56 AM Eastern Daylight Time	08/02/2019 08:45:59 AM Eastern Daylight Time	07/30/2019 11:17:43 PM Eastern Daylight Time			08/05/2019 04:03:16 PM Eastern Daylight Time	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	WellCare	www.wellcare.com/medicare	WellCare Prime (PPO)	1	4		1			H7323	4	0	2020	Select counties in TX		2	2169	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(833)444-9088		(833)444-9088		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7326	1	0	1	4	1	H7326_001_0	6	1			07/11/2019	2020.01	07/11/2019 01:07:28 PM Eastern Daylight Time	08/02/2019 08:47:40 AM Eastern Daylight Time	07/30/2019 11:18:20 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF SOUTH CAROLINA, INC."	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H7326	1	0	2020	Select Counties in SC		2	31051	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7326	2	0	1	4	1	H7326_002_0	6	1			07/11/2019	2020.01	07/11/2019 01:08:30 PM Eastern Daylight Time	08/02/2019 08:49:21 AM Eastern Daylight Time	07/30/2019 11:18:56 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF SOUTH CAROLINA, INC."	WellCare	www.wellcare.com/medicare	WellCare Prime (PPO)	1	4		1			H7326	2	0	2020	Select Counties in SC		2	12227	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7326	3	0	1	4	1	H7326_003_0	7	1			07/11/2019	2020.01	07/11/2019 01:09:22 PM Eastern Daylight Time	08/02/2019 08:51:03 AM Eastern Daylight Time	07/30/2019 11:19:32 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF SOUTH CAROLINA, INC."	WellCare	www.wellcare.com/medicare	WellCare Absolute (PPO)	1	4		1			H7326	3	0	2020	Select counties in SC		2	11084	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7326	4	0	1	4	1	H7326_004_0	7	1			07/11/2019	2020.01	07/11/2019 01:32:19 PM Eastern Daylight Time	08/02/2019 08:52:45 AM Eastern Daylight Time	07/30/2019 11:20:08 PM Eastern Daylight Time			08/05/2019 03:50:23 PM Eastern Daylight Time	"WELLCARE OF SOUTH CAROLINA, INC."	WellCare	www.wellcare.com/medicare	WellCare Flex Complete (PPO)	1	4		1			H7326	4	0	2020	Select counties in SC		2	505	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7330	1	0	1	1	1	H7330_001_0	7	1			08/06/2019	2020.01	08/06/2019 01:39:50 PM Central Daylight Time	08/06/2019 01:38:50 PM Central Daylight Time	08/06/2019 01:38:50 PM Central Daylight Time			08/06/2019 01:40:16 PM Central Daylight Time	"ZING HEALTH, INC."	Zing Health	myzinghealth.com	Zing Choice IL (HMO)	1	1		1			H7330	1	0	2020	Cook County		2	30000	2			2						myzinghealth.com	myzinghealth.com	myzinghealth.com	(866)946-4458		(866)946-4458		(833)946-4458		(833)946-4458		(855)946-4458		(855)946-4458		(855)946-4458		(855)946-4458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7394	1	0	1	1	1	H7394_001_0	10	1			08/06/2019	2020.01	08/06/2019 05:31:19 PM Eastern Daylight Time	08/06/2019 05:29:00 PM Eastern Daylight Time	08/06/2019 05:29:14 PM Eastern Daylight Time			08/06/2019 05:51:31 PM Eastern Daylight Time	"APEX HEALTH, INC."	"ApexHealth, Inc."	www.apexhealth.com	ApexAscend (HMO)	1	1		1			H7394	1	0	2020	"Buncombe, Macon, Mitchell"		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com			(844)279-0508				(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7394	2	0	1	1	1	H7394_002_0	10	1			08/06/2019	2020.01	08/06/2019 05:32:53 PM Eastern Daylight Time	08/06/2019 05:29:00 PM Eastern Daylight Time	08/06/2019 05:29:14 PM Eastern Daylight Time			08/06/2019 05:51:31 PM Eastern Daylight Time	"APEX HEALTH, INC."	"ApexHealth, Inc."	www.apexhealth.com	ApexBold (HMO)	1	1		1			H7394	2	0	2020	"Buncombe, Macon, Mitchell"		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com			(844)279-0508				(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7394	3	0	1	1	1	H7394_003_0	10	1			08/06/2019	2020.01	08/06/2019 05:33:06 PM Eastern Daylight Time	08/06/2019 05:29:00 PM Eastern Daylight Time	08/06/2019 05:29:14 PM Eastern Daylight Time			08/06/2019 05:51:31 PM Eastern Daylight Time	"APEX HEALTH, INC."	"ApexHealth, Inc."	www.apexhealth.com	ApexAscend (HMO)	1	1		1			H7394	3	0	2020	"McDowell, Transylvania"		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com			(844)279-0508				(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7394	4	0	1	1	1	H7394_004_0	10	1			08/06/2019	2020.01	08/06/2019 05:33:12 PM Eastern Daylight Time	08/06/2019 05:29:00 PM Eastern Daylight Time	08/06/2019 05:29:14 PM Eastern Daylight Time			08/06/2019 05:51:31 PM Eastern Daylight Time	"APEX HEALTH, INC."	"ApexHealth, Inc."	www.apexhealth.com	ApexBold (HMO)	1	1		1			H7394	4	0	2020	"McDowell, Transylvania"		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com			(844)279-0508				(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7394	5	0	1	1	1	H7394_005_0	8	1	2	1	08/06/2019	2020.01	08/06/2019 05:33:18 PM Eastern Daylight Time	08/06/2019 05:29:00 PM Eastern Daylight Time	08/06/2019 05:29:14 PM Eastern Daylight Time			08/06/2019 05:51:31 PM Eastern Daylight Time	"APEX HEALTH, INC."	"ApexHealth, Inc."	www.apexhealth.com	ApexComplete (HMO D-SNP)	1	1		1			H7394	5	0	2020	NC DSNP		2		2			1	3		1		1	www.apexhealth.com	www.apexhealth.com	www.apexhealth.com			(844)279-0508				(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H7394	6	0	1	1	1	H7394_006_0	10	1			08/06/2019	2020.01	08/06/2019 05:33:24 PM Eastern Daylight Time	08/06/2019 05:29:00 PM Eastern Daylight Time	08/06/2019 05:29:14 PM Eastern Daylight Time			08/06/2019 05:51:31 PM Eastern Daylight Time	"APEX HEALTH, INC."	"ApexHealth, Inc."	www.apexhealth.com	ApexAscend (HMO)	1	1		1			H7394	6	0	2020	"Charleston, Colleton, Pickens, York"		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com			(844)279-0508				(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7394	7	0	1	1	1	H7394_007_0	10	1			08/06/2019	2020.01	08/06/2019 05:33:31 PM Eastern Daylight Time	08/06/2019 05:29:00 PM Eastern Daylight Time	08/06/2019 05:29:14 PM Eastern Daylight Time			08/06/2019 05:51:31 PM Eastern Daylight Time	"APEX HEALTH, INC."	"ApexHealth, Inc."	www.apexhealth.com	ApexBold (HMO)	1	1		1			H7394	7	0	2020	"Charleston, Colleton, Pickens, York"		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com			(844)279-0508				(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7394	8	0	1	1	1	H7394_008_0	10	1			08/06/2019	2020.01	08/06/2019 05:33:38 PM Eastern Daylight Time	08/06/2019 05:29:00 PM Eastern Daylight Time	08/06/2019 05:29:14 PM Eastern Daylight Time			08/06/2019 05:51:31 PM Eastern Daylight Time	"APEX HEALTH, INC."	"ApexHealth, Inc."	www.apexhealth.com	ApexAscend (HMO)	1	1		1			H7394	8	0	2020	"Anderson, Beaufort, Horry, Jasper"		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com			(844)279-0508				(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7394	9	0	1	1	1	H7394_009_0	10	1			08/06/2019	2020.01	08/06/2019 05:33:45 PM Eastern Daylight Time	08/06/2019 05:29:00 PM Eastern Daylight Time	08/06/2019 05:29:14 PM Eastern Daylight Time			08/06/2019 05:51:31 PM Eastern Daylight Time	"APEX HEALTH, INC."	"ApexHealth, Inc."	www.apexhealth.com	ApexBold (HMO)	1	1		1			H7394	9	0	2020	"Anderson, Beaufort, Horry, Jasper"		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com			(844)279-0508				(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7394	10	0	1	1	1	H7394_010_0	10	1			08/06/2019	2020.01	08/06/2019 05:33:52 PM Eastern Daylight Time	08/06/2019 05:29:00 PM Eastern Daylight Time	08/06/2019 05:29:14 PM Eastern Daylight Time			08/06/2019 05:51:31 PM Eastern Daylight Time	"APEX HEALTH, INC."	"ApexHealth, Inc."	www.apexhealth.com	ApexAscend (HMO)	1	1		1			H7394	10	0	2020	"Davidson, Hamilton, Rutherford, Shelby"		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com			(844)279-0508				(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7394	11	0	1	1	1	H7394_011_0	10	1			08/06/2019	2020.01	08/06/2019 05:33:59 PM Eastern Daylight Time	08/06/2019 05:29:00 PM Eastern Daylight Time	08/06/2019 05:29:14 PM Eastern Daylight Time			08/06/2019 05:51:31 PM Eastern Daylight Time	"APEX HEALTH, INC."	"ApexHealth, Inc."	www.apexhealth.com	ApexBold (HMO)	1	1		1			H7394	11	0	2020	"Davidson, Hamilton, Rutherford, Shelby"		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com			(844)279-0508				(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7394	12	0	1	1	1	H7394_012_0	10	1			08/06/2019	2020.01	08/06/2019 05:34:05 PM Eastern Daylight Time	08/06/2019 05:29:00 PM Eastern Daylight Time	08/06/2019 05:29:14 PM Eastern Daylight Time			08/06/2019 05:51:31 PM Eastern Daylight Time	"APEX HEALTH, INC."	"ApexHealth, Inc."	www.apexhealth.com	ApexAscend (HMO)	1	1		1			H7394	12	0	2020	"Counties: Algy, Ffx, FCCity, Ldn, Mgy, SalCity"		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com			(844)279-0508				(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7394	13	0	1	1	1	H7394_013_0	10	1			08/06/2019	2020.01	08/06/2019 05:34:12 PM Eastern Daylight Time	08/06/2019 05:29:00 PM Eastern Daylight Time	08/06/2019 05:29:14 PM Eastern Daylight Time			08/06/2019 05:51:31 PM Eastern Daylight Time	"APEX HEALTH, INC."	"ApexHealth, Inc."	www.apexhealth.com	ApexBold (HMO)	1	1		1			H7394	13	0	2020	"Counties: Algy, Ffx, FCCity, Ldn, Mgy, SalCity"		2		2			2						www.apexhealth.com	www.apexhealth.com	www.apexhealth.com			(844)279-0508				(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(844)279-0508		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7399	1	0	1	1	1	H7399_001_0	3	1			08/01/2019	2020.01	08/01/2019 09:51:36 AM US Mountain Standard Time	08/05/2019 04:24:55 PM Central Daylight Time	08/05/2019 03:37:45 PM Central Daylight Time			08/06/2019 11:25:15 AM Central Daylight Time	CENTENE VENTURE COMPANY ILLINOIS	Ascension Complete	illinois.ascensioncomplete.com	Ascension Complete Illinois Reward (HMO)	1	1		1			H7399	1	0	2020	"Cook, DuPage, Kane and Will Counties"		2		2			2						illinois.ascensioncomplete.com	illinois.ascensioncomplete.com	illinois.ascensioncomplete.com	(833)293-5966		(833)293-5966		(877)831-9411		(877)831-9411		(833)293-5966		(833)293-5966		(877)831-9411		(877)831-9411		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7399	2	0	1	1	1	H7399_002_0	3	1			08/01/2019	2020.01	08/01/2019 09:52:33 AM US Mountain Standard Time	08/05/2019 04:24:51 PM Central Daylight Time	08/05/2019 03:37:38 PM Central Daylight Time			08/06/2019 11:25:15 AM Central Daylight Time	CENTENE VENTURE COMPANY ILLINOIS	Ascension Complete	illinois.ascensioncomplete.com	Ascension Complete Illinois Secure (HMO)	1	1		1			H7399	2	0	2020	"Cook, DuPage, Kane and Will Counties"		2		2			2						illinois.ascensioncomplete.com	illinois.ascensioncomplete.com	illinois.ascensioncomplete.com	(833)293-5966		(833)293-5966		(877)831-9411		(877)831-9411		(833)293-5966		(833)293-5966		(877)831-9411		(877)831-9411		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7404	1	0	1	4	1	H7404_001_0	6	1			08/02/2019	2020.01	08/02/2019 10:46:59 AM Central Daylight Time	08/02/2019 11:51:57 AM Central Daylight Time	07/30/2019 09:56:45 PM Central Daylight Time			08/06/2019 11:32:29 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Headwaters (PPO)	1	4		1			H7404	1	0	2020	Select Counties in Twin Cities Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	2	0	1	4	1	H7404_002_0	6	1			08/02/2019	2020.01	08/02/2019 10:47:36 AM Central Daylight Time	08/02/2019 11:52:16 AM Central Daylight Time	07/30/2019 09:57:18 PM Central Daylight Time			08/06/2019 11:32:29 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Lakeshore (PPO)	1	4		1			H7404	2	0	2020	Select Counties in Twin Cities Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	4	0	1	4	1	H7404_004_0	7	1			08/02/2019	2020.01	08/02/2019 10:50:40 AM Central Daylight Time	08/02/2019 11:52:35 AM Central Daylight Time	07/30/2019 09:57:49 PM Central Daylight Time			08/06/2019 11:32:29 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Sync (PPO)	1	4		1			H7404	4	0	2020	Select Counties in Twin Cities Area		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(844)876-6177		(844)876-6177		(800)555-5757		(800)555-5757		(844)876-6177		(844)876-6177		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	5	0	1	4	1	H7404_005_0	8	1			08/02/2019	2020.01	08/02/2019 10:38:55 AM Central Daylight Time	08/02/2019 11:52:53 AM Central Daylight Time	07/30/2019 09:58:22 PM Central Daylight Time			08/06/2019 11:32:29 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Headwaters (PPO)	1	4		1			H7404	5	0	2020	Select Counties in Minnesota and North Dakota		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	6	0	1	4	1	H7404_006_0	6	1			08/02/2019	2020.01	08/02/2019 10:41:27 AM Central Daylight Time	08/02/2019 11:53:12 AM Central Daylight Time	07/30/2019 09:58:56 PM Central Daylight Time			08/06/2019 11:32:29 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Lakeshore (PPO)	1	4		1			H7404	6	0	2020	Carlton and St. Louis Counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	11	0	1	4	1	H7404_011_0	6	1			08/02/2019	2020.01	08/02/2019 10:43:15 AM Central Daylight Time	08/02/2019 11:53:31 AM Central Daylight Time	07/30/2019 09:59:29 PM Central Daylight Time			08/06/2019 11:32:29 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Headwaters (PPO)	1	4		1			H7404	11	0	2020	Select Counties in MN		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	12	0	1	4	1	H7404_012_0	6	1			08/02/2019	2020.01	08/02/2019 10:45:34 AM Central Daylight Time	08/02/2019 11:53:49 AM Central Daylight Time	07/30/2019 10:00:04 PM Central Daylight Time			08/06/2019 11:32:29 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Lakeshore (PPO)	1	4		1			H7404	12	0	2020	Select Counties in MN		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7404	14	0	1	4	1	H7404_014_0	6	1			08/02/2019	2020.01	08/02/2019 10:48:52 AM Central Daylight Time	08/02/2019 11:54:08 AM Central Daylight Time	07/30/2019 10:00:35 PM Central Daylight Time			08/06/2019 11:32:29 AM Central Daylight Time	PACIFICARE LIFE ASSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Riverbank (PPO)	1	4		1			H7404	14	0	2020	Select Counties in MN		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(844)867-3487		(844)867-3487		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7409	1	0	1	1	1	H7409_001_0	7	1			06/02/2019	2020.01	06/02/2019 12:47:31 PM Central Daylight Time	08/02/2019 04:24:54 PM Central Daylight Time	08/02/2019 04:34:59 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH COMPANY OF SOUTH CAROLINA, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage (HMO)	1	1		1			H7409	1	0	2020	"Anderson, Greenville, and Pickens Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-5537		(844)221-5537		(833)412-7709		(833)412-7709		(844)221-5537		(844)221-5537		(833)412-7709		(833)412-7709		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7409	2	0	1	1	1	H7409_002_0	7	1			06/03/2019	2020.01	06/03/2019 08:54:03 AM Central Daylight Time	08/02/2019 04:23:46 PM Central Daylight Time	08/02/2019 04:34:56 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH COMPANY OF SOUTH CAROLINA, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Assist (HMO)	1	1		1			H7409	2	0	2020	"Anderson, Greenville, and Pickens Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-5537		(844)221-5537		(833)412-7709		(833)412-7709		(844)221-5537		(844)221-5537		(833)412-7709		(833)412-7709		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7419	1	0	1	48	5	H7419_001_0	2	1			07/11/2019	2020.01	07/11/2019 02:36:12 PM Eastern Daylight Time					07/11/2019 02:40:07 PM Eastern Daylight Time	"TUFTS HEALTH PUBLIC PLANS, INC."	Tufts Health Plan	www.ChooseUnify.org	Tufts Health Unify (Medicare-Medicaid Plan)	5	48		1			H7419	1	0	2020	"Middlesex, Worcester and Suffolk counties"		2	54000	2			2						www.TuftsHealthUnify.org	www.TuftsHealthUnify.org	www.TuftsHealthUnify.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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H7445	4	0	1	1	1	H7445_004_0	2	1			05/30/2019	2020.01	05/30/2019 04:26:19 PM Central Daylight Time	08/02/2019 11:05:25 AM Central Daylight Time	07/30/2019 10:01:09 PM Central Daylight Time			08/06/2019 02:36:31 PM Central Daylight Time	"UNITEDHEALTHCARE OF ILLINOIS, INC."	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage (HMO)	1	1		1			H7445	4	0	2020	Carroll county		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7464	1	0	1	1	1	H7464_001_0	4	1	2	1	07/11/2019	2020.01	07/11/2019 05:32:55 PM Central Daylight Time	08/02/2019 11:05:55 AM Central Daylight Time	07/30/2019 10:01:44 PM Central Daylight Time			08/06/2019 03:47:42 PM Central Daylight Time	"UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO D-SNP)	1	1		1			H7464	1	0	2020	Select Counties in VA		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-7151		(844)368-7151		(888)834-3721		(888)834-3721		(844)368-7151		(844)368-7151		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7469	1	0	1	20	8	H7469_001_0	2	1			08/07/2019	2020.01	08/07/2019 05:44:14 PM Eastern Daylight Time		09/05/2019 03:44:05 PM Eastern Daylight Time			09/05/2019 03:47:41 PM Eastern Daylight Time	PACE PARTNERS OF NORTHEAST FLORIDA	PACE Partners of Northeast Florida	thepaceplace.com	PACE Partners of Northeast Florida (PACE)	8	20		1			H7469	1	0	2020	"Duval, Clay, Nassau and St. Johns Counties"		2		2			2						@trhc.com	N/A	N/A											(904)428-0400	6207			(904)428-0400												(800)955-8771				(800)955-8771																
H7469	2	0	1	20	8	H7469_002_0	2	1			08/07/2019	2020.01	08/07/2019 05:45:07 PM Eastern Daylight Time		09/05/2019 03:44:06 PM Eastern Daylight Time			09/05/2019 03:47:41 PM Eastern Daylight Time	PACE PARTNERS OF NORTHEAST FLORIDA	PACE Partners of Northeast Florida	@thepaceplace.com	PACE Partners of Northeast Florida MO (PACE)	8	20		1			H7469	2	0	2020	Medicare Only		2		2			2						@trhc.com	N/A	N/A											(904)407-6207	6207			(904)407-6207	6207											(800)955-8771				(800)955-8771																
H7501	1	0	1	20	8	H7501_001_0	1	1			05/22/2019	2020.01	05/22/2019 10:09:01 AM Pacific Daylight Time		05/21/2019 06:14:11 PM Pacific Daylight Time			05/22/2019 10:13:51 AM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima PACE	https://www.caloptima.org/en/Members/PACE.aspx	CalOptima PACE (PACE)	8	20		1			H7501	1	0	2020	"Orange County, California"		2		2			2						www.caloptima.org/home/providers/pharmacy.aspx	www.caloptima.org										(855)785-2584		(714)468-1100		(855)785-2584		(714)468-1100										(800)735-2929		(714)468-1063		(800)735-2929		(714)468-1063																
H7501	2	0	1	20	8	H7501_002_0	1	1			05/22/2019	2020.01	05/22/2019 10:07:10 AM Pacific Daylight Time		05/21/2019 06:14:03 PM Pacific Daylight Time			05/22/2019 10:13:51 AM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima PACE	www.caloptima.org	CalOptima PACE (PACE)	8	20		1			H7501	2	0	2020	Orange County		2		2			2						www.caloptima.org/home/providers/pharmacy.aspx	www.caloptima.org										(855)785-2584		(714)468-1100		(855)785-2584		(714)468-1100										(800)735-2929		(714)468-1063		(800)735-2929		(714)468-1063																
H7511	1	0	1	1	1	H7511_001_0	5	1		1	08/01/2019	2020.01	08/01/2019 11:55:51 AM Central Daylight Time	08/01/2019 01:16:39 PM Central Daylight Time	07/31/2019 04:06:04 PM Central Daylight Time			08/05/2019 04:36:39 PM Central Daylight Time	"GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC."	Great Plains Medicare Advantage	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage (HMO I-SNP)	1	1		1			H7511	1	0	2020	Nebraska (partial)		2	8573	2			1	1	3				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7511	2	0	1	1	1	H7511_002_0	7	1		1	07/19/2019	2020.01	07/19/2019 03:36:07 PM Central Daylight Time	08/01/2019 11:14:06 AM Central Daylight Time	07/31/2019 04:07:33 PM Central Daylight Time			08/05/2019 04:36:39 PM Central Daylight Time	"GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC."	Great Plains Medicare Advantage	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage Gold (HMO I-SNP)	1	1		1			H7511	2	0	2020	Nebraska (partial)		2	953	2			1	1	3				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7518	1	0	1	4	1	H7518_001_0	4	1			07/12/2019	2020.01	07/12/2019 05:02:17 PM Eastern Daylight Time	08/02/2019 08:54:22 AM Eastern Daylight Time	07/30/2019 11:20:43 PM Eastern Daylight Time			08/05/2019 04:23:11 PM Eastern Daylight Time	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H7518	1	0	2020	Select counties in MO		2	1865	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7518	2	0	1	4	1	H7518_002_0	5	1			07/12/2019	2020.01	07/12/2019 05:16:34 PM Eastern Daylight Time	07/12/2019 06:06:39 PM Eastern Daylight Time				07/12/2019 09:50:32 PM Eastern Daylight Time	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY	WellCare	www.wellcare.com/medicare	WellCare Absolute (PPO)	1	4		1			H7518	2	0	2020	Select counties in MO		2	236	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7522	1	0	1	4	1	H7522_001_0	8	1			07/23/2019	2020.01	07/23/2019 02:14:35 PM SA Western Standard Time	08/05/2019 05:17:28 PM SA Western Standard Time	08/05/2019 05:17:28 PM SA Western Standard Time			08/05/2019 05:21:16 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage (PPO)	1	4		1			H7522	1	0	2020	Puerto Rico		2	48	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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						1	1	7d;8a1;8b1;8b2;8b3;9a1;9a2;9b;12;	
H7522	801	0	1	4	1	H7522_801_0	3	1			05/30/2019	2020.01	05/30/2019 03:11:05 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group $0 Calendar (PPO)	1	4		1			H7522	801	0	2020	Puerto Rico		1	15470	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	802	0	1	4	1	H7522_802_0	3	1			05/30/2019	2020.01	05/30/2019 03:18:50 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group $25 Calendar (PPO)	1	4		1			H7522	802	0	2020	Puerto Rico		1	0	2			2						www.mmm-pr.com	www.mmm-pr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	804	0	1	4	1	H7522_804_0	3	1			05/30/2019	2020.01	05/30/2019 03:19:21 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group $50 Calendar (PPO)	1	4		1			H7522	804	0	2020	Puerto Rico		1	0	2			2						www.mmm-pr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	805	0	1	4	1	H7522_805_0	3	1			05/30/2019	2020.01	05/30/2019 03:19:47 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group $100 Calendar (PPO)	1	4		1			H7522	805	0	2020	Puerto Rico		1	0	2			2						www.mmm-pr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	806	0	1	4	1	H7522_806_0	3	1			05/30/2019	2020.01	05/30/2019 03:20:09 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group $0 Non-Calendar (PPO)	1	4		1			H7522	806	0	2020	Puerto Rico		1	0	2			2						www.mmm-pr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	807	0	1	4	1	H7522_807_0	3	1			05/30/2019	2020.01	05/30/2019 03:20:33 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group $25 Non-Calendar (PPO)	1	4		1			H7522	807	0	2020	Puerto Rico		1	0	2			2						www.mmm-pr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	808	0	1	4	1	H7522_808_0	3	1			05/30/2019	2020.01	05/30/2019 03:20:56 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group $50 Non-Calendar (PPO)	1	4		1			H7522	808	0	2020	Puerto Rico		1	0	2			2						www.mmm-pr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7522	809	0	1	4	1	H7522_809_0	3	1			05/30/2019	2020.01	05/30/2019 03:21:21 PM SA Western Standard Time					06/02/2019 05:53:29 PM SA Western Standard Time	"MMM HEALTHCARE, LLC"	Medicare y Mucho Ms	www.mmmpr.com	MMM Advantage Group $100 Non-Calendar (PPO)	1	4		1			H7522	809	0	2020	Puerto Rico		1	0	2			2						www.mmm-pr.com	www.mmmpr.com	www.mmmpr.com	(866)333-5470		(787)620-2397		(833)647-9555		(787)620-2396		(866)333-5470		(787)620-2397		(833)647-9555		(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		1	1	1a;1b;2;5;6;7c;7i;7k;8b1;8b2;9a1;9a2;9b;9c;11a;11b;11c;	2		1									
H7559	1	0	1	1	1	H7559_001_0	4	1	2	1	08/01/2019	2020.01	08/01/2019 10:47:01 PM Eastern Daylight Time	08/01/2019 11:53:12 AM Eastern Daylight Time	08/01/2019 11:03:10 AM Eastern Daylight Time			08/05/2019 11:27:37 PM Eastern Daylight Time	"MAGELLAN COMPLETE CARE OF VIRGINIA, LLC"	Magellan Complete Care	mccofva.com	"Magellan Complete Care of Virginia, LLC (HMO D-SNP)"	1	1		1			H7559	1	0	2020	Virginia		2	4000	2			1	3		2		1	mccofva.com	mccofva.com	mccofva.com	(800)424-4495		(800)424-4495		(800)424-4497		(800)424-4497		(800)424-4495		(800)424-4495		(800)424-4497		(800)424-4497		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7617	1	0	1	4	1	H7617_001_0	2	1			05/31/2019	2020.01	05/31/2019 03:53:10 PM Eastern Daylight Time	08/04/2019 04:00:00 PM Eastern Daylight Time	08/02/2019 01:18:59 PM Eastern Daylight Time			08/05/2019 11:06:27 AM Eastern Daylight Time	EMPHESYS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H7617-001 (PPO)	1	4		1			H7617	1	0	2020	Greenville County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7619	1	0	1	20	8	H7619_001_0	2	1			05/28/2019	2020.01	05/28/2019 09:24:17 AM Eastern Daylight Time		07/16/2019 07:46:56 AM Eastern Daylight Time			07/16/2019 09:39:27 AM Eastern Daylight Time	"ATLANTICARE HEALTH SERVICES, INC."	AtlantiCare LIFE Connection	www.atlanticare.org	AtlantiCare LIFE Connection (PACE)	8	20		1			H7619	1	0	2020	Atlantic and Cape May Counties		2		2			2						NA	NA										(888)569-1000		(609)407-2052		(888)569-1000		(609)407-2052												(800)852-7899				(800)852-7899																
H7619	2	0	1	20	8	H7619_002_0	2	1			05/28/2019	2020.01	05/28/2019 09:24:50 AM Eastern Daylight Time		07/16/2019 07:46:32 AM Eastern Daylight Time			07/16/2019 09:39:27 AM Eastern Daylight Time	"ATLANTICARE HEALTH SERVICES, INC."	AtlantiCare LIFE Connection	www.atlanticare.org	AtlantiCare LIFE Connection (PACE)	8	20		1			H7619	2	0	2020	"Counties: Atlantic, Cape May"		2		2			2						NA	NA										(888)569-1000		(609)407-2052		(888)569-1000		(609)407-2052												(800)852-7899				(800)852-7899																
H7621	1	0	1	1	1	H7621_001_0	3	1			08/02/2019	2020.01	08/02/2019 05:36:35 PM Eastern Daylight Time	08/02/2019 09:47:18 AM Eastern Daylight Time	08/02/2019 01:18:59 PM Eastern Daylight Time			08/05/2019 11:14:25 AM Eastern Daylight Time	"HUMANA HEALTH PLAN OF CALIFORNIA, INC."	Humana	www.humana.com/medicare	Humana Community (HMO)	1	1		1			H7621	1	0	2020	Select Counties in Kansas City Metro area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7621	2	0	1	1	1	H7621_002_0	2	1			08/01/2019	2020.01	08/01/2019 04:54:11 PM Eastern Daylight Time	08/03/2019 10:47:22 AM Eastern Daylight Time	08/02/2019 01:18:59 PM Eastern Daylight Time			08/05/2019 11:00:12 AM Eastern Daylight Time	"HUMANA HEALTH PLAN OF CALIFORNIA, INC."	Humana	www.humana.com/medicare	Humana Community (HMO)	1	1		1			H7621	2	0	2020	Riverside County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7621	3	0	1	1	1	H7621_003_0	3	1			08/01/2019	2020.01	08/01/2019 04:55:18 PM Eastern Daylight Time	08/03/2019 10:53:46 AM Eastern Daylight Time	08/02/2019 01:18:59 PM Eastern Daylight Time			08/05/2019 11:00:12 AM Eastern Daylight Time	"HUMANA HEALTH PLAN OF CALIFORNIA, INC."	Humana	www.humana.com/medicare	Humana Community (HMO)	1	1		1			H7621	3	0	2020	San Joaquin County		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	1	0	1	2	1	H7646_001_0	7	1			08/01/2019	2020.01	08/01/2019 09:37:24 AM Central Daylight Time	08/01/2019 09:39:03 AM Central Daylight Time	08/01/2019 09:42:48 AM Central Daylight Time			08/02/2019 02:35:28 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmichigan.com	Sparrow Advantage (HMO-POS)	1	2		1			H7646	1	0	2020	Greater Lansing Area		2		2			2						www.phpmichigan.com	www.phpmichigan.com	www.phpmichigan.com	(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	2	0	1	2	1	H7646_002_0	7	1			08/01/2019	2020.01	08/01/2019 09:45:27 AM Central Daylight Time	08/01/2019 09:49:46 AM Central Daylight Time	08/01/2019 09:53:30 AM Central Daylight Time			08/02/2019 02:35:28 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmichigan.com	Covenant Advantage (HMO-POS)	1	2		1			H7646	2	0	2020	"Bay, Saginaw, Tuscola counties"		2		2			2						www.phpmichigan.com	www.phpmichigan.com	www.phpmichigan.com	(844)529-3757		(844)529-3757		(844)527-9389		(844)527-9389		(844)529-3757		(844)529-3757		(844)527-9389		(844)527-9389		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	3	0	1	2	1	H7646_003_0	7	1			08/01/2019	2020.01	08/01/2019 09:50:54 AM Central Daylight Time	08/01/2019 09:57:57 AM Central Daylight Time	08/01/2019 09:59:39 AM Central Daylight Time			08/02/2019 02:35:28 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmichigan.com	PHP Advantage (HMO-POS)	1	2		1			H7646	3	0	2020	Calhoun and Kalamazoo counties		2		2			2						www.phpmichigan.com	www.phpmichigan.com	www.phpmichigan.com	(844)529-3757		(844)529-3757		(844)527-9395		(844)527-9395		(844)529-3757		(844)529-3757		(844)527-9395		(844)527-9395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	4	0	1	2	1	H7646_004_0	7	1			08/01/2019	2020.01	08/01/2019 09:56:27 AM Central Daylight Time	08/01/2019 10:05:52 AM Central Daylight Time	08/01/2019 10:08:59 AM Central Daylight Time			08/02/2019 02:35:28 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmichigan.com	Sparrow Advantage Plus (HMO-POS)	1	2		1			H7646	4	0	2020	Greater Lansing Area		2		2			2						www.phpmichigan.com	www.phpmichigan.com	www.phpmichigan.com	(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	5	0	1	2	1	H7646_005_0	7	1			08/01/2019	2020.01	08/01/2019 10:03:06 AM Central Daylight Time	08/01/2019 10:14:24 AM Central Daylight Time	08/01/2019 10:15:59 AM Central Daylight Time			08/02/2019 02:35:28 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmichigan.com	Covenant Advantage Plus (HMO-POS)	1	2		1			H7646	5	0	2020	"Bay, Saginaw, Tuscola counties"		2		2			2						www.phpmichigan.com	www.phpmichigan.com	www.phpmichigan.com	(844)529-3757		(844)529-3757		(844)527-9389		(844)527-9389		(844)529-3757		(844)529-3757		(844)527-9389		(844)527-9389		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	6	0	1	2	1	H7646_006_0	7	1			08/01/2019	2020.01	08/01/2019 10:08:22 AM Central Daylight Time	08/01/2019 10:20:07 AM Central Daylight Time	08/01/2019 10:23:20 AM Central Daylight Time			08/02/2019 02:35:28 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmichigan.com	PHP Advantage Plus (HMO-POS)	1	2		1			H7646	6	0	2020	Calhoun and Kalamazoo counties		2		2			2						www.phpmichigan.com	www.phpmichigan.com	www.phpmichigan.com	(844)529-3757		(844)529-3757		(844)527-9395		(844)527-9395		(844)529-3757		(844)529-3757		(844)527-9395		(844)527-9395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7646	801	0	1	2	1	H7646_801_0	3	1			05/21/2019	2020.01	05/21/2019 08:08:37 PM Central Daylight Time					05/30/2019 02:48:37 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmichigan.com	EGWP MAPD Calendar year (HMO-POS)	1	2		1			H7646	801	0	2020	Certain Counties in Michigan		1	300	2			2						www.phpmichigan.com	www.phpmichigan.com	www.phpmichigan.com	(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;17a;18a;	1	2		2		1				
H7646	802	0	1	2	1	H7646_802_0	3	1			05/21/2019	2020.01	05/21/2019 08:15:10 PM Central Daylight Time					05/30/2019 02:48:37 PM Central Daylight Time	PHP MEDICARE	PHP Medicare	www.phpmichigan.com	EGWP MAPD Non-Calendar year (HMO-POS)	1	2		1			H7646	802	0	2020	Certain Counties in Michigan		1	300	2			2						www.phpmichigan.com	www.phpmichigan.com	www.phpmichigan.com	(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(844)529-3757		(844)529-3757		(844)529-3826		(844)529-3826		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;7e;7h;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;15;16b;	1	3-1;3-2;3-3;3-4;6;7b;7c;7d;7f;7g;7i;8a;8b1;8b2;8b3;9a1;16b;17a;18a;	1	2		2		1				
H7660	1	0	1	20	8	H7660_001_0	1	1			05/22/2019	2020.01	05/22/2019 01:24:07 PM Eastern Daylight Time		05/22/2019 11:32:03 AM Eastern Daylight Time			05/22/2019 01:27:47 PM Eastern Daylight Time	"VIECARE BEAVER, LLC"	LIFE Beaver and Lawrence Counties	http://www.lutheranseniorlife.org	"VieCare Beaver, LLC dba LIFE Beaver and Lawrence C (PACE)"	8	20		1			H7660	1	0	2020	Beaver and Lawrence Counties		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)378-5400				(724)378-5400												(711)-				(711)-																
H7660	2	0	1	20	8	H7660_002_0	1	1			05/22/2019	2020.01	05/22/2019 01:24:21 PM Eastern Daylight Time		05/22/2019 11:32:27 AM Eastern Daylight Time			05/22/2019 01:27:47 PM Eastern Daylight Time	"VIECARE BEAVER, LLC"	LIFE Beaver and Lawrence Counties	www.LutheranSeniorLife.org	"VieCare Beaver, LLC dba LIFE Beaver and Lawrence C (PACE)"	8	20		1			H7660	2	0	2020	Beaver and Lawrence Counties		2		2			2						www.lutheranseniorlife.org	www.lutheranseniorlife.org												(724)378-5400				(724)378-5400												(711)-				(711)-																
H7678	1	0	1	1	1	H7678_001_0	8	1	2	1	08/02/2019	2020.01	08/02/2019 05:42:11 PM Pacific Daylight Time	08/05/2019 10:05:52 AM Pacific Daylight Time	07/31/2019 11:35:06 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF TEXAS, INC."	"Molina Healthcare of Texas, Inc."	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	1	1		1			H7678	1	0	2020	Select Counties in Texas		2		2			1	3		1		1	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	2			
H7680	1	0	1	2	1	H7680_001_0	13	1			08/05/2019	2020.01	08/05/2019 04:10:48 PM Pacific Daylight Time	07/31/2019 04:16:04 PM Pacific Daylight Time	07/31/2019 04:04:09 PM Pacific Daylight Time			08/06/2019 04:26:48 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO-POS)	1	2		1			H7680	1	0	2020	"Potter,Gray,Moore,DS,Cooke,Fannin,Grayson,Randall"		2	27144	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7680	2	0	1	2	1	H7680_002_0	13	1			08/05/2019	2020.01	08/05/2019 04:43:37 PM Pacific Daylight Time	07/31/2019 04:16:56 PM Pacific Daylight Time	07/31/2019 04:05:26 PM Pacific Daylight Time			08/06/2019 04:26:48 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Plus (HMO-POS)	1	2		1			H7680	2	0	2020	"Hildago,Starr and Brooks"		2	20184	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7680	801	0	1	1	1	H7680_801_0	2	1			06/25/2019	2020.01	06/25/2019 03:59:52 PM Pacific Daylight Time					07/01/2019 04:53:06 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	1	1		1			H7680	801	0	2020	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7680	802	0	1	1	1	H7680_802_0	2	1			06/25/2019	2020.01	06/25/2019 04:00:11 PM Pacific Daylight Time					07/01/2019 04:53:06 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	1	1		1			H7680	802	0	2020	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7680	803	0	1	1	1	H7680_803_0	2	1			06/25/2019	2020.01	06/25/2019 04:00:32 PM Pacific Daylight Time					07/01/2019 04:53:06 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	1	1		1			H7680	803	0	2020	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7680	804	0	1	1	1	H7680_804_0	2	1			06/25/2019	2020.01	06/25/2019 04:01:00 PM Pacific Daylight Time					07/01/2019 04:53:06 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	1	1		1			H7680	804	0	2020	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H7680	805	0	1	1	1	H7680_805_0	2	1			06/25/2019	2020.01	06/25/2019 04:01:19 PM Pacific Daylight Time					07/01/2019 04:53:06 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	1	1		1			H7680	805	0	2020	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7680	806	0	1	1	1	H7680_806_0	2	1			06/25/2019	2020.01	06/25/2019 04:01:44 PM Pacific Daylight Time					07/01/2019 04:53:06 PM Pacific Daylight Time	PROMINENCE HEALTHFIRST OF TEXAS	Prominence Health Plan	www.prominencemedicare.com	Prominence Health Plan (HMO)	1	1		1			H7680	806	0	2020	National		1	0	2			2						www.prominencemedicare.com	www.prominencemedicare.com	www.prominencemedicare.com	(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(855)969-5882		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7728	2	0	1	4	1	H7728_002_0	8	1			07/17/2019	2020.01	07/17/2019 12:52:01 PM Pacific Daylight Time	08/05/2019 01:14:40 PM Pacific Daylight Time	08/05/2019 01:19:14 PM Pacific Daylight Time			08/05/2019 01:30:39 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Access (PPO)	1	4		1			H7728	2	0	2020	State of New Hampshire		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)304-1787		(855)304-1787		(844)368-4245		(844)368-4245		(855)304-1787		(855)304-1787		(844)368-4244		(844)368-4244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	4	1	1	4	1	H7728_004_1	5	1			06/25/2019	2020.01	06/25/2019 05:23:26 PM Eastern Daylight Time	08/05/2019 10:07:35 AM Eastern Daylight Time	07/30/2019 07:51:24 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Access (PPO)	1	4		1			H7728	4	1	2020	Select Counties in Kentucky	Lexington and Cincinnati	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)690-7795		(855)690-7795		(844)368-4245		(844)368-4245		(855)690-7795		(855)690-7795		(844)368-4244		(844)368-4244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	4	2	1	4	1	H7728_004_2	6	1			07/17/2019	2020.01	07/17/2019 01:49:49 PM Eastern Daylight Time	08/05/2019 10:07:37 AM Eastern Daylight Time	07/30/2019 07:52:02 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Access (PPO)	1	4		1			H7728	4	2	2020	Select Counties in Kentucky	Louisville	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)690-7795		(855)690-7795		(844)368-4245		(844)368-4245		(855)690-7795		(855)690-7795		(844)368-4244		(844)368-4244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	5	0	1	4	1	H7728_005_0	6	1			06/25/2019	2020.01	06/25/2019 05:43:56 PM Eastern Daylight Time	08/05/2019 10:07:37 AM Eastern Daylight Time	07/30/2019 07:53:14 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	www.bcbsga.com/medicare	Anthem MediBlue Access (PPO)	1	4		1			H7728	5	0	2020	Select Counties in Georgia		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(866)438-9968		(866)438-9968		(844)368-4245		(844)368-4245		(866)438-9968		(866)438-9968		(844)368-4244		(844)368-4244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	6	0	1	4	1	H7728_006_0	6	1			08/01/2019	2020.01	08/01/2019 01:29:46 PM Eastern Daylight Time	08/05/2019 10:07:38 AM Eastern Daylight Time	07/30/2019 07:54:39 PM Eastern Daylight Time			08/05/2019 03:18:37 PM Eastern Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Basic (PPO)	1	4		1			H7728	6	0	2020	Select Counties in Georgia		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(866)438-9968		(866)438-9968		(844)368-4245		(844)368-4245		(866)438-9968		(866)438-9968		(844)368-4244		(844)368-4244		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7728	801	0	1	4	1	H7728_801_0	2	1			05/30/2019	2020.01	05/30/2019 04:52:30 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H7728	801	0	2020	New Hampshire		1	161102	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	802	0	1	4	1	H7728_802_0	2	1			05/30/2019	2020.01	05/30/2019 04:52:41 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H7728	802	0	2020	New Hampshire		1	118538	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	803	0	1	4	1	H7728_803_0	2	1			05/30/2019	2020.01	05/30/2019 04:52:48 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H7728	803	0	2020	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	804	0	2	4	1	H7728_804_0	2	1			05/30/2019	2020.01	05/30/2019 04:52:57 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H7728	804	0	2020	National		1	679	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	805	0	1	4	1	H7728_805_0	2	1			05/30/2019	2020.01	05/30/2019 04:53:11 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H7728	805	0	2020	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	806	0	1	4	1	H7728_806_0	2	1			05/30/2019	2020.01	05/30/2019 04:53:18 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H7728	806	0	2020	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	807	0	2	4	1	H7728_807_0	2	1			05/30/2019	2020.01	05/30/2019 04:53:28 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H7728	807	0	2020	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	808	0	2	4	1	H7728_808_0	2	1			05/30/2019	2020.01	05/30/2019 04:53:35 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H7728	808	0	2020	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	809	0	2	4	1	H7728_809_0	2	1			05/30/2019	2020.01	05/30/2019 04:53:42 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		2	1		H7728	809	0	2020	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	810	0	1	4	1	H7728_810_0	2	1			05/30/2019	2020.01	05/30/2019 04:53:50 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H7728	810	0	2020	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	811	0	1	4	1	H7728_811_0	2	1			05/30/2019	2020.01	05/30/2019 04:53:57 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H7728	811	0	2020	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7728	812	0	1	4	1	H7728_812_0	2	1			05/30/2019	2020.01	05/30/2019 04:54:04 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	"ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem Medicare Preferred (PPO)	1	4		1			H7728	812	0	2020	New Hampshire		1	600	2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H7779	1	0	1	1	1	H7779_001_0	3	1		1	08/01/2019	2020.01	08/01/2019 05:54:57 PM Central Daylight Time	08/01/2019 02:20:07 PM Central Daylight Time	07/30/2019 05:12:37 PM Central Daylight Time			08/05/2019 04:56:33 PM Central Daylight Time	"AMERICAN HEALTH PLAN, INC."	American Health Advantage of Tennessee	tn.amhealthplans.com	American Health Advantage of Tennessee (HMO I-SNP)	1	1		1			H7779	1	0	2020	Tennessee		2	7194	2			1	1	3				tn.amhealthplans.com	tn.amhealthplans.com	tn.amhealthplans.com	(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2	2			
H7779	2	0	1	1	1	H7779_002_0	2	1			08/01/2019	2020.01	08/01/2019 05:55:12 PM Central Daylight Time	08/01/2019 02:20:55 PM Central Daylight Time	07/30/2019 05:13:18 PM Central Daylight Time			08/05/2019 04:56:33 PM Central Daylight Time	"AMERICAN HEALTH PLAN, INC."	American Health Advantage of Tennessee	tn.amhealthplans.com	American Health Advantage of Tennessee (HMO)	1	1		1			H7779	2	0	2020	Tennessee		2	1234	2			2						tn.amhealthplans.com	tn.amhealthplans.com	tn.amhealthplans.com	(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2	2			
H7787	1	0	1	4	1	H7787_001_0	8	1			07/18/2019	2020.01	07/18/2019 04:09:07 PM Central Daylight Time	07/31/2019 05:37:35 PM Central Daylight Time	07/30/2019 04:27:30 PM Central Daylight Time			08/02/2019 11:52:48 AM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (PPO)	1	4		1			H7787	1	0	2020	North Texas		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7787	2	0	1	4	1	H7787_002_0	8	1			07/18/2019	2020.01	07/18/2019 04:09:27 PM Central Daylight Time	08/01/2019 06:36:11 PM Central Daylight Time				08/06/2019 09:26:48 AM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (PPO)	1	4		1			H7787	2	0	2020	North Texas		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7802	1	0	1	1	1	H7802_001_0	8	1		1	07/24/2019	2020.01	07/24/2019 01:08:14 PM Central Daylight Time	08/01/2019 11:43:30 AM Central Daylight Time	07/31/2019 02:58:36 PM Central Daylight Time			08/05/2019 06:27:26 PM Central Daylight Time	"SPARTAN PLAN VA, INC."	Sunrise Advantage Plan	www.sunriseadvantageplan.com	Sunrise Advantage Plan (HMO I-SNP)	1	1		1			H7802	1	0	2020	Virginia (partial)		2	432	2			1	1	3				www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7802	2	0	1	1	1	H7802_002_0	8	1		1	07/24/2019	2020.01	07/24/2019 01:08:31 PM Central Daylight Time	08/01/2019 11:44:53 AM Central Daylight Time	07/31/2019 02:57:05 PM Central Daylight Time			08/05/2019 06:27:26 PM Central Daylight Time	"SPARTAN PLAN VA, INC."	Sunrise Advantage Plan	www.sunriseadvantageplan.com	Reflections (HMO C-SNP)	1	1		1			H7802	2	0	2020	Virginia (partial)		2	144	2			1	4			1E+14		www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7802	3	0	1	1	1	H7802_003_0	9	1			07/24/2019	2020.01	07/24/2019 01:08:46 PM Central Daylight Time	08/01/2019 11:46:09 AM Central Daylight Time	07/31/2019 02:57:16 PM Central Daylight Time			08/05/2019 06:27:26 PM Central Daylight Time	"SPARTAN PLAN VA, INC."	Sunrise Advantage Plan	www.sunriseadvantageplan.com	Sunrise Advantage Community Plan (HMO)	1	1		1			H7802	3	0	2020	Virginia (partial)		2	400	2			2						www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	www.sunriseadvantageplan.com	(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(844)896-0628		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7833	1	0	1	48	5	H7833_001_0	6	1			08/21/2019	2020.01	08/21/2019 04:28:08 PM Eastern Daylight Time					08/21/2019 04:52:12 PM Eastern Daylight Time	"UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C."	UnitedHealthcare	www.UHCCommunityplan.com	UnitedHealthcare Connected (Medicare-Medicaid Plan)	5	48		1			H7833	1	0	2020	Harris County		2	12	2			2						www.optumrx.com	www.UHCCommunityplan.com	www.UHCCommunityplan.com	(800)256-6533		(800)256-6533		(800)256-6533		(800)256-6533		(800)256-6533		(800)256-6533		(800)256-6533		(800)256-6533		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H7844	1	0	1	48	5	H7844_001_0	5	1			06/13/2019	2020.01	06/13/2019 10:33:04 AM Pacific Daylight Time					06/13/2019 10:35:26 AM Pacific Daylight Time	"MOLINA HEALTHCARE OF MICHIGAN, INC."	Molina Healthcare of Michigan	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	5	48		1			H7844	1	0	2020	Wayne and Macomb Counties		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)735-5604		(855)735-5604		(855)701-4885		(855)701-4885		(855)735-5604		(855)735-5604		(855)701-4885		(855)701-4885		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H7849	1	0	1	4	1	H7849_001_0	8	1			07/08/2019	2020.01	07/08/2019 04:27:26 PM Central Daylight Time	07/31/2019 05:37:56 PM Central Daylight Time	07/30/2019 04:27:44 PM Central Daylight Time			08/02/2019 12:23:53 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice (PPO)	1	4		1			H7849	1	0	2020	Denver and Boulder Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	2	0	1	4	1	H7849_002_0	8	1			07/08/2019	2020.01	07/08/2019 04:28:08 PM Central Daylight Time	07/31/2019 05:38:17 PM Central Daylight Time	07/30/2019 04:27:58 PM Central Daylight Time			08/02/2019 12:23:53 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice (PPO)	1	4		1			H7849	2	0	2020	Chicago Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	3	0	1	4	1	H7849_003_0	10	1			08/01/2019	2020.01	08/01/2019 03:17:11 PM Central Daylight Time	08/01/2019 09:30:39 AM Central Daylight Time	07/30/2019 04:28:11 PM Central Daylight Time			08/02/2019 12:23:53 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice (PPO)	1	4		1			H7849	3	0	2020	Georgia		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	6	0	1	4	1	H7849_006_0	8	1			07/08/2019	2020.01	07/08/2019 04:29:28 PM Central Daylight Time	07/31/2019 05:38:59 PM Central Daylight Time	07/30/2019 04:28:24 PM Central Daylight Time			08/02/2019 12:23:53 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice (PPO)	1	4		1			H7849	6	0	2020	Philadelphia Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	7	0	1	4	1	H7849_007_0	8	1			07/08/2019	2020.01	07/08/2019 04:30:14 PM Central Daylight Time	07/31/2019 05:39:19 PM Central Daylight Time	07/30/2019 04:28:38 PM Central Daylight Time			08/02/2019 12:23:53 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Plus (PPO)	1	4		1			H7849	7	0	2020	Philadelphia Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	8	0	1	4	1	H7849_008_0	8	1			07/08/2019	2020.01	07/08/2019 04:30:57 PM Central Daylight Time	07/31/2019 05:39:39 PM Central Daylight Time	07/30/2019 04:28:52 PM Central Daylight Time			08/02/2019 12:23:53 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice (PPO)	1	4		1			H7849	8	0	2020	Delaware		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	9	0	1	4	1	H7849_009_0	8	1			07/08/2019	2020.01	07/08/2019 04:31:42 PM Central Daylight Time	07/31/2019 05:40:00 PM Central Daylight Time	07/30/2019 04:29:05 PM Central Daylight Time			08/02/2019 12:23:53 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Plus (PPO)	1	4		1			H7849	9	0	2020	Delaware		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	10	0	1	4	1	H7849_010_0	8	1			07/08/2019	2020.01	07/08/2019 04:32:25 PM Central Daylight Time	07/31/2019 05:40:20 PM Central Daylight Time	07/30/2019 04:29:19 PM Central Daylight Time			08/02/2019 12:23:53 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice (PPO)	1	4		1			H7849	10	0	2020	Middle Tennessee		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	11	0	1	4	1	H7849_011_0	9	1			07/08/2019	2020.01	07/08/2019 04:33:08 PM Central Daylight Time	07/31/2019 05:40:40 PM Central Daylight Time	07/30/2019 04:29:32 PM Central Daylight Time			08/02/2019 12:23:53 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice (PPO)	1	4		1			H7849	11	0	2020	North Carolina		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	12	0	1	4	1	H7849_012_0	8	1			07/08/2019	2020.01	07/08/2019 04:33:49 PM Central Daylight Time	07/31/2019 06:23:21 PM Central Daylight Time	07/30/2019 04:29:46 PM Central Daylight Time			08/02/2019 12:23:53 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice (PPO)	1	4		1			H7849	12	0	2020	Alabama		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	13	0	1	4	1	H7849_013_0	8	1			07/08/2019	2020.01	07/08/2019 04:34:35 PM Central Daylight Time	07/31/2019 06:23:42 PM Central Daylight Time	07/30/2019 04:30:00 PM Central Daylight Time			08/02/2019 12:23:53 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice (PPO)	1	4		1			H7849	13	0	2020	Alabama		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7849	801	0	1	4	1	H7849_801_0	5	1			05/30/2019	2020.01	05/30/2019 04:45:57 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Rx CY (PPO)	1	4		1			H7849	801	0	2020	Statewide TN		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	802	0	1	4	1	H7849_802_0	4	1			05/29/2019	2020.01	05/29/2019 11:37:11 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Core CY (PPO)	1	4		1			H7849	802	0	2020	Statewide TN		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	803	0	1	4	1	H7849_803_0	4	1			05/29/2019	2020.01	05/29/2019 11:36:59 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Rx CY (PPO)	1	4		1			H7849	803	0	2020	"Statewide DC, DE, MD, VA"		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	804	0	1	4	1	H7849_804_0	4	1			05/29/2019	2020.01	05/29/2019 11:36:48 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Core CY (PPO)	1	4		1			H7849	804	0	2020	"Statewide DC, DE, MD, VA"		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	805	0	1	4	1	H7849_805_0	4	1			05/29/2019	2020.01	05/29/2019 11:36:37 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Rx CY (PPO)	1	4		1			H7849	805	0	2020	"Statewide NJ, PA"		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	806	0	1	4	1	H7849_806_0	4	1			05/29/2019	2020.01	05/29/2019 11:36:27 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Core CY (PPO)	1	4		1			H7849	806	0	2020	"Statewide NJ, PA"		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	807	0	1	4	1	H7849_807_0	4	1			05/29/2019	2020.01	05/29/2019 11:36:17 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Rx CY (PPO)	1	4		1			H7849	807	0	2020	Statewide NC		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	808	0	1	4	1	H7849_808_0	4	1			05/29/2019	2020.01	05/29/2019 11:36:07 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Core CY (PPO)	1	4		1			H7849	808	0	2020	Statewide NC		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	809	0	1	4	1	H7849_809_0	4	1			05/29/2019	2020.01	05/29/2019 11:35:50 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Rx CY (PPO)	1	4		1			H7849	809	0	2020	Statewide IL		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	810	0	1	4	1	H7849_810_0	4	1			05/29/2019	2020.01	05/29/2019 11:35:44 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Core CY (PPO)	1	4		1			H7849	810	0	2020	Statewide IL		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	811	0	1	4	1	H7849_811_0	4	1			05/29/2019	2020.01	05/29/2019 11:35:28 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Rx CY (PPO)	1	4		1			H7849	811	0	2020	Statewide CO		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	812	0	1	4	1	H7849_812_0	4	1			05/29/2019	2020.01	05/29/2019 11:35:19 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Core CY (PPO)	1	4		1			H7849	812	0	2020	Statewide CO		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	813	0	1	4	1	H7849_813_0	4	1			05/29/2019	2020.01	05/29/2019 11:35:06 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Rx CY (PPO)	1	4		1			H7849	813	0	2020	Statewide GA		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	814	0	1	4	1	H7849_814_0	4	1			05/29/2019	2020.01	05/29/2019 11:34:59 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Core CY (PPO)	1	4		1			H7849	814	0	2020	Statewide GA		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	815	0	1	4	1	H7849_815_0	4	1			05/29/2019	2020.01	05/29/2019 11:34:46 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Rx CY (PPO)	1	4		1			H7849	815	0	2020	Statewide AL		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	816	0	1	4	1	H7849_816_0	4	1			05/29/2019	2020.01	05/29/2019 11:34:41 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Core CY (PPO)	1	4		1			H7849	816	0	2020	Statewide AL		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	817	0	1	4	1	H7849_817_0	4	1			05/29/2019	2020.01	05/29/2019 11:34:27 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Rx CY (PPO)	1	4		1			H7849	817	0	2020	Nationwide		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7849	818	0	1	4	1	H7849_818_0	4	1			05/29/2019	2020.01	05/29/2019 11:32:35 PM Central Daylight Time					06/01/2019 08:30:17 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring True Choice Core CY (PPO)	1	4		1			H7849	818	0	2020	Nationwide		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(855)982-6172		(855)982-6172										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H7853	1	0	1	1	1	H7853_001_0	7	1			06/01/2019	2020.01	06/01/2019 12:01:00 PM Central Daylight Time	08/02/2019 04:23:27 PM Central Daylight Time	08/02/2019 04:34:53 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage (HMO)	1	1		1			H7853	1	0	2020	Greater Denver Area		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	2	0	1	1	1	H7853_002_0	7	1			06/01/2019	2020.01	06/01/2019 12:01:13 PM Central Daylight Time	08/02/2019 04:18:57 PM Central Daylight Time	08/02/2019 04:34:50 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Plus (HMO)	1	1		1			H7853	2	0	2020	Greater Denver Area		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	3	0	1	2	1	H7853_003_0	6	1			06/03/2019	2020.01	06/03/2019 09:36:52 AM Central Daylight Time	08/02/2019 04:23:19 PM Central Daylight Time	08/02/2019 04:34:48 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Choice (HMO-POS)	1	2		1			H7853	3	0	2020	Greater Denver Area		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	4	0	1	2	1	H7853_004_0	6	1			06/02/2019	2020.01	06/02/2019 06:10:46 PM Central Daylight Time	08/02/2019 04:23:14 PM Central Daylight Time	08/02/2019 04:34:02 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Choice Plus (HMO-POS)	1	2		1			H7853	4	0	2020	Greater Denver Area		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	5	0	1	1	1	H7853_005_0	6	1			06/03/2019	2020.01	06/03/2019 08:56:46 AM Central Daylight Time	08/02/2019 04:23:08 PM Central Daylight Time	08/02/2019 04:33:37 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Assist (HMO)	1	1		1			H7853	5	0	2020	Greater Denver Area		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(844)202-4793		(844)202-4793		(844)679-2029		(844)679-2029		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	6	0	1	1	1	H7853_006_0	6	1			06/03/2019	2020.01	06/03/2019 09:38:02 AM Central Daylight Time	08/02/2019 04:23:03 PM Central Daylight Time	08/02/2019 04:32:50 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Choice (HMO)	1	1		1			H7853	6	0	2020	"Dodge, Douglas, and Sarpy Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-7728		(844)221-7728		(833)412-6737		(833)412-6737		(844)221-7728		(844)221-7728		(833)412-6737		(833)412-6737		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	7	0	1	1	1	H7853_007_0	6	1			06/01/2019	2020.01	06/01/2019 11:33:03 AM Central Daylight Time	08/02/2019 04:22:57 PM Central Daylight Time	08/02/2019 04:32:27 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage (HMO)	1	1		1			H7853	7	0	2020	"Dodge, Douglas, and Sarpy Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-7728		(844)221-7728		(833)412-6737		(833)412-6737		(844)221-7728		(844)221-7728		(833)412-6737		(833)412-6737		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7853	8	0	1	1	1	H7853_008_0	6	1			06/02/2019	2020.01	06/02/2019 09:47:22 PM Central Daylight Time	08/02/2019 04:19:00 PM Central Daylight Time	08/02/2019 04:31:08 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Plus (HMO)	1	1		1			H7853	8	0	2020	"Dodge, Douglas, and Sarpy Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-7728		(844)221-7728		(833)412-6737		(833)412-6737		(844)221-7728		(844)221-7728		(833)412-6737		(833)412-6737		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7855	1	0	1	20	8	H7855_001_0	1	1			05/20/2019	2020.01	05/20/2019 07:40:57 AM Pacific Daylight Time		05/20/2019 07:25:53 AM Pacific Daylight Time			05/20/2019 07:45:50 AM Pacific Daylight Time	"BRANDMAN CENTERS FOR SENIOR CARE, INC."	Brandman Centers for Senior Care	www.brandmanseniorcare.org	Brandman Centers for Senior Care-Dual (PACE)	8	20		1			H7855	1	0	2020	Brandman Centers for Senior Care-Dual		2		2			2						www.carekinesis.com	Not applicable										(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	2	0	1	20	8	H7855_002_0	1	1			05/20/2019	2020.01	05/20/2019 07:42:27 AM Pacific Daylight Time		05/20/2019 07:25:38 AM Pacific Daylight Time			05/20/2019 07:45:50 AM Pacific Daylight Time	"BRANDMAN CENTERS FOR SENIOR CARE, INC."	Brandman Centers for Senior Care	www.brandmanseniorcare.org	Brandman Centers for Senior Care-Medicare Only (PACE)	8	20		1			H7855	2	0	2020	Brandman Centers for Senior Care-Medicare Only		2		2			2						www.carekinesis.com	Not applicable										(855)774-8444		(818)774-8444		(855)774-8444		(818)774-8444										(818)774-3194		(818)774-3194		(818)774-3194		(818)774-3194																
H7885	1	0	1	48	5	H7885_001_0	3	1			08/21/2019	2020.01	08/21/2019 01:59:20 PM Pacific Daylight Time					08/21/2019 02:00:37 PM Pacific Daylight Time	SAN MATEO HEALTH COMMISSION	Health Plan of San Mateo	www.hpsm.org	CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)	5	48		1			H7885	1	0	2020	San Mateo County		2		1	1		2						https://www.hpsm.org/provider	https://www.hpsm.org/member/view-my-medication-benefits	https://www.hpsm.org/provider	(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																
H7890	1	0	1	48	5	H7890_001_0	8	1			08/21/2019	2020.01	08/21/2019 02:06:28 PM Pacific Daylight Time					08/21/2019 02:12:42 PM 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)	5	48		1			H7890	1	0	2020	Santa Clara County		2	90000	2			2						www.scfhp.com/healthcareplans/calmediconnect	www.scfhp.com	www.scfhp.com/healthcareplans/calmediconnect	(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																
H7917	8	0	1	4	1	H7917_008_0	6	1			07/22/2019	2020.01	07/22/2019 01:52:57 PM Eastern Daylight Time	08/05/2019 03:18:48 PM Eastern Daylight Time	08/05/2019 03:19:23 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	1	4		1			H7917	8	0	2020	West Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	9	0	1	4	1	H7917_009_0	4	1			07/22/2019	2020.01	07/22/2019 01:53:10 PM Eastern Daylight Time	08/05/2019 03:18:49 PM Eastern Daylight Time	08/05/2019 03:19:24 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	1	4		1			H7917	9	0	2020	Middle Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	10	0	1	4	1	H7917_010_0	4	1			07/22/2019	2020.01	07/22/2019 01:53:10 PM Eastern Daylight Time	08/05/2019 03:18:50 PM Eastern Daylight Time	08/05/2019 03:19:24 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	1	4		1			H7917	10	0	2020	Southeast Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	11	0	1	4	1	H7917_011_0	7	1			07/22/2019	2020.01	07/22/2019 01:53:10 PM Eastern Daylight Time	08/05/2019 03:18:50 PM Eastern Daylight Time	08/05/2019 03:19:25 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Diamond (PPO)	1	4		1			H7917	11	0	2020	Northeast Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	12	0	1	4	1	H7917_012_0	5	1			08/02/2019	2020.01	08/02/2019 09:17:08 AM Eastern Daylight Time	08/05/2019 03:18:51 PM Eastern Daylight Time	08/05/2019 03:19:26 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	1	4		1			H7917	12	0	2020	West Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	13	0	1	4	1	H7917_013_0	5	1			08/02/2019	2020.01	08/02/2019 09:16:28 AM Eastern Daylight Time	08/05/2019 03:18:52 PM Eastern Daylight Time	08/05/2019 03:19:26 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	1	4		1			H7917	13	0	2020	Middle Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	14	0	1	4	1	H7917_014_0	5	1			08/02/2019	2020.01	08/02/2019 09:15:51 AM Eastern Daylight Time	08/05/2019 03:18:53 PM Eastern Daylight Time	08/05/2019 03:19:27 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	1	4		1			H7917	14	0	2020	Southeast Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	15	0	1	4	1	H7917_015_0	7	1			08/02/2019	2020.01	08/02/2019 09:14:49 AM Eastern Daylight Time	08/05/2019 03:18:54 PM Eastern Daylight Time	08/05/2019 03:19:27 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Ruby (PPO)	1	4		1			H7917	15	0	2020	Northeast Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	30	0	1	4	1	H7917_030_0	5	1			08/02/2019	2020.01	08/02/2019 09:39:38 AM Eastern Daylight Time	08/05/2019 03:18:55 PM Eastern Daylight Time	08/05/2019 03:19:28 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Sapphire (PPO)	1	4		1			H7917	30	0	2020	Southeast Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	31	0	1	4	1	H7917_031_0	7	1			08/02/2019	2020.01	08/02/2019 09:13:17 AM Eastern Daylight Time	08/05/2019 03:18:55 PM Eastern Daylight Time	08/05/2019 03:19:28 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Sapphire (PPO)	1	4		1			H7917	31	0	2020	Northeast Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	32	0	1	4	1	H7917_032_0	5	1			08/02/2019	2020.01	08/02/2019 09:12:30 AM Eastern Daylight Time	08/05/2019 03:18:56 PM Eastern Daylight Time	08/05/2019 03:19:29 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Garnet (PPO)	1	4		1			H7917	32	0	2020	Middle Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	33	0	1	4	1	H7917_033_0	5	1			08/02/2019	2020.01	08/02/2019 09:11:46 AM Eastern Daylight Time	08/05/2019 03:18:57 PM Eastern Daylight Time	08/05/2019 03:19:29 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Garnet (PPO)	1	4		1			H7917	33	0	2020	West Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	34	0	1	4	1	H7917_034_0	5	1			08/02/2019	2020.01	08/02/2019 09:10:59 AM Eastern Daylight Time	08/05/2019 03:18:57 PM Eastern Daylight Time	08/05/2019 03:19:30 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Emerald (PPO)	1	4		1			H7917	34	0	2020	West Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	35	0	1	4	1	H7917_035_0	5	1			08/02/2019	2020.01	08/02/2019 09:10:15 AM Eastern Daylight Time	08/05/2019 03:18:58 PM Eastern Daylight Time	08/05/2019 03:19:31 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Emerald (PPO)	1	4		1			H7917	35	0	2020	Middle Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	36	0	1	4	1	H7917_036_0	5	1			08/02/2019	2020.01	08/02/2019 09:09:30 AM Eastern Daylight Time	08/05/2019 03:18:59 PM Eastern Daylight Time	08/05/2019 03:19:31 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Emerald (PPO)	1	4		1			H7917	36	0	2020	Southeast Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	37	0	1	4	1	H7917_037_0	5	1			08/02/2019	2020.01	08/02/2019 09:08:25 AM Eastern Daylight Time	08/05/2019 03:19:00 PM Eastern Daylight Time	08/05/2019 03:19:32 PM Eastern Daylight Time			08/05/2019 03:41:16 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Emerald (PPO)	1	4		1			H7917	37	0	2020	Northeast Tennessee		2		2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.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						2			
H7917	801	0	1	4	1	H7917_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:36:27 AM Eastern Daylight Time					05/31/2019 05:52:45 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	1	4		1			H7917	801	0	2020	22 County Region		1	39072	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072		(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	802	0	1	4	1	H7917_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:39:29 AM Eastern Daylight Time					05/31/2019 05:52:45 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	1	4		1			H7917	802	0	2020	22 County Region		1	100	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072		(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7917	803	0	1	4	1	H7917_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:42:17 AM Eastern Daylight Time					05/31/2019 05:52:45 PM Eastern Daylight Time	"BLUECROSS BLUESHIELD OF TENNESSEE, INC."	BlueCross BlueShield of Tennessee	bcbstmedicare.com	BlueAdvantage Plus (PPO)	1	4		1			H7917	803	0	2020	22 County Region		1	100	2			2						bcbstmedicare.com	bcbstmedicare.com	bcbstmedicare.com	(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-										2					2						2			
H7971	1	0	1	4	1	H7971_001_0	8	1			07/17/2019	2020.01	07/17/2019 10:11:48 AM Eastern Daylight Time	08/05/2019 02:29:50 PM Eastern Daylight Time	08/05/2019 02:29:08 PM Eastern Daylight Time			08/05/2019 02:39:04 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com/Medicare	Horizon Medicare Blue (PPO)	1	4		1			H7971	1	0	2020	Sussex County		2	220	2			2						www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://directory.horizonblue.com	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H7971	801	0	1	4	1	H7971_801_0	1	1			05/22/2019	2020.01	05/22/2019 02:10:57 PM Eastern Daylight Time					05/22/2019 02:25:06 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Group (PPO)	1	4		1			H7971	801	0	2020	National		1	13977	2			2						medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H7971	802	0	1	4	1	H7971_802_0	2	1			05/22/2019	2020.01	05/22/2019 12:43:13 PM Eastern Daylight Time					05/22/2019 02:25:06 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Group w/Rx (PPO)	1	4		1			H7971	802	0	2020	National		1	36	2			2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en/find-medicine.html	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H7971	807	0	1	4	1	H7971_807_0	1	1			05/22/2019	2020.01	05/22/2019 12:43:20 PM Eastern Daylight Time					05/22/2019 02:25:06 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Group w/Rx Ideal (PPO)	1	4		1			H7971	807	0	2020	National		1	1500	2			2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en/find-medicine.html	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H7971	808	0	1	4	1	H7971_808_0	1	1			05/22/2019	2020.01	05/22/2019 12:43:31 PM Eastern Daylight Time					05/22/2019 02:25:06 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.HorizonBlue.com	Horizon Medicare Blue Group w/Rx Complete (PPO)	1	4		1			H7971	808	0	2020	National		1	1200	2			2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPPOG/en/find-medicine.html	http://directory.horizonblue.com/	(800)365-2223		(800)365-2223		(888)765-7134		(888)765-7134		(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7c;7d;7e;7h;7i;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;15;	2		1									
H7993	1	0	1	1	1	H7993_001_0	5	1			07/16/2019	2020.01	07/16/2019 03:55:22 PM Eastern Daylight Time	08/01/2019 05:23:24 PM Eastern Daylight Time	08/01/2019 04:28:14 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS	Devoted Health	www.Devoted.com	Devoted Health Core (HMO)	1	1		1			H7993	1	0	2020	Houston		2	23940	2			2						www.Devoted.com	www.Devoted.com/drug-search	www.Devoted.com/search-providers	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H7993	2	0	1	1	1	H7993_002_0	5	1			07/16/2019	2020.01	07/16/2019 03:55:51 PM Eastern Daylight Time	08/01/2019 05:25:54 PM Eastern Daylight Time	08/01/2019 04:29:20 PM Eastern Daylight Time			08/05/2019 02:54:22 PM Eastern Daylight Time	DEVOTED HEALTH PLAN OF TEXAS	Devoted Health	www.Devoted.com	Devoted Health Prime (HMO)	1	1		1			H7993	2	0	2020	Houston		2	3060	2			2						www.Devoted.com	www.Devoted.com/drug-search	www.Devoted.com/search-providers	(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(800)338-6833		(800)338-6833		(800)990-0723		(800)990-0723		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8003	1	0	1	4	1	H8003_001_0	6	1			07/08/2019	2020.01	07/08/2019 05:02:34 PM Eastern Daylight Time	08/01/2019 03:06:52 PM Eastern Daylight Time	08/01/2019 03:09:00 PM Eastern Daylight Time			08/01/2019 03:21:31 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx20	BlueCross Total (PPO)	1	4		1			H8003	1	0	2020	Upstate		2		2			2						www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8003	2	0	1	4	1	H8003_002_0	6	1			07/08/2019	2020.01	07/08/2019 05:00:00 PM Eastern Daylight Time	08/01/2019 03:06:58 PM Eastern Daylight Time	08/01/2019 03:08:36 PM Eastern Daylight Time			08/01/2019 03:21:31 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx20	BlueCross Total (PPO)	1	4		1			H8003	2	0	2020	Midlands/Coastal		2		2			2						www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8003	3	0	1	4	1	H8003_003_0	6	1			07/08/2019	2020.01	07/08/2019 04:58:59 PM Eastern Daylight Time	08/01/2019 03:07:04 PM Eastern Daylight Time	08/01/2019 03:08:40 PM Eastern Daylight Time			08/01/2019 03:21:31 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx20	BlueCross Total (PPO)	1	4		1			H8003	3	0	2020	Lowcountry		2		2			2						www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20	(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(855)204-2744		(855)204-2744		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8003	801	0	1	4	1	H8003_801_0	1	1			05/24/2019	2020.01	05/24/2019 01:54:08 PM Eastern Daylight Time					05/31/2019 05:30:06 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com/retplan20	BlueCross MAPD Calendar Year Group (PPO)	1	4		1			H8003	801	0	2020	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com/retplan20	www.SCBluesMedAdvantage.com/retplan20	www.SCBluesMedAdvantage.com/retplan20	(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836		(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H8003	802	0	1	4	1	H8003_802_0	1	1			05/24/2019	2020.01	05/24/2019 12:47:22 PM Eastern Daylight Time					05/31/2019 05:30:06 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com/retplan20	BlueCross MAPD Non-calendar Year Group (PPO)	1	4		1			H8003	802	0	2020	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com/retplan20	www.SCBluesMedAdvantage.com/retplan20	www.SCBluesMedAdvantage.com/retplan20	(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836		(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H8003	803	0	1	4	1	H8003_803_0	1	1			05/24/2019	2020.01	05/24/2019 12:52:20 PM Eastern Daylight Time					05/31/2019 05:30:06 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com/retplan20	BlueCross MA Only Calendar Year Group (PPO)	1	4		1			H8003	803	0	2020	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com/retplan20	www.SCBluesMedAdvantage.com/retplan20	www.SCBluesMedAdvantage.com/retplan20	(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H8003	804	0	1	4	1	H8003_804_0	1	1			05/24/2019	2020.01	05/24/2019 12:54:21 PM Eastern Daylight Time					05/31/2019 05:30:06 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.SCBluesMedAdvantage.com/retplan20	BlueCross MA Only Non-calendar Year Group (PPO)	1	4		1			H8003	804	0	2020	Nationwide		1	120	2			2						www.SCBluesMedAdvantage.com/retplan20	www.SCBluesMedAdvantage.com/retplan20	www.SCBluesMedAdvantage.com/retplan20	(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-										1	2		2		1									
H8010	2	0	1	1	1	H8010_002_0	7	1			08/05/2019	2020.01	08/05/2019 04:58:31 PM Pacific Daylight Time	08/06/2019 06:19:33 PM Pacific Daylight Time	08/06/2019 06:20:04 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	"CLOVER HMO OF NEW JERSEY, INC."	Clover Health	www.cloverhealth.com	Clover Health Classic (HMO)	1	1		1			H8010	2	0	2020	Select NJ Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8010	3	0	1	1	1	H8010_003_0	7	1			08/05/2019	2020.01	08/05/2019 05:00:47 PM Pacific Daylight Time	08/06/2019 06:19:34 PM Pacific Daylight Time	08/06/2019 06:20:05 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	"CLOVER HMO OF NEW JERSEY, INC."	Clover Health	www.cloverhealth.com	Clover Health Value (HMO)	1	1		1			H8010	3	0	2020	Select NJ Counties		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8010	5	0	1	1	1	H8010_005_0	7	1			08/05/2019	2020.01	08/05/2019 05:01:24 PM Pacific Daylight Time	08/06/2019 06:19:34 PM Pacific Daylight Time	08/06/2019 06:20:06 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	"CLOVER HMO OF NEW JERSEY, INC."	Clover Health	www.cloverhealth.com	Clover Health Classic (HMO)	1	1		1			H8010	5	0	2020	Bexar County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8010	8	0	1	1	1	H8010_008_0	7	1			08/05/2019	2020.01	08/05/2019 05:02:34 PM Pacific Daylight Time	08/06/2019 06:19:34 PM Pacific Daylight Time	08/06/2019 06:20:08 PM Pacific Daylight Time			08/06/2019 07:26:56 PM Pacific Daylight Time	"CLOVER HMO OF NEW JERSEY, INC."	Clover Health	www.cloverhealth.com	Clover Health Classic (HMO)	1	1		1			H8010	8	0	2020	El Paso County		2		2			2						www.cloverhealth.com	www.cloverhealth.com	www.cloverhealth.com	(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(888)657-1207		(201)414-9690		(888)466-5044		(201)425-9257		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8016	1	0	1	48	5	H8016_001_0	5	1			08/22/2019	2020.01	08/22/2019 03:53:14 PM Pacific Daylight Time					08/22/2019 03:53:53 PM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	OneCare Connect	www.caloptima.org/onecareconnect	OneCare Connect (Medicare-Medicaid Plan)	5	48		1			H8016	1	0	2020	"Orange County, California"		2		2			2						http://www.caloptima.org/Home/Providers/Pharmacy.aspx	www.caloptima.org	www.caloptima.org/OneCareConnect	(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																
H8026	1	0	1	48	5	H8026_001_0	4	1			08/08/2019	2020.01	08/08/2019 02:32:15 PM Central Daylight Time					08/08/2019 02:32:57 PM Central 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)	5	48		1			H8026	1	0	2020	"Wayne, Macomb and Southwest Michigan Regions"		2	92533	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)-																
H8046	1	0	1	48	5	H8046_001_0	5	1			06/20/2019	2020.01	06/20/2019 10:43:15 AM Pacific Daylight Time					06/20/2019 11:03:26 AM Pacific Daylight Time	"MOLINA HEALTHCARE OF ILLINOIS, INC."	Molina Healthcare of Illinois	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	5	48		1			H8046	1	0	2020	Select counties in Illinois		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(877)901-8181		(877)901-8181		(855)895-9987		(855)895-9987		(877)901-8181		(877)901-8181		(855)895-9987		(855)895-9987		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8064	2	0	1	4	1	H8064_002_0	5	1			07/18/2019	2020.01	07/18/2019 09:45:46 AM Pacific Daylight Time	08/05/2019 02:38:22 PM Pacific Daylight Time	07/31/2019 11:01:35 AM Pacific Daylight Time			08/05/2019 05:31:31 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct PPO Plus (PPO)	1	4		1			H8064	2	0	2020	South Central North Carolina		2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8064	4	0	1	4	1	H8064_004_0	5	1			07/18/2019	2020.01	07/18/2019 09:46:00 AM Pacific Daylight Time	08/05/2019 02:40:46 PM Pacific Daylight Time	07/31/2019 11:12:05 AM Pacific Daylight Time			08/05/2019 05:31:31 PM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstMedicare Direct	www.firstmedicare.com	FirstMedicare Direct PPO Premier (PPO)	1	4		1			H8064	4	0	2020	South Central North Carolina		2		2			2						www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(844)201-4957		(844)201-4957		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8067	1	0	1	1	1	H8067_001_0	14	1		1	08/06/2019	2020.01	08/06/2019 10:46:49 AM Eastern Daylight Time	08/06/2019 12:47:42 AM Eastern Daylight Time	08/06/2019 12:47:42 AM Eastern Daylight Time			08/06/2019 11:04:13 AM Eastern Daylight Time	"PROVIDER PARTNERS HEALTH PLAN, INC."	Provider Partners Maryland Advantage Plan	pphealthplan.com	Provider Partners Maryland Advantage Plan (HMO I-SNP)	1	1		1			H8067	1	0	2020	Western & Central Maryland		2	18672	2			1	1	1				pphealthplan.com	pphealthplan.com	pphealthplan.com	(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(800)405-9681		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8082	1	0	1	20	8	H8082_001_0	1	1			05/21/2019	2020.01	05/21/2019 11:34:05 AM Mountain Daylight Time		05/21/2019 11:00:10 AM Mountain Daylight Time			05/21/2019 11:35:16 AM Mountain Daylight Time	STOCKTON PACE	Stockton PACE	https://stocktonpace.welbehealth.com/	Stockton PACE (PACE)	8	20		1			H8082	1	0	2020	Parts of Stanislaus and San Joaquin County in CA		2		2			2						https://www.omnicare.com/	N/A												(209)442-6077				(209)442-6077												(209)932-0357				(209)932-0357																
H8082	2	0	1	20	8	H8082_002_0	1	1			05/21/2019	2020.01	05/21/2019 11:34:19 AM Mountain Daylight Time		05/21/2019 10:59:59 AM Mountain Daylight Time			05/21/2019 11:35:16 AM Mountain Daylight Time	STOCKTON PACE	Stockton PACE	https://stocktonpace.welbehealth.com/	Stockton PACE - Medicare only (PACE)	8	20		1			H8082	2	0	2020	Parts of Stanislaus and San Joaquin County in CA		2		2			2						https://www.omnicare.com/	N/A												(209)442-6077				(209)442-6077												(209)932-0357				(209)932-0357																
H8087	1	0	1	4	1	H8087_001_0	4	1			08/02/2019	2020.01	08/02/2019 01:50:27 PM Eastern Daylight Time	08/04/2019 03:07:22 PM Eastern Daylight Time	08/02/2019 01:18:59 PM Eastern Daylight Time			08/05/2019 10:59:57 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H8087-001 (PPO)	1	4		1			H8087	1	0	2020	Select Counties in Michigan		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8087	2	0	1	4	1	H8087_002_0	2	1			05/25/2019	2020.01	05/25/2019 10:47:13 AM Eastern Daylight Time	08/04/2019 03:11:53 PM Eastern Daylight Time	08/02/2019 01:19:00 PM Eastern Daylight Time			08/05/2019 11:09:08 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H8087-002 (PPO)	1	4		1			H8087	2	0	2020	Select counties in Michigan		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8087	3	0	1	4	1	H8087_003_0	2	1	2	1	05/26/2019	2020.01	05/26/2019 09:35:53 AM Eastern Daylight Time	08/04/2019 03:17:08 PM Eastern Daylight Time	08/02/2019 01:19:00 PM Eastern Daylight Time			08/05/2019 11:09:08 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice SNP-DE H8087-003 (PPO D-SNP)	1	4		1			H8087	3	0	2020	Select Counties in Michigan		2		2			1	3		2		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8087	801	0	1	4	1	H8087_801_0	1	1			05/30/2019	2020.01	05/30/2019 09:52:02 AM Eastern Daylight Time					05/31/2019 09:08:14 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H8087	801	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H8087	802	0	1	4	1	H8087_802_0	1	1			05/30/2019	2020.01	05/30/2019 09:52:47 AM Eastern Daylight Time					05/31/2019 09:08:14 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H8087	802	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H8087	803	0	2	4	1	H8087_803_0	1	1			05/30/2019	2020.01	05/30/2019 09:53:51 AM Eastern Daylight Time					05/31/2019 09:08:14 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		2	1		H8087	803	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H8087	804	0	2	4	1	H8087_804_0	1	1			05/30/2019	2020.01	05/30/2019 10:12:02 AM Eastern Daylight Time					05/31/2019 09:08:14 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		2	1		H8087	804	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H8087	805	0	1	4	1	H8087_805_0	1	1			05/30/2019	2020.01	05/30/2019 10:12:45 AM Eastern Daylight Time					05/31/2019 09:08:14 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H8087	805	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H8087	806	0	1	4	1	H8087_806_0	1	1			05/30/2019	2020.01	05/30/2019 10:13:25 AM Eastern Daylight Time					05/31/2019 09:08:14 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H8087	806	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H8087	807	0	1	4	1	H8087_807_0	1	1			05/30/2019	2020.01	05/30/2019 10:14:09 AM Eastern Daylight Time					05/31/2019 09:08:14 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H8087	807	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H8087	808	0	1	4	1	H8087_808_0	1	1			05/30/2019	2020.01	05/30/2019 10:14:48 AM Eastern Daylight Time					05/31/2019 09:08:14 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H8087	808	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H8087	809	0	1	4	1	H8087_809_0	1	1			05/30/2019	2020.01	05/30/2019 10:15:26 AM Eastern Daylight Time					05/31/2019 09:08:14 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H8087	809	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711	1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H8087	810	0	1	4	1	H8087_810_0	1	1			05/30/2019	2020.01	05/30/2019 10:16:05 AM Eastern Daylight Time					05/31/2019 09:08:14 AM Eastern Daylight Time	HUMANADENTAL INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PPO)	1	4		1			H8087	810	0	2020	Select Counties in Multi-States		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(888)396-8810	711	(888)396-8810	711	(800)824-8242	711	(800)824-8242	711									1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
H8093	1	0	1	1	1	H8093_001_0	3	1		1	05/30/2019	2020.01	05/30/2019 08:56:52 PM Central Daylight Time	08/01/2019 02:21:40 PM Central Daylight Time	07/30/2019 05:13:56 PM Central Daylight Time			08/05/2019 04:57:58 PM Central Daylight Time	"GEORGIA ASSURANCE, INC."	Georgia Assurance	www.georgiahealthadvantage.com	Georgia Health Advantage (HMO I-SNP)	1	1		1			H8093	1	0	2020	Central Georgia		2	4317	2			1	1	3				www.georgiahealthadvantage.com	www.georgiahealthadvantage.com	www.georgiahealthadvantage.com	(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2	2			
H8096	1	0	1	20	8	H8096_001_0	1	1			05/22/2019	2020.01	05/22/2019 02:48:04 PM Eastern Daylight Time		05/22/2019 03:02:34 PM Eastern Daylight Time			05/22/2019 03:05:33 PM Eastern Daylight Time	"CENTRA HEALTH, INC."	Centra PACE	http://www.centrapace.com	Centra PACE - Dual (PACE)	8	20		1			H8096	1	0	2020	"Centra PACE - Lynchburg, Farmville, & Gretna VA"		2		2			2						www.centrahealth.com	http:\\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	2	0	1	20	8	H8096_002_0	1	1			05/22/2019	2020.01	05/22/2019 02:48:58 PM Eastern Daylight Time		05/22/2019 03:03:37 PM Eastern Daylight Time			05/22/2019 03:05:33 PM Eastern Daylight Time	"CENTRA HEALTH, INC."	Centra PACE	http://www.centrapace.com	Centra PACE - Medicare only (PACE)	8	20		1			H8096	2	0	2020	"Centra PACE - Lynchburg, Farmville, & Gretna VA"		2		2			2						www.centrahealth.com	http:\\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																
H8125	2	0	1	1	1	H8125_002_0	4	1	2	1	07/11/2019	2020.01	07/11/2019 10:00:52 AM Central Daylight Time	08/02/2019 11:20:14 AM Central Daylight Time	07/30/2019 10:02:20 PM Central Daylight Time			08/06/2019 03:47:42 PM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP1 (HMO D-SNP)	1	1		1			H8125	2	0	2020	Select Counties in Ohio		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)944-3488		(866)944-3488		(888)834-3721		(888)834-3721		(866)944-3488		(866)944-3488		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8125	3	0	1	1	1	H8125_003_0	3	1	2	1	07/11/2019	2020.01	07/11/2019 01:40:32 PM Central Daylight Time	08/02/2019 11:21:01 AM Central Daylight Time	07/30/2019 10:02:55 PM Central Daylight Time			08/06/2019 01:22:06 PM Central Daylight Time	"SYMPHONIX HEALTH INSURANCE, INC."	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP1 (HMO D-SNP)	1	1		1			H8125	3	0	2020	Select counties in Oklahoma		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-7150		(844)368-7150		(888)834-3721		(888)834-3721		(844)368-7150		(844)368-7150		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8130	1	0	1	1	1	H8130_001_0	7	1	2	1	08/02/2019	2020.01	08/02/2019 05:24:22 PM Pacific Daylight Time	08/05/2019 10:07:40 AM Pacific Daylight Time	07/31/2019 11:37:18 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF FLORIDA, INC."	Molina Healthcare of Florida	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	1	1		1			H8130	1	0	2020	"Tampa, West Palm Beach and Miami Metro Areas"		2		2			1	3		2		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	2			
H8133	1	0	1	1	1	H8133_001_0	5	1			05/29/2019	2020.01	05/29/2019 03:41:52 PM Central Daylight Time	08/06/2019 02:24:30 PM Central Daylight Time	08/06/2019 02:24:34 PM Central Daylight Time			08/06/2019 05:03:07 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	1	1		1			H8133	1	0	2020	Houston Metro Area		2	31905	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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	2			
H8133	3	0	1	1	1	H8133_003_0	5	1			05/29/2019	2020.01	05/29/2019 03:43:12 PM Central Daylight Time	08/06/2019 02:24:30 PM Central Daylight Time	08/06/2019 02:24:34 PM Central Daylight Time			08/06/2019 05:03:07 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	1	1		1			H8133	3	0	2020	El Paso		2	2919	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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	2			
H8133	5	0	1	1	1	H8133_005_0	5	1			05/29/2019	2020.01	05/29/2019 03:43:29 PM Central Daylight Time	08/06/2019 02:24:30 PM Central Daylight Time	08/06/2019 02:24:34 PM Central Daylight Time			08/06/2019 05:03:07 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	1	1		1			H8133	5	0	2020	South Texas		2	15802	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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	2			
H8133	7	0	1	1	1	H8133_007_0	5	1			07/18/2019	2020.01	07/18/2019 05:30:17 PM Central Daylight Time	08/06/2019 02:24:30 PM Central Daylight Time	08/06/2019 02:24:34 PM Central Daylight Time			08/06/2019 05:03:07 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Basic (HMO)	1	1		1			H8133	7	0	2020	Austin		2	6610	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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	2			
H8133	801	0	1	1	1	H8133_801_0	2	1			05/30/2019	2020.01	05/30/2019 03:08:44 PM Central Daylight Time					06/03/2019 02:13:48 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage (HMO)	1	1		1			H8133	801	0	2020	Houston		1	1	2			2						www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H8133	803	0	1	1	1	H8133_803_0	2	1			05/30/2019	2020.01	05/30/2019 02:50:16 PM Central Daylight Time					06/03/2019 02:13:48 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage (HMO)	1	1		1			H8133	803	0	2020	Houston		1	1	2			2						www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H8133	805	0	1	1	1	H8133_805_0	2	1			05/30/2019	2020.01	05/30/2019 03:08:24 PM Central Daylight Time					06/03/2019 02:13:48 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com	Blue Cross Medicare Advantage (HMO)	1	1		1			H8133	805	0	2020	Houston		1	1	2			2						www.getbluetx.com	www.getbluetx.com	www.getbluetx.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H8142	1	0	1	1	1	H8142_001_0	5	1			08/05/2019	2020.01	08/05/2019 02:27:41 PM Central Daylight Time	08/05/2019 02:57:50 PM Central Daylight Time	08/07/2019 12:08:42 PM Central Daylight Time			08/08/2019 01:38:02 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage Select Rx (HMO)	1	1		1			H8142	1	0	2020	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8142	2	0	1	1	1	H8142_002_0	5	1			08/05/2019	2020.01	08/05/2019 02:37:09 PM Central Daylight Time	08/05/2019 02:57:08 PM Central Daylight Time	08/07/2019 12:13:36 PM Central Daylight Time			08/08/2019 01:38:02 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage Preferred Rx (HMO)	1	1		1			H8142	2	0	2020	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8142	3	0	1	1	1	H8142_003_0	5	1			05/29/2019	2020.01	05/29/2019 01:56:06 PM Central Daylight Time	08/05/2019 02:56:00 PM Central Daylight Time	08/07/2019 12:14:06 PM Central Daylight Time			08/08/2019 01:38:02 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage Premium Rx (HMO)	1	1		1			H8142	3	0	2020	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8142	4	0	1	1	1	H8142_004_0	3	1			05/31/2019	2020.01	05/31/2019 09:56:41 AM Central Daylight Time	06/03/2019 02:18:52 PM Central Daylight Time				06/03/2019 05:56:39 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage Select (HMO)	1	1		1			H8142	4	0	2020	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8142	5	0	1	1	1	H8142_005_0	3	1			06/02/2019	2020.01	06/02/2019 08:54:58 AM Central Daylight Time	06/03/2019 02:19:36 PM Central Daylight Time				06/03/2019 05:56:39 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage Preferred (HMO)	1	1		1			H8142	5	0	2020	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8142	6	0	1	1	1	H8142_006_0	3	1			05/29/2019	2020.01	05/29/2019 11:52:52 AM Central Daylight Time	06/03/2019 02:20:26 PM Central Daylight Time				06/03/2019 05:56:39 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage Premium (HMO)	1	1		1			H8142	6	0	2020	Central Texas		2		2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8142	801	0	1	1	1	H8142_801_0	3	1			05/29/2019	2020.01	05/29/2019 10:36:18 AM Central Daylight Time					06/03/2019 05:56:39 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage EGWP CY Rx (HMO)	1	1		1			H8142	801	0	2020	Central Texas		1	1200	2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7e;7g;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;9d;10a;11a;11b;12;15;	2		1					1				
H8142	802	0	1	1	1	H8142_802_0	3	1			05/29/2019	2020.01	05/29/2019 10:43:55 AM Central Daylight Time					06/03/2019 05:56:39 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage EGWP CY (HMO)	1	1		1			H8142	802	0	2020	Central Texas		1	1200	2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7e;7g;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;9d;10a;11a;11b;12;15;	2		1					1				
H8142	803	0	1	1	1	H8142_803_0	3	1			05/29/2019	2020.01	05/29/2019 10:59:38 AM Central Daylight Time					06/03/2019 05:56:39 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage EGWP FY Rx (HMO)	1	1		1			H8142	803	0	2020	Central Texas		1	1200	2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7e;7g;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;9d;10a;11a;11b;12;15;	2		1					1				
H8142	804	0	1	1	1	H8142_804_0	3	1			05/29/2019	2020.01	05/29/2019 11:05:03 AM Central Daylight Time					06/03/2019 05:56:39 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan	advantage.swhp.org	SeniorCare Advantage EGWP FY (HMO)	1	1		1			H8142	804	0	2020	Central Texas		1	1200	2			2						https://portal.swhp.org/#/search	advantage.swhp.org	https://portal.swhp.org/#/search	(866)334-3141		(866)334-3141		(866)334-3141		(866)334-3141										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7e;7g;7i;7k;8a;8b1;8b2;9a1;9a2;9b;9c;9d;10a;11a;11b;12;15;	2		1					1				
H8145	4	0	1	9	4	H8145_004_0	5	1			07/15/2019	2020.01	07/15/2019 11:02:42 AM Eastern Daylight Time	08/04/2019 04:28:27 PM Eastern Daylight Time	08/02/2019 01:19:00 PM Eastern Daylight Time			08/05/2019 11:15:31 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-004 (PFFS)	4	9	1	1			H8145	4	0	2020	Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	6	0	1	9	4	H8145_006_0	6	1			07/23/2019	2020.01	07/23/2019 02:10:19 PM Eastern Daylight Time	08/04/2019 03:01:49 PM Eastern Daylight Time	08/02/2019 01:19:00 PM Eastern Daylight Time			08/05/2019 10:56:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-006 (PFFS)	4	9	1	1			H8145	6	0	2020	Select Counties in Michigan and Wisconsin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	8	0	1	9	4	H8145_008_0	3	1			07/15/2019	2020.01	07/15/2019 11:34:53 AM Eastern Daylight Time	08/04/2019 02:53:04 PM Eastern Daylight Time	08/02/2019 01:19:00 PM Eastern Daylight Time			08/05/2019 10:56:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-008 (PFFS)	4	9	1	1			H8145	8	0	2020	Select Counties in Illinois		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	11	0	1	9	4	H8145_011_0	5	1			08/02/2019	2020.01	08/02/2019 01:25:08 PM Eastern Daylight Time	08/04/2019 02:40:16 PM Eastern Daylight Time	08/02/2019 01:19:00 PM Eastern Daylight Time			08/05/2019 11:09:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-011 (PFFS)	4	9	1	1			H8145	11	0	2020	Select Counties in Indiana		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	21	0	1	9	4	H8145_021_0	3	1			07/15/2019	2020.01	07/15/2019 02:05:18 PM Eastern Daylight Time	08/04/2019 06:26:49 PM Eastern Daylight Time	08/02/2019 01:19:00 PM Eastern Daylight Time			08/05/2019 11:16:22 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-021 (PFFS)	4	9	1	1			H8145	21	0	2020	Select Counties in Kentucky and West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	32	0	1	9	4	H8145_032_0	5	1			08/02/2019	2020.01	08/02/2019 01:38:24 PM Eastern Daylight Time	08/04/2019 02:48:37 PM Eastern Daylight Time	08/02/2019 01:19:00 PM Eastern Daylight Time			08/05/2019 11:09:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-032 (PFFS)	4	9	1	1			H8145	32	0	2020	Select Counties in Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	42	0	1	9	4	H8145_042_0	4	1			07/15/2019	2020.01	07/15/2019 11:10:10 AM Eastern Daylight Time	06/01/2019 12:27:42 PM Eastern Daylight Time				07/16/2019 05:05:30 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-042 (PFFS)	4	9	1	1			H8145	42	0	2020	Select Counties in Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	50	0	1	9	4	H8145_050_0	1	1			05/30/2019	2020.01	05/30/2019 04:30:29 PM Eastern Daylight Time	05/31/2019 04:43:02 PM Eastern Daylight Time				05/31/2019 07:34:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-050 (PFFS)	4	9	1	1			H8145	50	0	2020	Select Counties in West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	51	0	1	9	4	H8145_051_0	2	1			05/30/2019	2020.01	05/30/2019 04:32:22 PM Eastern Daylight Time	08/04/2019 06:23:06 PM Eastern Daylight Time	08/02/2019 01:19:01 PM Eastern Daylight Time			08/05/2019 11:16:22 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-051 (PFFS)	4	9	1	1			H8145	51	0	2020	Select Counties in West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	52	0	1	9	4	H8145_052_0	4	1			07/15/2019	2020.01	07/15/2019 02:35:06 PM Eastern Daylight Time	08/04/2019 06:28:39 PM Eastern Daylight Time	08/02/2019 01:19:01 PM Eastern Daylight Time			08/05/2019 11:16:22 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-052 (PFFS)	4	9	1	1			H8145	52	0	2020	Select Counties in Pennsylvania		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	55	0	1	9	4	H8145_055_0	5	1			07/23/2019	2020.01	07/23/2019 02:04:36 PM Eastern Daylight Time	05/31/2019 04:47:25 PM Eastern Daylight Time				07/23/2019 04:51:05 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-055 (PFFS)	4	9	1	1			H8145	55	0	2020	Select Counties in Pennsylvania		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	61	0	1	9	4	H8145_061_0	3	1			07/15/2019	2020.01	07/15/2019 10:41:46 AM Eastern Daylight Time	08/04/2019 05:06:13 PM Eastern Daylight Time	08/02/2019 01:19:01 PM Eastern Daylight Time			08/05/2019 11:10:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-061 (PFFS)	4	9	1	1			H8145	61	0	2020	Select Counties in Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	63	0	1	9	4	H8145_063_0	4	1			07/15/2019	2020.01	07/15/2019 11:00:21 AM Eastern Daylight Time	08/04/2019 04:27:39 PM Eastern Daylight Time	08/02/2019 01:19:01 PM Eastern Daylight Time			08/05/2019 11:13:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-063 (PFFS)	4	9	1	1			H8145	63	0	2020	North Carolina Select		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	69	0	1	9	4	H8145_069_0	3	1			07/15/2019	2020.01	07/15/2019 11:27:02 AM Eastern Daylight Time	08/04/2019 11:50:53 AM Eastern Daylight Time	08/02/2019 01:19:01 PM Eastern Daylight Time			08/05/2019 11:06:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-069 (PFFS)	4	9	1	1			H8145	69	0	2020	Select Counties in Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	75	0	1	9	4	H8145_075_0	5	1			07/15/2019	2020.01	07/15/2019 11:03:15 AM Eastern Daylight Time	08/02/2019 05:22:53 PM Eastern Daylight Time	08/02/2019 01:19:01 PM Eastern Daylight Time			08/05/2019 11:17:40 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-075 (PFFS)	4	9	1	1			H8145	75	0	2020	Select Counties in Alabama		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	84	0	1	9	4	H8145_084_0	4	1			07/15/2019	2020.01	07/15/2019 11:58:11 AM Eastern Daylight Time	08/04/2019 04:12:15 PM Eastern Daylight Time	08/02/2019 01:19:01 PM Eastern Daylight Time			08/05/2019 11:29:28 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-084 (PFFS)	4	9	1	1			H8145	84	0	2020	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	87	0	1	9	4	H8145_087_0	4	1			07/15/2019	2020.01	07/15/2019 01:27:28 PM Eastern Daylight Time	08/03/2019 10:42:27 AM Eastern Daylight Time	08/02/2019 01:19:01 PM Eastern Daylight Time			08/05/2019 01:26:21 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-087 (PFFS)	4	9	1	1			H8145	87	0	2020	Select Counties in Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	89	0	1	9	4	H8145_089_0	3	1			07/15/2019	2020.01	07/15/2019 11:35:19 AM Eastern Daylight Time	08/04/2019 02:56:44 PM Eastern Daylight Time	08/02/2019 01:19:01 PM Eastern Daylight Time			08/05/2019 10:56:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-089 (PFFS)	4	9	1	1			H8145	89	0	2020	"Select Counties in IA, MN, MT, ND, SD"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	91	0	1	9	4	H8145_091_0	3	1			07/15/2019	2020.01	07/15/2019 11:04:52 AM Eastern Daylight Time	08/02/2019 05:23:43 PM Eastern Daylight Time	08/02/2019 01:19:02 PM Eastern Daylight Time			08/05/2019 11:17:40 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-091 (PFFS)	4	9	1	1			H8145	91	0	2020	Select Counties in Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	108	0	1	9	4	H8145_108_0	2	1			07/15/2019	2020.01	07/15/2019 11:06:35 AM Eastern Daylight Time	05/30/2019 09:02:07 PM Eastern Daylight Time				07/16/2019 04:49:48 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-108 (PFFS)	4	9	1	1			H8145	108	0	2020	Select Counties in Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	120	0	1	9	4	H8145_120_0	2	1			07/15/2019	2020.01	07/15/2019 11:04:29 AM Eastern Daylight Time	05/31/2019 02:37:44 PM Eastern Daylight Time				07/16/2019 05:28:45 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-120 (PFFS)	4	9	1	1			H8145	120	0	2020	"Select Counties in AR, CO, KS, MO and OK"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	121	0	1	9	4	H8145_121_0	1	1			05/31/2019	2020.01	05/31/2019 10:22:27 AM Eastern Daylight Time	05/31/2019 10:33:29 AM Eastern Daylight Time				05/31/2019 06:55:49 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-121 (PFFS)	4	9	1	1			H8145	121	0	2020	Select Counties in Illinois and Michigan		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	122	0	1	9	4	H8145_122_0	3	1			07/15/2019	2020.01	07/15/2019 11:05:12 AM Eastern Daylight Time	08/02/2019 09:29:30 AM Eastern Daylight Time	08/02/2019 01:19:02 PM Eastern Daylight Time			08/05/2019 11:14:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-122 (PFFS)	4	9	1	1			H8145	122	0	2020	"Select Counties in Arkansas, Kansas and Oklahoma"		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	123	0	1	9	4	H8145_123_0	3	1			06/03/2019	2020.01	06/03/2019 10:03:31 AM Eastern Daylight Time	08/04/2019 10:49:48 AM Eastern Daylight Time	08/02/2019 01:19:02 PM Eastern Daylight Time			08/05/2019 11:12:35 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-123 (PFFS)	4	9	1	1			H8145	123	0	2020	Select Counties in Colorado and New Mexico		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	1	1	4b;8a1;8a2;8b3;	
H8145	125	0	1	9	4	H8145_125_0	3	1			07/15/2019	2020.01	07/15/2019 11:05:46 AM Eastern Daylight Time	08/02/2019 09:30:54 AM Eastern Daylight Time	08/02/2019 01:19:02 PM Eastern Daylight Time			08/05/2019 11:14:25 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-125 (PFFS)	4	9	1	1			H8145	125	0	2020	Select Counties in Missouri		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8145	126	0	1	9	4	H8145_126_0	2	1			07/15/2019	2020.01	07/15/2019 11:58:44 AM Eastern Daylight Time	05/31/2019 08:26:06 AM Eastern Daylight Time				07/16/2019 05:35:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-126 (PFFS)	4	9	1	1			H8145	126	0	2020	Select Counties in Texas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8145	155	0	1	9	4	H8145_155_0	2	1			07/15/2019	2020.01	07/15/2019 11:40:16 AM Eastern Daylight Time	05/31/2019 10:36:25 AM Eastern Daylight Time				07/16/2019 04:23:51 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Gold Choice H8145-155 (PFFS)	4	9	1	1			H8145	155	0	2020	Select Counties in Iowa		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8170	1	0	1	1	1	H8170_001_0	7	1			08/02/2019	2020.01	08/02/2019 01:47:11 PM Eastern Daylight Time	08/05/2019 03:30:50 PM Eastern Daylight Time	08/05/2019 12:02:30 PM Eastern Daylight Time			08/06/2019 07:25:47 AM 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)	1	1		1			H8170	1	0	2020	Select Counties in SC		2	0	2			2						www.americas1stchoice.com	www.americas1stchoice.com	www.americas1stchoice.com	(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8170	2	0	1	1	1	H8170_002_0	7	1		1	08/02/2019	2020.01	08/02/2019 01:47:55 PM Eastern Daylight Time	08/05/2019 03:31:54 PM Eastern Daylight Time	08/05/2019 12:03:10 PM Eastern Daylight Time			08/06/2019 07:25:47 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 C-SNP)	1	1		1			H8170	2	0	2020	Select Counties in SC		2	0	2			1	4			10		www.americas1stchoice.com	www.americas1stchoice.com	www.americas1stchoice.com	(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(888)563-3289		(803)391-3101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8176	1	0	1	1	1	H8176_001_0	6	1	2	1	05/30/2019	2020.01	05/30/2019 11:46:52 PM Pacific Daylight Time	08/05/2019 10:09:42 AM Pacific Daylight Time	07/31/2019 11:39:02 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF SOUTH CAROLINA, LLC"	Molina Healthcare of South Carolina	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	1	1		1			H8176	1	0	2020	Select Counties in South Carolina		2		2			1	3		2		2	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)665-3086		(800)665-3086		(866)403-8293		(866)403-8293		(800)665-3086		(800)665-3086		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8176	2	0	1	1	1	H8176_002_0	7	1	2	1	08/02/2019	2020.01	08/02/2019 06:00:37 PM Pacific Daylight Time	08/05/2019 10:12:36 AM Pacific Daylight Time	07/31/2019 11:40:36 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF SOUTH CAROLINA, LLC"	Molina Healthcare of South Carolina	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	1	1		1			H8176	2	0	2020	Select Counties In Ohio		2		2			1	3		2		2	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)665-3086		(800)665-3086		(866)403-8293		(866)403-8293		(800)665-3086		(800)665-3086		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8181	1	0	1	4	1	H8181_001_0	5	1			05/31/2019	2020.01	05/31/2019 10:25:48 AM Eastern Daylight Time	08/05/2019 03:23:55 PM Eastern Daylight Time	08/05/2019 03:23:56 PM Eastern Daylight Time			08/05/2019 03:49:29 PM Eastern Daylight Time	"SAPPHIRE EDGE, INC."	Blue Cross and Blue Shield of Nebraska	http://medicare.nebraskablue.com	Blue Cross Blue Shield Nebraska MA Access (PPO)	1	4		1			H8181	1	0	2020	Omaha/ Lincoln Metro Area and Central Nebraska		2	5182	2			2						https://www.myprime.com/en/find-pharmacy.html	https://medicare.nebraskablue.com/MedicareAdvantage/RXCost	https://medicare.nebraskablue.com/MedicareAdvantage/FindADoc	(844)255-2583		(844)225-2583		(844)899-6060		(844)899-6060		(855)457-1349		(855)457-1349		(844)899-6060		(844)899-6060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8181	801	0	1	4	1	H8181_801_0	3	1			05/15/2019	2020.01	05/15/2019 10:32:11 PM Eastern Daylight Time					06/03/2019 08:46:29 AM Eastern Daylight Time	"SAPPHIRE EDGE, INC."	Blue Cross and Blue Shield of Nebraska	http://medicare.nebraskablue.com	BCBSNE Employer Group PPO Rx CY (PPO)	1	4		1			H8181	801	0	2020	Omaha/ Lincoln Metro Area and Central Nebraska		1	20000	2			2						https://www.myprime.com/en/find-pharmacy.html	https://medicare.nebraskablue.com/MedicareAdvantage/RXCost	https://medicare.nebraskablue.com/MedicareAdvantage/FindADoc	(844)225-2583		(844)225-2583		(844)899-6060		(844)899-6060		(855)457-1349		(855)457-1349		(844)899-6060		(844)899-6060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;2;8a;8b1;8b2;9a1;9b;9d;11a;15;	2		1									
H8181	802	0	1	4	1	H8181_802_0	3	1			05/15/2019	2020.01	05/15/2019 10:32:23 PM Eastern Daylight Time					06/03/2019 08:46:29 AM Eastern Daylight Time	"SAPPHIRE EDGE, INC."	Blue Cross and Blue Shield of Nebraska	http://medicare.nebraskablue.com	BCBSNE Employer Group PPO CY (PPO)	1	4		1			H8181	802	0	2020	Omaha/ Lincoln Metro Area and Central Nebraska		1	2400	2			2						https://www.myprime.com/en/find-pharmacy.html	https://medicare.nebraskablue.com/MedicareAdvantage/RXCost	https://medicare.nebraskablue.com/MedicareAdvantage/FindADoc	(844)225-2583		(844)225-2583		(844)899-6060		(844)899-6060										(711)-		(711)-		(711)-		(711)-										1	1	1a;2;8a;8b1;8b2;9a1;9b;9d;11a;15;	2		1									
H8189	1	0	1	1	1	H8189_001_0	4	1	2	1	07/08/2019	2020.01	07/08/2019 01:27:57 PM Eastern Daylight Time	07/15/2019 10:52:55 AM Pacific Daylight Time	06/28/2019 02:19:44 PM Pacific Daylight Time			07/15/2019 06:05:25 PM Pacific Daylight Time	"MANAGED HEALTH SERVICES, WISCONSIN"	Allwell	allwell.mhswi.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H8189	1	0	2020	"Southeastern, Northeastern, Central Counties"		2		2			1	3		1		1	allwell.mhswi.com/findadoctor	allwell.mhswi.com/formulary	allwell.mhswi.com/findadoctor	(877)935-8024		(877)935-8024		(877)826-5521		(877)826-5521		(877)935-8024		(877)935-8024		(877)826-5521		(877)826-5521		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8189	3	0	1	1	1	H8189_003_0	3	1			07/11/2019	2020.01	07/11/2019 10:12:10 AM Eastern Daylight Time	07/09/2019 03:30:38 PM Pacific Daylight Time				07/15/2019 06:05:25 PM Pacific Daylight Time	"MANAGED HEALTH SERVICES, WISCONSIN"	Allwell	allwell.mhswi.com	Allwell Medicare Essentials (HMO)	1	1		1			H8189	3	0	2020	"Southeastern, Northeastern, Central Counties"		2		2			2						allwell.mhswi.com/findadoctor	allwell.mhswi.com/formulary	allwell.mhswi.com/findadoctor	(877)935-8024		(877)935-8024		(877)826-5521		(877)826-5521										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8197	1	0	1	48	5	H8197_001_0	10	1			08/21/2019	2020.01	08/21/2019 12:51:27 PM Pacific Daylight Time					08/21/2019 06:10:41 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF TEXAS, INC."	Molina Healthcare of Texas	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	5	48		1			H8197	1	0	2020	"Bexar, Dallas, El Paso, Harris & Hidalgo counties"		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(866)856-8699		(866)856-8699		(855)895-9992		(855)895-9992		(866)856-8699		(866)856-8699		(855)895-9992		(855)895-9992		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8211	1	0	1	4	1	H8211_001_0	4	1			08/02/2019	2020.01	08/02/2019 11:09:06 AM Central Daylight Time	08/02/2019 12:30:30 PM Central Daylight Time	07/30/2019 10:03:28 PM Central Daylight Time			08/06/2019 03:06:27 PM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	1	4		1			H8211	1	0	2020	Select Counties in West Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8211	2	0	1	4	1	H8211_002_0	4	1			08/02/2019	2020.01	08/02/2019 11:12:01 AM Central Daylight Time	08/02/2019 12:32:12 PM Central Daylight Time	07/30/2019 10:04:02 PM Central Daylight Time			08/06/2019 03:06:27 PM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	1	4		1			H8211	2	0	2020	Select Counties in West Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8211	3	0	1	4	1	H8211_003_0	4	1			08/02/2019	2020.01	08/02/2019 11:12:12 AM Central Daylight Time	08/02/2019 12:33:50 PM Central Daylight Time	07/30/2019 10:04:35 PM Central Daylight Time			08/06/2019 03:06:27 PM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 1 (PPO)	1	4		1			H8211	3	0	2020	Select Counties in West Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8211	4	0	1	4	1	H8211_004_0	4	1			08/02/2019	2020.01	08/02/2019 11:10:26 AM Central Daylight Time	08/02/2019 12:35:29 PM Central Daylight Time	07/30/2019 10:05:11 PM Central Daylight Time			08/06/2019 03:06:27 PM Central Daylight Time	MAMSI LIFE AND HEALTH INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice Plan 2 (PPO)	1	4		1			H8211	4	0	2020	Select Counties in West Virginia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8213	1	0	1	48	5	H8213_001_0	2	1			06/25/2019	2020.01	06/25/2019 02:09:51 PM Central Daylight Time					06/25/2019 02:47:42 PM Central Daylight Time	"SELECT HEALTH OF SOUTH CAROLINA, INC."	FIRST CHOICE VIP CARE PLUS	http://www.firstchoicevipcareplus.com	First Choice VIP Care Plus (Medicare-Medicaid Plan)	5	48		1			H8213	1	0	2020	South Carolina - 39 counties		2		2			2						http://www.firstchoicevipcareplus.com	http://www.firstchoicevipcareplus.com	http://www.firstchoicevipcareplus.com	(888)978-0862		(888)978-0862		(877)703-9109		(877)703-9109		(888)978-0862		(888)978-0862		(877)703-9109		(877)703-9109		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8225	1	0	1	1	1	H8225_001_0	3	1			08/02/2019	2020.01	08/02/2019 08:12:31 AM US Mountain Standard Time	08/05/2019 04:25:42 PM Central Daylight Time	08/05/2019 03:38:58 PM Central Daylight Time			08/06/2019 11:34:17 AM Central Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	florida.ascensioncomplete.com	Ascension Complete St. Vincent's Reward (HMO)	1	1		1			H8225	1	0	2020	Jacksonville Metro Area		2		2			2						florida.ascensioncomplete.com	florida.ascensioncomplete.com	florida.ascensioncomplete.com	(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(833)603-2971		(833)603-2971		(877)831-9406		(877)931-9406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	2	0	1	1	1	H8225_002_0	3	1			08/02/2019	2020.01	08/02/2019 08:12:52 AM US Mountain Standard Time	08/05/2019 04:25:48 PM Central Daylight Time	08/05/2019 03:38:32 PM Central Daylight Time			08/06/2019 11:34:17 AM Central Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	florida.ascensioncomplete.com	Ascension Complete Sacred Heart Reward (HMO)	1	1		1			H8225	2	0	2020	Pensacola Metro Area		2		2			2						florida.ascensioncomplete.com	florida.ascensioncomplete.com	florida.ascensioncomplete.com	(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	3	0	1	1	1	H8225_003_0	3	1			08/01/2019	2020.01	08/01/2019 09:49:39 AM US Mountain Standard Time	08/05/2019 04:25:52 PM Central Daylight Time	08/05/2019 03:38:40 PM Central Daylight Time			08/06/2019 11:34:17 AM Central Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	florida.ascensioncomplete.com	Ascension Complete St. Vincent's Secure (HMO)	1	1		1			H8225	3	0	2020	Jacksonville Metro Area		2		2			2						florida.ascensioncomplete.com	florida.ascensioncomplete.com	florida.ascensioncomplete.com	(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8225	4	0	1	1	1	H8225_004_0	3	1			08/01/2019	2020.01	08/01/2019 09:50:52 AM US Mountain Standard Time	08/05/2019 04:25:37 PM Central Daylight Time	08/05/2019 03:38:51 PM Central Daylight Time			08/06/2019 11:34:17 AM Central Daylight Time	CENTENE VENTURE COMPANY FLORIDA	Ascension Complete	florida.ascensioncomplete.com	Ascension Complete Sacred Heart Secure (HMO)	1	1		1			H8225	4	0	2020	Pensacola Metro Area		2		2			2						florida.ascensioncomplete.com	florida.ascensioncomplete.com	florida.ascensioncomplete.com	(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(833)603-2971		(833)603-2971		(877)831-9406		(877)831-9406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8258	1	0	1	48	5	H8258_001_0	5	1			08/21/2019	2020.01	08/21/2019 04:05:57 PM Pacific Daylight Time					08/21/2019 04:16:35 PM Pacific Daylight Time	LOCAL INITIATIVE HEALTH AUTHORITY FOR L.A. COUNTY	L.A. Care Cal MediConnect Plan	www.calmediconnectla.org	L.A. Care Cal MediConnect Plan (Medicare-Medicaid Plan)	5	48		1			H8258	1	0	2020	Los Angeles County		2	203613	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8280	1	0	1	1	1	H8280_001_0	8	1			07/16/2019	2020.01	07/16/2019 01:55:57 PM Central Daylight Time	08/02/2019 04:18:55 PM Central Daylight Time	08/02/2019 04:42:28 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF ALABAMA, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Choice (HMO)	1	1		1			H8280	1	0	2020	"Chilton, Jefferson, Shelby, and Walker Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8280	2	0	1	1	1	H8280_002_0	8	1			07/16/2019	2020.01	07/16/2019 01:57:22 PM Central Daylight Time	08/02/2019 04:22:49 PM Central Daylight Time	08/02/2019 04:41:52 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF ALABAMA, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Plus (HMO)	1	1		1			H8280	2	0	2020	"Chilton, Jefferson, Shelby, and Walker Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8293	1	0	1	1	1	H8293_001_0	6	1			07/03/2019	2020.01	07/03/2019 11:20:49 AM Central Daylight Time	08/06/2019 02:11:21 PM Central Daylight Time	08/06/2019 02:11:30 PM Central Daylight Time			08/06/2019 02:39:04 PM Central Daylight Time	"CLEAR SPRING HEALTH (VA), INC."	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Essential (HMO)	1	1		1			H8293	1	0	2020	Southeast Virginia		2	7449	2			2						www.clearspringhealthcare.com	www.clearspringhealthcare.com	www.clearspringhealthcare.com	(877)384-1241		(877)384-1241		(877)384-1241		(877)384-1241		(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8298	1	0	1	1	1	H8298_001_0	7	1	2	1	08/05/2019	2020.01	08/05/2019 11:05:00 AM Eastern Daylight Time	08/05/2019 03:41:38 PM Eastern Daylight Time	08/05/2019 03:39:51 PM Eastern Daylight Time			08/05/2019 03:49:34 PM Eastern Daylight Time	"HORIZON HEALTHCARE OF NEW JERSEY, INC."	Horizon Blue Cross Blue Shield of New Jersey	www.Horizonblue.com/Medicare	Horizon NJ TotalCare (HMO D-SNP)	1	1		1			H8298	1	0	2020	New Jersey		2	154914	2			1	3		1		1	www.horizonblue.com/ma-pharmacy-search	www.horizonblue.com/ma-drug-search	http://doctorfinder.horizonblue.com/	(800)543-5656		(800)543-5656		(888)765-7134		(888)765-7134		(855)457-1346		(855)457-1346		(888)765-7134		(888)765-7134		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8364	1	0	1	4	1	H8364_001_0	7	1			08/08/2019	2020.01	08/08/2019 02:18:55 PM Central Daylight Time	08/02/2019 04:22:44 PM Central Daylight Time	08/02/2019 04:41:04 PM Central Daylight Time			08/08/2019 02:20:54 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF ALABAMA, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex Choice (PPO)	1	4		1			H8364	1	0	2020	"Chilton, Jefferson, Shelby, and Walker Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8364	2	0	1	4	1	H8364_002_0	6	1			07/16/2019	2020.01	07/16/2019 02:06:04 PM Central Daylight Time	08/02/2019 04:22:38 PM Central Daylight Time	08/02/2019 04:40:31 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF ALABAMA, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex Plus (PPO)	1	4		1			H8364	2	0	2020	"Chilton, Jefferson, Shelby, and Walker Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8364	3	0	1	4	1	H8364_003_0	6	1			08/01/2019	2020.01	08/01/2019 02:45:20 PM Central Daylight Time	08/02/2019 04:21:49 PM Central Daylight Time	08/02/2019 04:39:46 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF ALABAMA, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Assist (PPO)	1	4		1			H8364	3	0	2020	"Chilton, Jefferson, Shelby, and Walker Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(844)202-4129		(844)202-4129		(844)679-2027		(844)679-2027		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8379	1	0	1	1	1	H8379_001_0	11	1	2	1	08/02/2019	2020.01	08/02/2019 11:33:19 AM Eastern Daylight Time	08/02/2019 12:31:16 PM Eastern Daylight Time	07/31/2019 11:55:26 AM Eastern Daylight Time			08/06/2019 10:36:41 AM Eastern Daylight Time	"PRIORITY HEALTH CHOICE, INC."	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare D-SNP (HMO D-SNP)	1	1		1			H8379	1	0	2020	68 lower peninsula Michigan counties		2	12795	2			1	3		1		1	www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8423	1	0	1	48	5	H8423_001_0	6	1			08/20/2019	2020.01	08/20/2019 02:46:03 PM Central Daylight Time					08/20/2019 07:37:19 PM Central Daylight Time	"HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC."	Cigna-HealthSpring CarePlan	www.CarePlanTX.com	Cigna-HealthSpring CarePlan (Medicare-Medicaid Plan)	5	48		1			H8423	1	0	2020	Valley		2		2			2						www.mycignahealthspring.com	www.CarePlanTX.com	www.CarePlanTX.com	(877)653-0327		(877)653-0327		(877)653-0327		(877)653-0327		(877)653-0327		(877)653-0327		(877)653-0327		(877)653-0327		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8424	1	0	1	20	8	H8424_001_0	1	1			05/31/2019	2020.01	05/31/2019 10:18:53 AM Central Daylight Time		05/31/2019 10:00:30 AM Central Daylight Time			05/31/2019 10:26:11 AM Central Daylight Time	"SIOUXLAND PACE, INC."	"SIOUXLAND PACE, INC."	https://www.unitypoint.org/siouxcity/services-pace	"Siouxland PACE, INC (PACE)"	8	20		1			H8424	1	0	2020	"Siouxland PACE, INC"		2		2			2						https://www.unitypoint.org/siouxcity/services-pace.aspx	https://www.unitypoint.org/siouxcity/services-pace.aspx										(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	2	0	1	20	8	H8424_002_0	1	1			05/31/2019	2020.01	05/31/2019 10:20:42 AM Central Daylight Time		05/31/2019 09:59:50 AM Central Daylight Time			05/31/2019 10:26:11 AM Central Daylight Time	"SIOUXLAND PACE, INC."	"SIOUXLAND PACE, INC."	www.siouxlandpace.org	"Siouxland PACE, INC (PACE)"	8	20		1			H8424	2	0	2020	"Siouxland PACE, INC"		2		2			2						https://www.unitypoint.org/siouxcity/services-pace.aspx	https://www.unitypoint.org/siouxcity/services-pace.aspx										(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	2	0	1	1	1	H8432_002_0	5	1	2	1	06/25/2019	2020.01	06/25/2019 05:08:55 PM Eastern Daylight Time	08/05/2019 10:07:38 AM Eastern Daylight Time	07/30/2019 07:56:04 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.anthem.com/shop	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H8432	2	0	2020	Select Counties in Maine		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)887-6351		(844)887-6351		(844)296-3997		(844)296-3997		(844)887-6351		(844)887-6351		(844)296-7202		(844)296-7202		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	5	0	1	2	1	H8432_005_0	6	1			06/25/2019	2020.01	06/25/2019 05:10:25 PM Eastern Daylight Time	08/05/2019 10:07:39 AM Eastern Daylight Time	07/30/2019 07:57:30 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	https://shop.anthem.com/medicare	Anthem MediBlue Choice (HMO-POS)	1	2		1			H8432	5	0	2020	"Androscoggin, Cumberland, Kennebec, Knox, York"		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	6	0	1	2	1	H8432_006_0	6	1			06/25/2019	2020.01	06/25/2019 05:11:02 PM Eastern Daylight Time	08/05/2019 10:07:39 AM Eastern Daylight Time	07/30/2019 07:58:55 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	https://shop.anthem.com/medicare	Anthem MediBlue Choice (HMO-POS)	1	2		1			H8432	6	0	2020	Penobscot		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	7	0	1	1	1	H8432_007_0	8	1	2	1	08/05/2019	2020.01	08/05/2019 04:35:46 PM Eastern Daylight Time	08/05/2019 10:07:39 AM Eastern Daylight Time	07/30/2019 08:00:21 PM Eastern Daylight Time			08/05/2019 04:37:14 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H8432	7	0	2020	New York City Area		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)269-5706		(877)269-5706		(844)630-1023		(844)630-1023		(877)269-5706		(877)269-5706		(844)630-1024		(844)630-1024		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	8	5	1	1	1	H8432_008_5	7	1			08/01/2019	2020.01	08/01/2019 12:31:28 PM Eastern Daylight Time	08/05/2019 10:07:40 AM Eastern Daylight Time	07/30/2019 08:01:47 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	1	1		1			H8432	8	5	2020	New York City Area	Bronx County	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	8	6	1	1	1	H8432_008_6	7	1			08/01/2019	2020.01	08/01/2019 12:32:25 PM Eastern Daylight Time	08/05/2019 10:07:40 AM Eastern Daylight Time	07/30/2019 08:03:12 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	1	1		1			H8432	8	6	2020	New York City Area	Queens County	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	8	7	1	1	1	H8432_008_7	7	1			08/01/2019	2020.01	08/01/2019 12:33:13 PM Eastern Daylight Time	08/05/2019 10:07:41 AM Eastern Daylight Time	07/30/2019 08:04:39 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	1	1		1			H8432	8	7	2020	New York City Area	Kings County	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	9	0	1	1	1	H8432_009_0	7	1			06/06/2019	2020.01	06/06/2019 03:13:39 PM Eastern Daylight Time	08/05/2019 10:07:41 AM Eastern Daylight Time	07/30/2019 08:06:04 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	1	1		1			H8432	9	0	2020	Rockland and Westchester Counties		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	10	0	1	1	1	H8432_010_0	8	1			06/06/2019	2020.01	06/06/2019 03:13:53 PM Eastern Daylight Time	08/05/2019 10:07:42 AM Eastern Daylight Time	07/30/2019 08:07:28 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	1	1		1			H8432	10	0	2020	Nassau County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	11	0	1	1	1	H8432_011_0	7	1			06/06/2019	2020.01	06/06/2019 03:14:10 PM Eastern Daylight Time	08/05/2019 10:07:42 AM Eastern Daylight Time	07/30/2019 08:08:56 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	1	1		1			H8432	11	0	2020	Suffolk County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	12	0	1	1	1	H8432_012_0	4	1			05/31/2019	2020.01	05/31/2019 05:37:52 PM Eastern Daylight Time	06/01/2019 01:20:53 PM Eastern Daylight Time				06/01/2019 05:29:34 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Core (HMO)	1	1		1			H8432	12	0	2020	Select Counties in New York		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8432	13	0	1	1	1	H8432_013_0	7	1			08/01/2019	2020.01	08/01/2019 12:41:03 PM Eastern Daylight Time	08/05/2019 10:07:43 AM Eastern Daylight Time	07/30/2019 08:10:22 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	1	1		1			H8432	13	0	2020	County of New York		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	14	0	1	2	1	H8432_014_0	7	1			08/01/2019	2020.01	08/01/2019 12:27:34 PM Eastern Daylight Time	08/05/2019 10:07:43 AM Eastern Daylight Time	07/30/2019 08:11:46 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Choice (HMO-POS)	1	2		1			H8432	14	0	2020	Nassau County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	15	0	1	2	1	H8432_015_0	7	1			06/06/2019	2020.01	06/06/2019 03:14:59 PM Eastern Daylight Time	08/05/2019 10:07:43 AM Eastern Daylight Time	07/30/2019 08:13:12 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Choice (HMO-POS)	1	2		1			H8432	15	0	2020	Kings County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	16	0	1	1	1	H8432_016_0	9	1			06/25/2019	2020.01	06/25/2019 05:14:17 PM Eastern Daylight Time	08/05/2019 10:07:44 AM Eastern Daylight Time	07/30/2019 08:14:40 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Select (HMO)	1	1		1			H8432	16	0	2020	Select Counties in New York		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	17	0	1	1	1	H8432_017_0	8	1			07/16/2019	2020.01	07/16/2019 06:57:43 PM Eastern Daylight Time	08/05/2019 10:07:44 AM Eastern Daylight Time	07/30/2019 08:16:06 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Plus (HMO)	1	1		1			H8432	17	0	2020	Select Counties in New York		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	18	0	1	1	1	H8432_018_0	9	1	2	1	06/25/2019	2020.01	06/25/2019 05:14:59 PM Eastern Daylight Time	08/05/2019 10:07:44 AM Eastern Daylight Time	07/30/2019 08:17:29 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H8432	18	0	2020	Select Counties in New York		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)269-5706		(877)269-5706		(844)630-1023		(844)630-1023		(877)269-5706		(877)269-5706		(844)630-1024		(844)630-1024		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	27	0	1	1	1	H8432_027_0	8	1			08/01/2019	2020.01	08/01/2019 12:46:41 PM Eastern Daylight Time	08/05/2019 10:07:27 AM Eastern Daylight Time	07/30/2019 08:18:54 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Select (HMO)	1	1		1			H8432	27	0	2020	Select Counties in New York City		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	28	0	1	1	1	H8432_028_0	8	1	2	1	08/02/2019	2020.01	08/02/2019 11:43:28 AM Eastern Daylight Time	08/05/2019 10:07:27 AM Eastern Daylight Time	07/30/2019 08:20:19 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Dual Advantage Select (HMO D-SNP)	1	1		1			H8432	28	0	2020	Select Counties in New York		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)469-1762		(844)469-1762		(844)630-1023		(844)630-1023		(844)469-1762		(844)469-1762		(844)630-1024		(844)630-1024		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	31	1	1	1	1	H8432_031_1	6	1			08/01/2019	2020.01	08/01/2019 12:26:29 PM Eastern Daylight Time	08/05/2019 10:09:46 AM Eastern Daylight Time	07/30/2019 08:21:43 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.anthem.com/shop	Anthem MediBlue Plus (HMO)	1	1		1			H8432	31	1	2020	Select Counties in ME	Select Counties in ME	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	31	2	1	1	1	H8432_031_2	6	1			06/25/2019	2020.01	06/25/2019 05:18:52 PM Eastern Daylight Time	08/05/2019 10:09:46 AM Eastern Daylight Time	07/30/2019 08:23:09 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.anthem.com/shop	Anthem MediBlue Plus (HMO)	1	1		1			H8432	31	2	2020	Select Counties in ME	Penobscot and Somerset	2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	32	0	1	1	1	H8432_032_0	8	1			06/25/2019	2020.01	06/25/2019 05:20:23 PM Eastern Daylight Time	08/05/2019 10:09:47 AM Eastern Daylight Time	07/30/2019 08:24:32 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Select (HMO)	1	1		1			H8432	32	0	2020	Nassau County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	33	0	1	1	1	H8432_033_0	7	1			06/25/2019	2020.01	06/25/2019 05:20:48 PM Eastern Daylight Time	08/05/2019 10:09:47 AM Eastern Daylight Time	07/30/2019 08:25:59 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/shop	Empire MediBlue Select (HMO)	1	1		1			H8432	33	0	2020	Suffolk County		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	34	0	1	1	1	H8432_034_0	8	1	2	1	08/01/2019	2020.01	08/01/2019 12:42:14 PM Eastern Daylight Time	08/05/2019 10:09:47 AM Eastern Daylight Time	07/30/2019 08:27:23 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	https://shop.anthem.com/medicare	Empire MediBlue Dual Select Advantage (HMO D-SNP)	1	1		1			H8432	34	0	2020	Suffolk County		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(877)269-5706		(877)269-5706		(844)630-1023		(844)630-1023		(877)269-5706		(877)269-5706		(844)630-1024		(844)630-1024		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	35	0	1	1	1	H8432_035_0	10	1			07/23/2019	2020.01	07/23/2019 10:45:10 AM Eastern Daylight Time	08/05/2019 10:09:48 AM Eastern Daylight Time	07/30/2019 08:28:52 PM Eastern Daylight Time			08/05/2019 04:05:49 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	https://shop.anthem.com/medicare	Empire MediBlue Extra (HMO)	1	1		1			H8432	35	0	2020	Select Counties in New York		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(844)364-2115		(844)364-2115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8432	36	0	1	1	1	H8432_036_0	4	1			05/31/2019	2020.01	05/31/2019 06:13:18 PM Eastern Daylight Time	06/01/2019 01:21:41 PM Eastern Daylight Time				06/01/2019 05:29:34 PM Eastern Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	https://shop.anthem.com/medicare	Empire MediBlue Core Select (HMO)	1	1		1			H8432	36	0	2020	Select Counties in NY		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8432	801	0	1	1	1	H8432_801_0	3	1			05/22/2019	2020.01	05/22/2019 02:04:15 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	1	1		1			H8432	801	0	2020	Select Counties in Maine		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	802	0	1	1	1	H8432_802_0	3	1			05/22/2019	2020.01	05/22/2019 01:57:52 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	1	1		1			H8432	802	0	2020	Select Counties in Maine		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	803	0	2	1	1	H8432_803_0	3	1			05/30/2019	2020.01	05/30/2019 07:31:02 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	1	1		2	1		H8432	803	0	2020	Maine - Select Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	804	0	1	1	1	H8432_804_0	3	1			05/30/2019	2020.01	05/30/2019 06:50:49 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	1	1		1			H8432	804	0	2020	New York - Select Counties		1	2400	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	805	0	1	1	1	H8432_805_0	3	1			05/30/2019	2020.01	05/30/2019 06:51:02 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	1	1		1			H8432	805	0	2020	New York - Select Counties		1	878	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	806	0	2	1	1	H8432_806_0	3	1			05/30/2019	2020.01	05/30/2019 07:31:58 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	1	1		2	1		H8432	806	0	2020	New York - Select Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	807	0	2	1	1	H8432_807_0	3	1			05/30/2019	2020.01	05/30/2019 07:31:09 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	1	1		2	1		H8432	807	0	2020	Select Maine Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	808	0	1	1	1	H8432_808_0	3	1			05/22/2019	2020.01	05/22/2019 02:00:29 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	1	1		1			H8432	808	0	2020	Select Maine counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	809	0	1	1	1	H8432_809_0	3	1			05/22/2019	2020.01	05/22/2019 02:00:55 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	1	1		1			H8432	809	0	2020	Select Maine Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	810	0	2	1	1	H8432_810_0	3	1			05/30/2019	2020.01	05/30/2019 07:31:31 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	1	1		2	1		H8432	810	0	2020	Select Maine Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	811	0	2	1	1	H8432_811_0	3	1			05/30/2019	2020.01	05/30/2019 07:32:06 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	1	1		2	1		H8432	811	0	2020	Select New York Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	812	0	1	1	1	H8432_812_0	3	1			05/22/2019	2020.01	05/22/2019 02:07:41 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	1	1		1			H8432	812	0	2020	Select New York Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	813	0	1	1	1	H8432_813_0	3	1			05/22/2019	2020.01	05/22/2019 02:08:05 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	1	1		1			H8432	813	0	2020	Select New York Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	814	0	2	1	1	H8432_814_0	3	1			05/30/2019	2020.01	05/30/2019 07:32:21 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	1	1		2	1		H8432	814	0	2020	Select New York Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	815	0	2	1	1	H8432_815_0	3	1			05/30/2019	2020.01	05/30/2019 07:31:38 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.anthem.com/me/medicare	Anthem MediBlue (HMO)	1	1		2	1		H8432	815	0	2020	Select Maine Counties		1	600	2			2						www.anthem.com/me/medicare	www.anthem.com/me/medicare	www.anthem.com/me/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8432	816	0	2	1	1	H8432_816_0	3	1			05/30/2019	2020.01	05/30/2019 07:32:27 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	"EMPIRE HEALTHCHOICE HMO, INC."	Empire BlueCross BlueShield	www.empireblue.com/ny/medicare	Empire MediBlue (HMO)	1	1		2	1		H8432	816	0	2020	Select NY Counties		1	600	2			2						www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	www.empireblue.com/ny/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H8452	1	0	1	48	5	H8452_001_0	5	1			08/21/2019	2020.01	08/21/2019 03:38:46 PM Eastern Daylight Time					08/21/2019 03:40:07 PM Eastern Daylight Time	CARESOURCE	CareSource MyCare Ohio	www.caresource.com/MyCare/	CareSource MyCare Ohio (Medicare-Medicaid Plan)	5	48		1			H8452	1	0	2020	"Northeast, Northeast Central, East Central Ohio"		2	318000	2			2						www.caresource.com	www.caresource.com/MyCare/	https://memberportal.caresource.com/App/OH/FindADoctor/MyCare	(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																
H8457	1	0	1	1	1	H8457_001_0	5	1		1	08/01/2019	2020.01	08/01/2019 12:11:51 PM Central Daylight Time	08/01/2019 10:01:26 AM Central Daylight Time	08/01/2019 10:34:25 AM Central Daylight Time			08/02/2019 12:26:08 PM Central Daylight Time	"LONGEVITY HEALTH PLAN OF NEW YORK, INC."	Longevity Health Plan	www.longevityhealthplan.com	Longevity Health Plan (HMO I-SNP)	1	1		1			H8457	1	0	2020	New York (partial)		2	2041	2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8492	1	0	1	1	1	H8492_001_0	4	1		1	05/31/2019	2020.01	05/31/2019 02:35:28 PM Central Daylight Time	08/05/2019 05:06:40 PM Central Daylight Time	08/05/2019 05:06:33 PM Central Daylight Time			08/05/2019 05:15:49 PM Central Daylight Time	DIGNITY CARE CORPORATION	Dignity HMO	www.dignityHMO	Dignity Health Plan (HMO I-SNP)	1	1		1			H8492	1	0	2020	Select Parishes in Louisiana		2	2262	2			1	1	1				www.dignityhmo.com	www.dignityhmo.com	www.dignityHMO	(866)266-6010		(225)964-8581		(866)266-6010		(225)964-8581		(866)266-6010		(225)964-8581		(866)266-6010		(225)964-8581		(866)266-6010		(225)964-8581		(866)266-6010		(225)964-8581		(866)266-6010		(225)964-8581		(866)266-6010		(225)964-8581		2					2					1	2			
H8552	20	0	1	4	1	H8552_020_0	11	1			06/25/2019	2020.01	06/25/2019 09:18:44 PM Eastern Daylight Time	08/07/2019 01:24:47 PM Pacific Daylight Time	07/30/2019 05:30:17 PM Pacific Daylight Time			08/07/2019 02:28:42 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem MediBlue Access (PPO)	1	4		1			H8552	20	0	2020	Orange County		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)811-3107		(877)811-3107		(844)364-2129		(844)364-2129		(877)811-3107		(877)811-3107		(844)364-2124		(844)364-2124		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8552	28	0	1	4	1	H8552_028_0	15	1		1	06/25/2019	2020.01	06/25/2019 09:19:01 PM Eastern Daylight Time		07/30/2019 05:31:44 PM Pacific Daylight Time		08/05/2019 07:09:38 AM Pacific Daylight Time	08/05/2019 01:44:26 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem MediBlue ESRD (PPO C-SNP)	1	4		1			H8552	28	0	2020	Select Counties in California		2		2			1	4			1E+11		https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(844)648-9540		(844)648-9540		(844)788-9044		(844)788-9044		(844)648-9540		(844)648-9540		(844)788-9045		(844)788-9045		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8552	29	0	1	4	1	H8552_029_0	9	1			06/25/2019	2020.01	06/25/2019 09:19:15 PM Eastern Daylight Time	08/05/2019 07:09:39 AM Pacific Daylight Time	07/30/2019 05:33:10 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem MediBlue Access (PPO)	1	4		1			H8552	29	0	2020	Select Counties in California		2		2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)811-3107		(877)811-3107		(844)364-2129		(844)364-2129		(877)811-3107		(877)811-3107		(844)364-2124		(844)364-2124		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8552	30	0	1	4	1	H8552_030_0	12	1	2	1	06/25/2019	2020.01	06/25/2019 09:19:31 PM Eastern Daylight Time	08/05/2019 07:09:39 AM Pacific Daylight Time	07/30/2019 05:34:38 PM Pacific Daylight Time			08/05/2019 01:44:26 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem MediBlue Dual Access (PPO D-SNP)	1	4		1			H8552	30	0	2020	Select Counties in California		2		2			1	3		2		2	https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(877)811-3107		(877)811-3107		(844)364-2129		(844)364-2129		(877)811-3107		(877)811-3107		(844)364-2124		(844)364-2124		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8552	801	0	1	4	1	H8552_801_0	2	1			05/30/2019	2020.01	05/30/2019 04:54:37 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	1	4		1			H8552	801	0	2020	California		1	41880	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	802	0	1	4	1	H8552_802_0	2	1			05/30/2019	2020.01	05/30/2019 04:54:47 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	1	4		1			H8552	802	0	2020	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	803	0	1	4	1	H8552_803_0	2	1			05/30/2019	2020.01	05/30/2019 04:54:53 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	1	4		1			H8552	803	0	2020	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	805	0	2	4	1	H8552_805_0	2	1			05/30/2019	2020.01	05/30/2019 04:55:00 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	1	4		2	1		H8552	805	0	2020	National		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	806	0	1	4	1	H8552_806_0	2	1			05/30/2019	2020.01	05/30/2019 04:55:08 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	1	4		1			H8552	806	0	2020	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	807	0	2	4	1	H8552_807_0	2	1			05/30/2019	2020.01	05/30/2019 04:55:15 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	1	4		2	1		H8552	807	0	2020	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	808	0	2	4	1	H8552_808_0	2	1			05/30/2019	2020.01	05/30/2019 04:55:23 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	1	4		2	1		H8552	808	0	2020	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	809	0	2	4	1	H8552_809_0	2	1			05/30/2019	2020.01	05/30/2019 04:55:31 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	1	4		2	1		H8552	809	0	2020	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	810	0	1	4	1	H8552_810_0	2	1			05/30/2019	2020.01	05/30/2019 04:55:39 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	1	4		1			H8552	810	0	2020	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	811	0	1	4	1	H8552_811_0	2	1			05/30/2019	2020.01	05/30/2019 04:55:47 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	1	4		1			H8552	811	0	2020	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	812	0	1	4	1	H8552_812_0	2	1			05/30/2019	2020.01	05/30/2019 04:55:54 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	1	4		1			H8552	812	0	2020	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8552	813	0	1	4	1	H8552_813_0	2	1			05/30/2019	2020.01	05/30/2019 04:56:11 PM Pacific Daylight Time					05/30/2019 04:58:30 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	https://shop.anthem.com/medicare/ca	Anthem Medicare Preferred (PPO)	1	4		1			H8552	813	0	2020	California		1	600	2			2						https://shop.anthem.com/medicare/ca	https://shop.anthem.com/medicare/ca	www.anthem.com/ca/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1									
H8554	1	0	1	1	1	H8554_001_0	5	1			05/29/2019	2020.01	05/29/2019 03:44:36 PM Central Daylight Time	08/06/2019 02:24:30 PM Central Daylight Time	08/06/2019 02:24:34 PM Central Daylight Time			08/06/2019 05:03:07 PM Central Daylight Time	GHS INSURANCE COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Value (HMO)	1	1		1			H8554	1	0	2020	State of Texas		2	10540	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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	2			
H8578	1	0	1	1	1	H8578_001_0	6	1			07/02/2019	2020.01	07/02/2019 01:33:32 PM Eastern Daylight Time	08/06/2019 10:24:31 AM Eastern Daylight Time	08/06/2019 10:24:32 AM Eastern Daylight Time			08/06/2019 10:30:03 AM Eastern Daylight Time	"HEALTH NEW ENGLAND, INC."	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Premium (HMO)	1	1		1			H8578	1	0	2020	"Hampden, Hampshire, Franklin, Berkshire Counties"		2	35807	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8578	3	0	1	1	1	H8578_003_0	5	1			07/02/2019	2020.01	07/02/2019 01:33:50 PM Eastern Daylight Time	06/12/2019 10:18:21 AM Eastern Daylight Time				07/02/2019 02:27:43 PM Eastern Daylight Time	"HEALTH NEW ENGLAND, INC."	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Premium No Rx (HMO)	1	1		1			H8578	3	0	2020	"Hampden, Hampshire, Franklin, Berkshire Counties"		2	2040	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8578	4	0	1	1	1	H8578_004_0	6	1			07/02/2019	2020.01	07/02/2019 01:39:46 PM Eastern Daylight Time	08/06/2019 10:24:32 AM Eastern Daylight Time	08/06/2019 10:24:23 AM Eastern Daylight Time			08/06/2019 10:30:03 AM Eastern Daylight Time	"HEALTH NEW ENGLAND, INC."	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Plus (HMO)	1	1		1			H8578	4	0	2020	"Hampden, Hampshire, Franklin, Berkshire Counties"		2	42845	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8578	9	0	1	1	1	H8578_009_0	4	1			07/02/2019	2020.01	07/02/2019 01:42:46 PM Eastern Daylight Time	05/31/2019 03:16:56 PM Eastern Daylight Time				07/02/2019 02:27:43 PM Eastern Daylight Time	"HEALTH NEW ENGLAND, INC."	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Basic No Rx (HMO)	1	1		1			H8578	9	0	2020	"Hampden, Hampshire, Franklin, Berkshire Counties"		2	2385	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8578	12	0	1	1	1	H8578_012_0	7	1			07/02/2019	2020.01	07/02/2019 01:47:51 PM Eastern Daylight Time	08/06/2019 10:24:31 AM Eastern Daylight Time	08/06/2019 10:24:31 AM Eastern Daylight Time			08/06/2019 10:30:03 AM Eastern Daylight Time	"HEALTH NEW ENGLAND, INC."	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Value (HMO)	1	1		1			H8578	12	0	2020	"Hampden, Hampshire, Franklin, Berkshire Counties"		2	25194	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8578	16	0	1	2	1	H8578_016_0	6	1			07/02/2019	2020.01	07/02/2019 01:52:46 PM Eastern Daylight Time	08/06/2019 10:24:31 AM Eastern Daylight Time	08/06/2019 10:24:31 AM Eastern Daylight Time			08/06/2019 10:30:03 AM Eastern Daylight Time	"HEALTH NEW ENGLAND, INC."	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Select (HMO-POS)	1	2		1			H8578	16	0	2020	"Hampden, Hampshire, Franklin, Berkshire Counties"		2	488	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8578	801	0	1	2	1	H8578_801_0	3	1			05/28/2019	2020.01	05/28/2019 04:49:53 PM Eastern Daylight Time					05/31/2019 03:36:32 PM Eastern Daylight Time	"HEALTH NEW ENGLAND, INC."	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	Health New England Medicare Employer Group RX (HMO-POS)	1	2		1			H8578	801	0	2020	United States		1	5658	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		1				
H8578	802	0	1	2	1	H8578_802_0	3	1			05/28/2019	2020.01	05/28/2019 04:46:14 PM Eastern Daylight Time					05/31/2019 03:36:32 PM Eastern Daylight Time	"HEALTH NEW ENGLAND, INC."	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	HNE Medicare Employer Group Calendar (HMO-POS)	1	2		1			H8578	802	0	2020	United States		1	61	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010										(711)-		(711)-		(711)-		(711)-										1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		1				
H8578	803	0	1	2	1	H8578_803_0	3	1			05/28/2019	2020.01	05/28/2019 04:46:25 PM Eastern Daylight Time					05/31/2019 03:36:32 PM Eastern Daylight Time	"HEALTH NEW ENGLAND, INC."	Health New England Medicare Advantage Plans	www.healthnewengland.org/medicare	HNE Medicare Employer Group Non-Calendar (HMO-POS)	1	2		1			H8578	803	0	2020	United States		1	61	2			2						www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	www.healthnewengland.org/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)393-0395		(800)393-0395		(800)393-0395		(800)393-0395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		1	1	2;5;6;7c;7i;8a;8b1;9a1;9a2;9b;10a;11a;11b;11c;14a;15;	2		1				
H8597	1	0	1	1	1	H8597_001_0	3	1	2	1	05/28/2019	2020.01	05/28/2019 11:57:48 AM Eastern Daylight Time	08/01/2019 12:30:46 PM Pacific Daylight Time	07/31/2019 01:41:54 AM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA BETTER HEALTH OF TEXAS INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Complete Plan (HMO D-SNP)	1	1		1			H8597	1	0	2020	Select Texas counties		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8597	2	0	1	1	1	H8597_002_0	2	1	2	1	05/28/2019	2020.01	05/28/2019 12:01:23 PM Eastern Daylight Time	08/01/2019 12:31:26 PM Pacific Daylight Time	07/31/2019 01:43:05 AM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA BETTER HEALTH OF TEXAS INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Complete Plan (HMO D-SNP)	1	1		1			H8597	2	0	2020	Dallas and Surrounding counties		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8597	3	0	1	1	1	H8597_003_0	2	1	2	1	05/28/2019	2020.01	05/28/2019 12:04:27 PM Eastern Daylight Time	08/01/2019 12:32:06 PM Pacific Daylight Time	07/31/2019 01:44:16 AM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	AETNA BETTER HEALTH OF TEXAS INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Dual Complete Plan (HMO D-SNP)	1	1		1			H8597	3	0	2020	Houston and Surrounding Counties		2		2			1	3		1		1	www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8604	10	0	1	4	1	H8604_010_0	8	1			08/08/2019	2020.01	08/08/2019 02:30:18 PM Eastern Daylight Time	08/01/2019 11:38:56 AM Eastern Daylight Time	07/31/2019 11:52:21 AM Eastern Daylight Time			08/08/2019 03:37:58 PM Eastern Daylight Time	THP INSURANCE COMPANY	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureChoice - Option II (PPO)	1	4		1			H8604	10	0	2020	East Central OH		2	4000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8604	11	0	1	4	1	H8604_011_0	7	1			08/08/2019	2020.01	08/08/2019 02:30:56 PM Eastern Daylight Time	08/01/2019 11:40:40 AM Eastern Daylight Time	07/31/2019 11:52:21 AM Eastern Daylight Time			08/08/2019 03:37:58 PM Eastern Daylight Time	THP INSURANCE COMPANY	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureChoice - Option II (PPO)	1	4		1			H8604	11	0	2020	"Southeastern OH, West Virginia"		2	12000	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8604	13	0	1	4	1	H8604_013_0	7	1			08/08/2019	2020.01	08/08/2019 02:31:22 PM Eastern Daylight Time	08/01/2019 11:42:27 AM Eastern Daylight Time	07/31/2019 11:52:22 AM Eastern Daylight Time			08/08/2019 03:37:58 PM Eastern Daylight Time	THP INSURANCE COMPANY	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureChoice Capitol Plan (PPO)	1	4		1			H8604	13	0	2020	Kanawha and Surrounding Counties		2	3500	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8604	801	0	1	4	1	H8604_801_0	1	1			05/29/2019	2020.01	05/29/2019 11:57:17 AM Eastern Daylight Time					05/30/2019 03:36:30 PM Eastern Daylight Time	THP INSURANCE COMPANY	The Health Plan	www.healthplan.org/medicare	The Health Plan SecureChoice - Employer (PPO)	1	4		1			H8604	801	0	2020	"Eastern Ohio and West Virginia, National"		1	500	2			2						www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(877)847-7907		(877)847-7907		(877)847-7915		(877)847-7915		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8634	2	0	1	4	1	H8634_002_0	4	1			07/01/2019	2020.01	07/01/2019 10:06:11 AM Mountain Daylight Time	08/06/2019 01:24:30 PM Mountain Daylight Time	08/06/2019 01:24:34 PM Mountain Daylight Time			08/06/2019 02:45:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.getbluenm.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	1	4		1			H8634	2	0	2020	"Bernalillo, Sandoval, Torrance and Valencia cntys"		2	14169	2			2						www.getbluenm.com/mapd/pharmacies	www.getbluenm.com/mapd/druglist	www.getbluenm.com/mapd/providers	(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			
H8634	3	0	1	4	1	H8634_003_0	4	1			05/30/2019	2020.01	05/30/2019 08:23:41 AM Central Daylight Time	08/06/2019 01:24:30 PM Mountain Daylight Time	08/06/2019 01:24:34 PM Mountain Daylight Time			08/06/2019 02:45:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.getblueil.com/mapd	Blue Cross Medicare Advantage Choice Plus (PPO)	1	4		1			H8634	3	0	2020	Chicago Metro Area		2	71200	2			2						www.getblueil.com/mapd/pharmacies	www.getblueil.com/mapd/druglist	www.getblueil.com/mapd/providers	(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			
H8634	4	0	1	4	1	H8634_004_0	5	1			05/30/2019	2020.01	05/30/2019 08:23:58 AM Central Daylight Time	08/06/2019 01:24:30 PM Mountain Daylight Time	08/06/2019 01:24:34 PM Mountain Daylight Time			08/06/2019 02:45:20 PM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.getblueil.com/mapd	Blue Cross Medicare Advantage Choice Premier (PPO)	1	4		1			H8634	4	0	2020	Chicago Metro Area		2	48077	2			2						www.getblueil.com/mapd/pharmacies	www.getblueil.com/mapd/druglist	www.getblueil.com/mapd/providers	(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			
H8634	801	0	1	4	1	H8634_801_0	2	1			05/30/2019	2020.01	05/30/2019 08:24:43 AM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.mybluemedicarenm.com	BlueCross Medicare Advantage (PPO)	1	4		1			H8634	801	0	2020	State of New Mexico		1	886	2			2						www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	803	0	1	4	1	H8634_803_0	2	1			05/30/2019	2020.01	05/30/2019 08:24:51 AM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.mybluemedicarenm.com	BlueCross Medicare Advantage (PPO)	1	4		1			H8634	803	0	2020	State of New Mexico		1	1	2			2						www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	805	0	1	4	1	H8634_805_0	2	1			05/30/2019	2020.01	05/30/2019 08:24:59 AM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.mybluemedicarenm.com	BlueCross Medicare Advantage (PPO)	1	4		1			H8634	805	0	2020	State of New Mexico		1	1	2			2						www.mybluemedicarenm.com	www.mybluemedicarenm.com	www.mybluemedicarenm.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	807	0	1	4	1	H8634_807_0	2	1			05/30/2019	2020.01	05/30/2019 03:28:53 PM Central Daylight Time					06/03/2019 11:20:09 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.mybluemedicareok.com	BlueCross Medicare Advantage (PPO)	1	4		1			H8634	807	0	2020	State of Oklahoma		1	829	2			2						www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	809	0	1	4	1	H8634_809_0	2	1			05/30/2019	2020.01	05/30/2019 03:29:19 PM Central Daylight Time					06/03/2019 11:20:09 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.mybluemedicareok.com	BlueCross Medicare Advantage (PPO)	1	4		1			H8634	809	0	2020	State of Oklahoma		1	1	2			2						www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	811	0	1	4	1	H8634_811_0	2	1			05/30/2019	2020.01	05/30/2019 03:29:49 PM Central Daylight Time					06/03/2019 11:20:09 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.mybluemedicareok.com	BlueCross Medicare Advantage (PPO)	1	4		1			H8634	811	0	2020	State of Oklahoma		1	1	2			2						www.mybluemedicareok.com	www.mybluemedicareok.com	www.mybluemedicareok.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	813	0	1	4	1	H8634_813_0	2	1			05/30/2019	2020.01	05/30/2019 08:25:19 AM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.getblueil.com	Blue Cross Medicare Advantage (PPO)	1	4		1			H8634	813	0	2020	State of Illinois		1	24722	2			2						www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	815	0	1	4	1	H8634_815_0	2	1			05/30/2019	2020.01	05/30/2019 04:46:39 PM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.getblueil.com	Blue Cross Medicare Advantage (PPO)	1	4		1			H8634	815	0	2020	State of Illinois		1	54118	2			2						www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8634	817	0	1	4	1	H8634_817_0	2	1			05/30/2019	2020.01	05/30/2019 08:25:57 AM Central Daylight Time					06/03/2019 09:46:49 AM Mountain Daylight Time	HEALTH CARE SERVICE CORPORATION	"Blue Cross and Blue Shield of IL, NM"	www.getblueil.com	Blue Cross Medicare Advantage (PPO)	1	4		1			H8634	817	0	2020	State of Illinois		1	1	2			2						www.getblueil.com	www.getblueil.com	www.getblueil.com	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		2									
H8649	3	0	1	1	1	H8649_003_0	3	1			07/31/2019	2020.01	07/31/2019 01:03:23 PM Eastern Daylight Time	08/01/2019 03:58:55 PM Eastern Daylight Time	07/31/2019 04:45:34 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	"AETNA HEALTH OF UTAH, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Advantra (HMO)	1	1		1			H8649	3	0	2020	Northern Utah		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8649	8	0	1	1	1	H8649_008_0	5	1			07/17/2019	2020.01	07/17/2019 02:56:10 PM Eastern Daylight Time	08/01/2019 03:59:37 PM Eastern Daylight Time	07/31/2019 04:46:45 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	"AETNA HEALTH OF UTAH, INC"	Aetna Medicare	www.aetnamedicare.com	Aetna Advantra Select (HMO)	1	1		1			H8649	8	0	2020	Northeastern Utah		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8649	801	0	1	1	1	H8649_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:57:05 AM Eastern Daylight Time					05/30/2019 07:09:57 PM Eastern Daylight Time	"AETNA HEALTH OF UTAH, INC"	Aetna Medicare	https://www.aetnamedicare.com	Aetna Altius Medicare Plan w/Rx (HMO)	1	1		1			H8649	801	0	2020	Utah		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H8649	803	0	1	1	1	H8649_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:57:15 AM Eastern Daylight Time					05/30/2019 07:09:57 PM Eastern Daylight Time	"AETNA HEALTH OF UTAH, INC"	Aetna Medicare	https://www.aetnamedicare.com	Aetna Altius Medicare Plan (HMO)	1	1		1			H8649	803	0	2020	Utah		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H8649	804	0	1	1	1	H8649_804_0	1	1			05/24/2019	2020.01	05/24/2019 09:57:26 AM Eastern Daylight Time					05/30/2019 07:09:57 PM Eastern Daylight Time	"AETNA HEALTH OF UTAH, INC"	Aetna Medicare	https://www.aetnamedicare.com	Aetna Altius Medicare Plan w/Rx SH (HMO)	1	1		1			H8649	804	0	2020	Utah		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	1	3-1;3-2;3-3;3-4;7b;7c;7d;7f;7g;7i;7k;8a;14d;14e2;18a;	1					1				
H8655	4	0	1	20	8	H8655_004_0	1	1			05/16/2019	2020.01	05/16/2019 03:33:08 PM Mountain Daylight Time		05/16/2019 02:32:52 PM Mountain Daylight Time			05/16/2019 03:34:19 PM Mountain Daylight Time	"INNOVAGE VIRGINIA PACE II, LLC"	InnovAge Virginia PACE - Richmond and Peninsula	www.MyInnovAge.com	Riverside PACE Dual (PACE)	8	20		1			H8655	4	0	2020	Riverside PACE Dual		2		2			2						https://www.granerx.com/	N/A - no formulary										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H8655	5	0	1	20	8	H8655_005_0	1	1			05/16/2019	2020.01	05/16/2019 03:33:20 PM Mountain Daylight Time		05/16/2019 02:32:53 PM Mountain Daylight Time			05/16/2019 03:34:19 PM Mountain Daylight Time	"INNOVAGE VIRGINIA PACE II, LLC"	InnovAge Virginia PACE - Richmond and Peninsula	www.MyInnovAge.com	Riverside PACE Medicare ONLY (PACE)	8	20		1			H8655	5	0	2020	Riverside PACE Medicare ONLY		2		2			2						https://www.granerx.com/	N/A - no formulary										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H8677	1	0	1	48	5	H8677_001_0	5	1			08/21/2019	2020.01	08/21/2019 01:05:33 PM Pacific Daylight Time					08/21/2019 06:10:41 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	5	48		1			H8677	1	0	2020	"Counties: San Diego, parts of Riv. & S. Bernardino"		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)665-4627		(855)665-4627		(866)408-9501		(866)408-9501		(855)665-4627		(855)665-4627		(866)408-9501		(866)408-9501		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8677	2	0	1	48	5	H8677_002_0	5	1			08/21/2019	2020.01	08/21/2019 01:04:42 PM Pacific Daylight Time					08/21/2019 06:10:41 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	5	48		1			H8677	2	0	2020	Los Angeles County		2		2			2						www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)665-4627		(855)665-4627		(866)408-9501		(866)408-9501		(855)665-4627		(855)665-4627		(866)408-9501		(866)408-9501		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8748	2	0	1	2	1	H8748_002_0	4	1			07/11/2019	2020.01	07/11/2019 04:53:15 PM Central Daylight Time	08/02/2019 11:17:08 AM Central Daylight Time	07/30/2019 10:05:46 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 1 (HMO-POS)	1	2		1			H8748	2	0	2020	Greenville and Pickens counties		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	8	0	1	2	1	H8748_008_0	3	1			08/02/2019	2020.01	08/02/2019 01:36:52 PM Central Daylight Time	08/02/2019 11:20:05 AM Central Daylight Time	07/30/2019 10:06:20 PM Central Daylight Time			08/06/2019 09:57:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plus Plan 1 (HMO-POS)	1	2		1			H8748	8	0	2020	Select Counties in Georgia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	9	0	1	2	1	H8748_009_0	3	1			08/02/2019	2020.01	08/02/2019 11:59:09 AM Central Daylight Time	08/02/2019 11:23:02 AM Central Daylight Time	07/30/2019 10:06:55 PM Central Daylight Time			08/06/2019 09:57:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plus Plan 2 (HMO-POS)	1	2		1			H8748	9	0	2020	Select Counties in Georgia		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	19	0	1	2	1	H8748_019_0	2	1			07/11/2019	2020.01	07/11/2019 04:53:36 PM Central Daylight Time	05/31/2019 11:27:51 AM Central Daylight Time				07/12/2019 12:16:48 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Essential (HMO-POS)	1	2		1			H8748	19	0	2020	Select Counties in South Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H8748	24	0	1	2	1	H8748_024_0	4	1			08/02/2019	2020.01	08/02/2019 12:28:17 PM Central Daylight Time	08/02/2019 11:28:09 AM Central Daylight Time	07/30/2019 10:07:28 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Premier (HMO-POS)	1	2		1			H8748	24	0	2020	Greenville County		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8748	25	0	1	2	1	H8748_025_0	4	1			08/02/2019	2020.01	08/02/2019 12:30:11 PM Central Daylight Time	08/02/2019 11:30:46 AM Central Daylight Time	07/30/2019 10:08:01 PM Central Daylight Time			08/05/2019 05:40:47 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Plan 2 (HMO-POS)	1	2		1			H8748	25	0	2020	Select Counties in South Carolina		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8764	1	0	1	1	1	H8764_001_0	7	1			07/11/2019	2020.01	07/11/2019 07:34:28 AM Pacific Daylight Time	08/06/2019 09:13:55 AM Pacific Daylight Time	07/31/2019 02:11:45 PM Pacific Daylight Time			08/06/2019 03:11:22 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Advantage (HMO)	1	1		1			H8764	1	0	2020	Monterey County		2		2			2						www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(888)839-3991		(831)375-1462		(866)632-7958		(866)632-7958		(888)839-3991		(831)375-1462		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(711)-		(711)-		2					2					2	2			
H8764	2	0	1	2	1	H8764_002_0	7	1			07/11/2019	2020.01	07/11/2019 07:36:32 AM Pacific Daylight Time	08/06/2019 09:14:19 AM Pacific Daylight Time	07/31/2019 02:10:38 PM Pacific Daylight Time			08/06/2019 03:11:22 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Plus (HMO-POS)	1	2		1			H8764	2	0	2020	Monterey County		2		2			2						www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(888)839-3991		(831)375-1462		(866)632-7958		(866)632-7958		(888)839-3991		(831)375-1462		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(711)-		(711)-		2					2					2	2			
H8764	3	0	1	1	1	H8764_003_0	7	1			08/06/2019	2020.01	08/06/2019 02:30:28 PM Pacific Daylight Time	08/06/2019 09:14:39 AM Pacific Daylight Time	07/31/2019 02:12:53 PM Pacific Daylight Time			08/06/2019 03:11:22 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Value (HMO)	1	1		1			H8764	3	0	2020	Monterey County		2		2			2						www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(888)839-3991		(831)375-1462		(866)632-7958		(866)632-7958		(888)839-3991		(831)375-1462		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(711)-		(711)-		2					2					2	2			
H8764	801	0	1	2	1	H8764_801_0	1	1			06/01/2019	2020.01	06/01/2019 03:32:41 PM Pacific Daylight Time					06/02/2019 07:55:47 PM Pacific Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Group Plus (HMO-POS)	1	2		1			H8764	801	0	2020	Monterey County		1	2520	2			2						www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(888)839-3991		(831)375-1462		(866)632-7958		(866)632-7958		(888)839-3991		(831)375-1462		(711)-		(711)-		(711)-		(711)-		(866)706-4757		(866)706-4757		(711)-		(711)-		2					2					2	2			
H8768	3	0	1	4	1	H8768_003_0	3	1			08/02/2019	2020.01	08/02/2019 12:27:20 PM Central Daylight Time	08/02/2019 11:22:31 AM Central Daylight Time	07/30/2019 10:08:39 PM Central Daylight Time			08/05/2019 05:28:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H8768	3	0	2020	Northwestern Illinois		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	5	0	1	4	1	H8768_005_0	3	1			08/02/2019	2020.01	08/02/2019 12:27:41 PM Central Daylight Time	08/02/2019 11:23:13 AM Central Daylight Time	07/30/2019 10:09:11 PM Central Daylight Time			08/05/2019 05:28:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H8768	5	0	2020	Chicago Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	6	0	1	4	1	H8768_006_0	3	1			08/02/2019	2020.01	08/02/2019 12:28:00 PM Central Daylight Time	08/02/2019 11:23:59 AM Central Daylight Time	07/30/2019 10:09:43 PM Central Daylight Time			08/05/2019 05:28:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H8768	6	0	2020	Toledo Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	7	0	1	4	1	H8768_007_0	2	1			08/02/2019	2020.01	08/02/2019 12:28:21 PM Central Daylight Time	08/02/2019 11:24:41 AM Central Daylight Time	07/30/2019 10:10:14 PM Central Daylight Time			08/05/2019 05:28:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H8768	7	0	2020	Central Ohio		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	8	0	1	4	1	H8768_008_0	2	1			08/02/2019	2020.01	08/02/2019 12:23:44 PM Central Daylight Time	08/02/2019 11:25:25 AM Central Daylight Time	07/30/2019 10:10:48 PM Central Daylight Time			08/05/2019 05:28:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H8768	8	0	2020	Oklahoma City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	9	0	1	4	1	H8768_009_0	2	1			08/02/2019	2020.01	08/02/2019 12:24:28 PM Central Daylight Time	08/02/2019 11:26:05 AM Central Daylight Time	07/30/2019 10:11:22 PM Central Daylight Time			08/05/2019 05:28:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H8768	9	0	2020	Tulsa Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	10	0	1	4	1	H8768_010_0	3	1			08/02/2019	2020.01	08/02/2019 12:28:44 PM Central Daylight Time	08/02/2019 11:26:46 AM Central Daylight Time	07/30/2019 10:11:55 PM Central Daylight Time			08/05/2019 05:28:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H8768	10	0	2020	Chicago Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	11	0	1	4	1	H8768_011_0	3	1			08/02/2019	2020.01	08/02/2019 12:29:02 PM Central Daylight Time	08/02/2019 11:27:28 AM Central Daylight Time	07/30/2019 10:12:27 PM Central Daylight Time			08/05/2019 05:28:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H8768	11	0	2020	Northwestern Illinois		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	12	0	1	4	1	H8768_012_0	4	1			08/02/2019	2020.01	08/02/2019 12:29:24 PM Central Daylight Time	08/02/2019 11:28:09 AM Central Daylight Time	07/30/2019 10:12:59 PM Central Daylight Time			08/05/2019 05:28:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H8768	12	0	2020	Lexington Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	13	0	1	4	1	H8768_013_0	4	1			08/02/2019	2020.01	08/02/2019 12:29:43 PM Central Daylight Time	08/02/2019 11:28:51 AM Central Daylight Time	07/30/2019 10:13:29 PM Central Daylight Time			08/05/2019 05:28:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H8768	13	0	2020	Louisville Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	14	0	1	4	1	H8768_014_0	3	1			08/02/2019	2020.01	08/02/2019 12:30:02 PM Central Daylight Time	08/02/2019 11:29:34 AM Central Daylight Time	07/30/2019 10:14:00 PM Central Daylight Time			08/05/2019 05:28:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H8768	14	0	2020	Cleveland Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	15	0	1	4	1	H8768_015_0	3	1			08/02/2019	2020.01	08/02/2019 12:30:23 PM Central Daylight Time	08/02/2019 11:30:22 AM Central Daylight Time	07/30/2019 10:14:34 PM Central Daylight Time			08/05/2019 05:28:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H8768	15	0	2020	Cincinnati/Dayton Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	16	0	1	4	1	H8768_016_0	3	1			08/05/2019	2020.01	08/05/2019 11:05:35 AM Central Daylight Time	08/02/2019 11:31:03 AM Central Daylight Time	07/30/2019 10:15:04 PM Central Daylight Time			08/05/2019 05:28:14 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Walgreens (PPO)	1	4		1			H8768	16	0	2020	Oklahoma City Metro Area		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	17	1	1	4	1	H8768_017_1	2	1			08/05/2019	2020.01	08/05/2019 10:52:31 AM Central Daylight Time	08/02/2019 11:31:44 AM Central Daylight Time	07/30/2019 10:15:36 PM Central Daylight Time			08/06/2019 11:39:19 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H8768	17	1	2020	Select Counties in IA	IA/IL Metros	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8768	17	2	1	4	1	H8768_017_2	4	1			08/05/2019	2020.01	08/05/2019 05:36:57 PM Central Daylight Time	08/02/2019 11:32:32 AM Central Daylight Time	07/30/2019 10:16:11 PM Central Daylight Time			08/06/2019 11:39:19 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (PPO)	1	4		1			H8768	17	2	2020	Select Counties in IA	IA Rural	2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8769	1	0	1	20	8	H8769_001_0	2	1			05/31/2019	2020.01	05/31/2019 08:54:19 PM Central Daylight Time		05/31/2019 08:55:17 PM Central Daylight Time			05/31/2019 08:57:20 PM Central Daylight Time	"GENESYS AMBULATORY HEALTH SERVICES, INC."	Genesys PACE of Genesee County	healthcare.ascension.org/Locations	Genesys PACE of Genesee County (PACE)	8	20		1			H8769	1	0	2020	"Counties: Genesee, Lap, Liv, Oak, Shi, Tus"		2		2			2						genesys.org/PACE	genesys.org/PACE												(810)236-7500				(810)236-7500												(810)236-7554				(810)236-7554																
H8769	2	0	1	20	8	H8769_002_0	2	1			05/31/2019	2020.01	05/31/2019 08:54:28 PM Central Daylight Time		05/31/2019 08:56:13 PM Central Daylight Time			05/31/2019 08:57:20 PM Central Daylight Time	"GENESYS AMBULATORY HEALTH SERVICES, INC."	Genesys PACE of Genesee County	healthcare.ascension.org/Locations	Genesys PACE of Genesee County (PACE)	8	20		1			H8769	2	0	2020	"Counties: Genesee, Lap, Liv, Oak, Shi, Tus"		2		2			2						genesys.org/PACE	genesys.org/PACE												(810)236-7500				(810)236-7500												(810)236-7554				(810)236-7554																
H8777	1	0	1	20	8	H8777_001_0	1	1			05/30/2019	2020.01	05/30/2019 02:10:01 PM Eastern Daylight Time		05/30/2019 12:33:05 PM Eastern Daylight Time			05/30/2019 02:16:41 PM Eastern Daylight Time	"COMPLETE SENIOR CARE, INC."	Complete Senior Care	completeseniorcare.org	Complete Senior Care Dual (PACE)	8	20		1			H8777	1	0	2020	"Niagara, NY"		2		2			2						Pharmastar	Pharmastar										(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	2	0	1	20	8	H8777_002_0	1	1			05/30/2019	2020.01	05/30/2019 02:11:11 PM Eastern Daylight Time		05/30/2019 12:32:55 PM Eastern Daylight Time			05/30/2019 02:16:41 PM Eastern Daylight Time	"COMPLETE SENIOR CARE, INC."	Complete Senior Care	completeseniorcare.org	Complete Senior Care Medicare Only (PACE)	8	20		1			H8777	2	0	2020	"Niagara, NY"		2		2			2						Pharmastar	Pharmastar										(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															
H8783	1	0	1	4	1	H8783_001_0	7	1			08/05/2019	2020.01	08/05/2019 05:17:33 PM Central Daylight Time	08/06/2019 02:50:27 PM Central Daylight Time	07/31/2019 10:31:25 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	"UCARE HEALTH, INC."	UCare	ucare.org	EssentiaCare Secure (PPO)	1	4		1			H8783	1	0	2020	Northern Minnesota and Wisconsin: 13 Counties		2		2			2						ucare.org	ucare.org	home.ucare.org/en-us/search-network	(855)432-7025		(218)722-4915		(855)432-7027		(612)676-6630		(855)432-7025		(218)722-4915		(855)432-7027		(612)676-6630		(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			
H8783	2	0	1	4	1	H8783_002_0	6	1			08/05/2019	2020.01	08/05/2019 05:18:27 PM Central Daylight Time	08/06/2019 02:49:44 PM Central Daylight Time	07/31/2019 10:32:39 AM Central Daylight Time			08/06/2019 03:15:05 PM Central Daylight Time	"UCARE HEALTH, INC."	UCare	ucare.org	EssentiaCare Grand (PPO)	1	4		1			H8783	2	0	2020	Northern Minnesota and Wisconsin: 13 Counties		2		2			2						ucare.org	ucare.org	home.ucare.org/en-us/search-network	(855)432-7025		(218)722-4915		(855)432-7027		(612)676-6630		(855)432-7025		(218)722-4915		(855)432-7027		(612)676-6630		(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			
H8786	1	0	1	48	5	H8786_001_0	6	1			08/20/2019	2020.01	08/20/2019 11:55:37 AM Pacific Daylight Time					08/20/2019 11:58:54 AM Pacific Daylight Time	"AMERIGROUP TEXAS, INC."	Amerigroup STAR+PLUS MMP	www.myamerigroup.com/txmmp	Amerigroup Medicare-Medicaid Plan (Medicare-Medicaid Plan)	5	48		1			H8786	1	0	2020	Select TX Service Areas		2	150833	2			2						www.myamerigroup/medicare.com	www.myamerigroup.com/txmmp	www.myamerigroup.com/txmmp	(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(855)878-1784		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H8800	1	0	1	20	8	H8800_001_0	1	1			05/17/2019	2020.01	05/17/2019 12:47:23 PM Eastern Daylight Time		05/17/2019 12:43:32 PM Eastern Daylight Time			05/17/2019 12:48:51 PM Eastern Daylight Time	"TOTAL SENIOR CARE, INC."	"Total Senior Care, Inc."	www.totalseniorcare.org	Total Senior Care - Dual (PACE)	8	20		1			H8800	1	0	2020	"Cattaraugus, Allegany and Chautauqua counties"		2		2			2						totalseniorcare.org	www.totalseniorcare.org	www.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	2	0	1	20	8	H8800_002_0	1	1			05/17/2019	2020.01	05/17/2019 12:47:40 PM Eastern Daylight Time		05/17/2019 12:43:33 PM Eastern Daylight Time			05/17/2019 12:48:51 PM Eastern Daylight Time	"TOTAL SENIOR CARE, INC."	"Total Senior Care, Inc."	www.totalseniorcare.org	Total Senior Care - Medicare Small Only (PACE)	8	20		1			H8800	2	0	2020	"Cattaraugus, Allegany and Chautauqua counties"		2		2			2						totalseniorcare.org	www.totalseniorcare.org	www.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																
H8845	1	0	1	1	1	H8845_001_0	4	1	2	1	05/30/2019	2020.01	05/30/2019 12:28:54 AM Eastern Daylight Time	08/01/2019 02:30:30 PM Eastern Daylight Time	08/01/2019 11:14:44 AM Eastern Daylight Time			08/05/2019 11:27:37 PM Eastern Daylight Time	"MAGELLAN COMPLETE CARE OF ARIZONA, INC"	Magellan Complete Care	mccofaz.com	Magellan Complete Care of Arizona (HMO D-SNP)	1	1		1			H8845	1	0	2020	"Gila, Maricopa, Pinal"		2	6320	2			1	3		2		1	mccofaz.com	mccofaz.com	mccofaz.com	(800)424-4509		(800)424-4509		(800)424-4505		(800)424-4505		(800)424-4509		(800)424-4509		(800)424-4505		(800)424-4505		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8854	2	0	1	1	1	H8854_002_0	12	1	2	1	09/17/2019	2020.01	09/17/2019 11:47:33 AM Eastern Daylight Time	08/05/2019 03:43:06 PM Eastern Daylight Time	08/06/2019 12:16:08 PM Eastern Daylight Time			09/17/2019 12:02:09 PM Eastern Daylight Time	"UNIVERSITY OF MARYLAND HEALTH ADVANTAGE, INC."	University of Maryland Health Advantage	www.UMMedicareAdvantage.org	UMHA Dual (HMO D-SNP)	1	1		1			H8854	2	0	2020	Select Maryland Counties		2	73377	2			1	3		2		1	www.UMMedicareAdvantage.org	www.UMMedicareAdvantage.org	www.UMMedicareAdvantage.org	(844)386-6762		(410)779-9932		(844)262-1122		(844)262-1122		(844)786-6762		(844)786-6762		(844)262-1122		(844)262-1122		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8889	1	0	1	4	1	H8889_001_0	10	1			07/26/2019	2020.01	07/26/2019 02:51:16 PM Central Daylight Time	08/01/2019 09:45:35 AM Central Daylight Time	08/01/2019 09:47:25 AM Central Daylight Time			08/01/2019 11:39:37 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-001 (PPO)	1	4		1			H8889	1	0	2020	Minneapolis/St. Paul Metro Area		2		2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8889	2	0	1	4	1	H8889_002_0	10	1			07/26/2019	2020.01	07/26/2019 02:51:51 PM Central Daylight Time	08/01/2019 09:44:29 AM Central Daylight Time	08/01/2019 09:47:30 AM Central Daylight Time			08/01/2019 11:39:37 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-002 (PPO)	1	4		1			H8889	2	0	2020	Select Counties in MN		2		2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8889	3	0	1	4	1	H8889_003_0	10	1			07/26/2019	2020.01	07/26/2019 02:52:26 PM Central Daylight Time	08/01/2019 09:44:37 AM Central Daylight Time	08/01/2019 09:47:36 AM Central Daylight Time			08/01/2019 11:39:37 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-003 (PPO)	1	4		1			H8889	3	0	2020	Minneapolis/St. Paul Metro Area		2		2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8889	4	0	1	4	1	H8889_004_0	10	1			07/26/2019	2020.01	07/26/2019 02:53:00 PM Central Daylight Time	08/01/2019 09:44:43 AM Central Daylight Time	08/01/2019 09:47:42 AM Central Daylight Time			08/01/2019 11:39:37 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Advantage Solution H8889-004 (PPO)	1	4		1			H8889	4	0	2020	Southern Minnesota		2		2			2						medica.com/Members	medica.com/Members	medica.com/Members	(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(866)269-6804		(952)992-2134		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H8889	801	0	1	4	1	H8889_801_0	2	1			05/22/2019	2020.01	05/22/2019 02:47:02 PM Central Daylight Time					05/28/2019 03:27:21 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica Group Advantage Solution (PPO)	1	4		1			H8889	801	0	2020	Select Counties in the US		1	41628	2			2						medica.com/Members	medica.com/Members	medica.com/Members	(800)575-2330		(952)992-2330		(800)906-5432		(952)992-2345		(800)575-2330		(952)992-2330		(800)906-5432		(952)992-2345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1									
H8908	1	0	1	1	1	H8908_001_0	3	1			07/16/2019	2020.01	07/16/2019 05:58:35 PM Eastern Daylight Time	08/04/2019 02:41:01 PM Eastern Daylight Time	08/02/2019 01:19:02 PM Eastern Daylight Time			08/05/2019 11:18:00 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF MICHIGAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H8908-001 (HMO)	1	1		1			H8908	1	0	2020	Detroit Area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8908	2	0	1	1	1	H8908_002_0	3	1			08/01/2019	2020.01	08/01/2019 02:38:44 PM Eastern Daylight Time	08/04/2019 02:52:22 PM Eastern Daylight Time	08/02/2019 01:19:02 PM Eastern Daylight Time			08/05/2019 11:18:00 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF MICHIGAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H8908-002 (HMO)	1	1		1			H8908	2	0	2020	Grand Rapids area		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8908	4	0	1	1	1	H8908_004_0	3	1			08/01/2019	2020.01	08/01/2019 02:39:18 PM Eastern Daylight Time	08/04/2019 03:04:22 PM Eastern Daylight Time	08/02/2019 01:19:02 PM Eastern Daylight Time			08/05/2019 11:18:00 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF MICHIGAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus H8908-004 (HMO)	1	1		1			H8908	4	0	2020	Southeast Michigan		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8908	5	0	1	1	1	H8908_005_0	2	1	2	1	05/30/2019	2020.01	05/30/2019 04:30:53 PM Eastern Daylight Time	08/04/2019 03:05:52 PM Eastern Daylight Time	08/02/2019 01:19:02 PM Eastern Daylight Time			08/05/2019 11:09:08 AM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF MICHIGAN, INC."	Humana	www.humana.com/medicare	Humana Gold Plus SNP-DE H8908-005 (HMO D-SNP)	1	1		1			H8908	5	0	2020	Select counties in Michigan		2		2			1	3		1		1	https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8908	801	0	1	1	1	H8908_801_0	1	1			05/29/2019	2020.01	05/29/2019 10:58:52 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF MICHIGAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H8908	801	0	2020	Select Counties in Michigan		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H8908	802	0	1	1	1	H8908_802_0	1	1			05/29/2019	2020.01	05/29/2019 10:59:28 AM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF MICHIGAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H8908	802	0	2020	Select Counties in Michigan		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H8908	804	0	1	1	1	H8908_804_0	1	1			05/29/2019	2020.01	05/29/2019 12:57:33 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF MICHIGAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H8908	804	0	2020	Select Counties in Michigan		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H8908	805	0	1	1	1	H8908_805_0	1	1			05/29/2019	2020.01	05/29/2019 12:58:37 PM Eastern Daylight Time					05/29/2019 02:22:57 PM Eastern Daylight Time	"HUMANA MEDICAL PLAN OF MICHIGAN, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (HMO)	1	1		1			H8908	805	0	2020	Select Counties in Michigan		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					2				
H8916	1	0	1	1	1	H8916_001_0	10	1			08/06/2019	2020.01	08/06/2019 11:15:51 AM Eastern Daylight Time	08/02/2019 01:34:16 PM Eastern Daylight Time	07/30/2019 04:51:32 PM Eastern Daylight Time			08/06/2019 11:49:51 AM Eastern Daylight Time	"BEST CARE PARTNERS, INC."	Clarion Health	www.clarionhealth.org	Clarion Health (HMO)	1	1		1			H8916	1	0	2020	Southern Florida		2		2			2						www.clarionhealth.org	www.clarionhealth.org	www.clarionhealth.org	(844)243-5131		(844)243-5131		(833)354-3258		(833)354-3258		(844)243-5131		(844)243-5131		(833)354-3258		(833)354-3258		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8967	1	0	1	1	1	H8967_001_0	5	1		1	08/01/2019	2020.01	08/01/2019 11:56:13 AM Central Daylight Time	08/01/2019 01:17:28 PM Central Daylight Time	07/31/2019 04:08:49 PM Central Daylight Time			08/05/2019 04:36:39 PM Central Daylight Time	"GOOD SAMARITAN INSURANCE PLAN OF NORTH DAKOTA, LLC"	Great Plains Medicare Advantage	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage (HMO I-SNP)	1	1		1			H8967	1	0	2020	North Dakota (partial)		2	3512	2			1	1	3				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H8967	2	0	1	1	1	H8967_002_0	7	1		1	07/19/2019	2020.01	07/19/2019 03:38:09 PM Central Daylight Time	08/01/2019 11:15:23 AM Central Daylight Time	07/31/2019 04:10:25 PM Central Daylight Time			08/05/2019 04:36:39 PM Central Daylight Time	"GOOD SAMARITAN INSURANCE PLAN OF NORTH DAKOTA, LLC"	Great Plains Medicare Advantage	www.greatplainsmedicareadvantage.com	Great Plains Medicare Advantage Gold (HMO I-SNP)	1	1		1			H8967	2	0	2020	North Dakota (partial)		2	389	2			1	1	3				www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	www.greatplainsmedicareadvantage.com	(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(844)637-4760		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9001	19	0	1	1	1	H9001_019_0	11	1	2	1	07/11/2019	2020.01	07/11/2019 12:24:00 PM Eastern Daylight Time	08/06/2019 03:50:16 PM Eastern Daylight Time	08/06/2019 03:50:18 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/navicare	NaviCare (HMO D-SNP)	1	1		1			H9001	19	0	2020	Massachusetts except Dukes and Nantucket counties		2	90955	2			1	3		1		1	fallonhealth.org/navicare-pharmacy	fallonhealth.org/navicare-formulary	fallonhealth.org/FindPhysician	(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					2					2	2			
H9001	29	4	1	1	1	H9001_029_4	8	1			07/11/2019	2020.01	07/11/2019 12:34:35 PM Eastern Daylight Time	06/19/2019 02:55:04 PM Eastern Daylight Time				07/15/2019 11:50:18 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Saver No Rx HMO (HMO)	1	1		1			H9001	29	4	2020	Massachusetts except Dukes and Nantucket Counties	Barnstable County	2	36	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	29	5	1	1	1	H9001_029_5	7	1			07/11/2019	2020.01	07/11/2019 12:40:15 PM Eastern Daylight Time	06/19/2019 02:55:05 PM Eastern Daylight Time				07/15/2019 11:50:18 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Saver No Rx HMO (HMO)	1	1		1			H9001	29	5	2020	Massachusetts except Dukes and Nantucket Counties	Hampshire and Hampden Counties	2	420	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	29	6	1	1	1	H9001_029_6	8	1			07/11/2019	2020.01	07/11/2019 12:42:07 PM Eastern Daylight Time	07/22/2019 02:27:13 PM Eastern Daylight Time				07/22/2019 02:38:52 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Saver No Rx HMO (HMO)	1	1		1			H9001	29	6	2020	Massachusetts except Dukes and Nantucket Counties	Worcester and Franklin Counties	2	2461	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	29	7	1	1	1	H9001_029_7	7	1			07/11/2019	2020.01	07/11/2019 12:44:53 PM Eastern Daylight Time	06/19/2019 02:55:06 PM Eastern Daylight Time				07/15/2019 11:50:18 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Saver No Rx HMO (HMO)	1	1		1			H9001	29	7	2020	Massachusetts except Dukes and Nantucket Counties	Berkshire County	2	24	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	29	8	1	1	1	H9001_029_8	7	1			07/11/2019	2020.01	07/11/2019 12:46:51 PM Eastern Daylight Time	06/19/2019 02:55:06 PM Eastern Daylight Time				07/15/2019 11:50:18 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Saver No Rx HMO (HMO)	1	1		1			H9001	29	8	2020	Massachusetts except Dukes and Nantucket Counties	"Essex, Suffolk and Plymouth Counties"	2	132	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	29	9	1	1	1	H9001_029_9	7	1			07/11/2019	2020.01	07/11/2019 12:49:24 PM Eastern Daylight Time	06/19/2019 02:55:06 PM Eastern Daylight Time				07/15/2019 11:50:18 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Saver No Rx HMO (HMO)	1	1		1			H9001	29	9	2020	Massachusetts except Dukes and Nantucket Counties	"Bristol, Middlesex and Norfolk Counties"	2	468	2			2						fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9001	30	4	1	1	1	H9001_030_4	8	1			07/12/2019	2020.01	07/12/2019 01:06:19 PM Eastern Daylight Time	08/06/2019 03:50:20 PM Eastern Daylight Time	08/06/2019 03:50:20 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Green HMO (HMO)	1	1		1			H9001	30	4	2020	Massachusetts except Dukes and Nantucket Counties	Barnstable County	2	550	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	30	5	1	1	1	H9001_030_5	8	1			07/12/2019	2020.01	07/12/2019 01:06:36 PM Eastern Daylight Time	08/06/2019 03:50:21 PM Eastern Daylight Time	08/06/2019 03:50:24 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Green HMO (HMO)	1	1		1			H9001	30	5	2020	Massachusetts except Dukes and Nantucket Counties	Hampshire and Hampden Counties	2	4318	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	30	7	1	1	1	H9001_030_7	8	1			07/12/2019	2020.01	07/12/2019 01:06:50 PM Eastern Daylight Time	08/06/2019 03:50:25 PM Eastern Daylight Time	08/06/2019 03:50:25 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Green HMO (HMO)	1	1		1			H9001	30	7	2020	Massachusetts except Dukes and Nantucket Counties	Berkshire County	2	96	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	30	8	1	1	1	H9001_030_8	8	1			07/12/2019	2020.01	07/12/2019 01:07:03 PM Eastern Daylight Time	08/06/2019 03:50:27 PM Eastern Daylight Time	08/06/2019 03:50:29 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Green HMO (HMO)	1	1		1			H9001	30	8	2020	Massachusetts except Dukes and Nantucket Counties	"Essex, Suffolk and Plymouth Counties"	2	1680	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	30	9	1	1	1	H9001_030_9	8	1			07/12/2019	2020.01	07/12/2019 03:58:31 PM Eastern Daylight Time	08/06/2019 03:50:30 PM Eastern Daylight Time	08/06/2019 03:50:30 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Green HMO (HMO)	1	1		1			H9001	30	9	2020	Massachusetts except Dukes and Nantucket Counties	"Bristol, Middlesex and Norfolk Counties"	2	4339	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	30	11	1	1	1	H9001_030_11	8	1			07/12/2019	2020.01	07/12/2019 01:07:37 PM Eastern Daylight Time	08/06/2019 03:50:30 PM Eastern Daylight Time	08/06/2019 03:50:30 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Green HMO (HMO)	1	1		1			H9001	30	11	2020	Massachusetts except Dukes and Nantucket Counties	Worcester and Franklin Counties	2	39260	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	31	4	1	1	1	H9001_031_4	8	1			07/12/2019	2020.01	07/12/2019 01:09:38 PM Eastern Daylight Time	08/06/2019 03:50:31 PM Eastern Daylight Time	08/06/2019 03:50:31 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Blue HMO (HMO)	1	1		1			H9001	31	4	2020	Massachusetts except Dukes and Nantucket Counties	Barnstable County	2	296	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	31	6	1	1	1	H9001_031_6	8	1			07/12/2019	2020.01	07/12/2019 01:09:57 PM Eastern Daylight Time	08/06/2019 03:50:32 PM Eastern Daylight Time	08/06/2019 03:50:33 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Blue HMO (HMO)	1	1		1			H9001	31	6	2020	Massachusetts except Dukes and Nantucket Counties	Worcester and Franklin Counties	2	17970	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	31	7	1	1	1	H9001_031_7	8	1			07/12/2019	2020.01	07/12/2019 01:10:10 PM Eastern Daylight Time	08/06/2019 03:50:35 PM Eastern Daylight Time	08/06/2019 03:50:36 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Blue HMO (HMO)	1	1		1			H9001	31	7	2020	Massachusetts except Dukes and Nantucket Counties	Berkshire County	2	48	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	31	8	1	1	1	H9001_031_8	8	1			07/12/2019	2020.01	07/12/2019 01:10:23 PM Eastern Daylight Time	08/06/2019 03:50:36 PM Eastern Daylight Time	08/06/2019 03:50:37 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Blue HMO (HMO)	1	1		1			H9001	31	8	2020	Massachusetts except Dukes and Nantucket Counties	"Essex, Suffolk and Plymouth Counties"	2	2371	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	31	9	1	1	1	H9001_031_9	9	1			07/12/2019	2020.01	07/12/2019 01:10:43 PM Eastern Daylight Time	08/06/2019 03:50:39 PM Eastern Daylight Time	08/06/2019 03:50:40 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Blue HMO (HMO)	1	1		1			H9001	31	9	2020	Massachusetts except Dukes and Nantucket Counties	"Bristol, Middlesex and Norfolk Counties"	2	6699	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	31	10	1	1	1	H9001_031_10	9	1			07/12/2019	2020.01	07/12/2019 01:11:07 PM Eastern Daylight Time	08/06/2019 03:50:40 PM Eastern Daylight Time	08/06/2019 03:50:41 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Blue HMO (HMO)	1	1		1			H9001	31	10	2020	Massachusetts except Dukes and Nantucket Counties	Hampshire and Hampden Counties	2	5827	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	32	4	1	1	1	H9001_032_4	8	1			07/11/2019	2020.01	07/11/2019 01:34:23 PM Eastern Daylight Time	08/06/2019 03:50:43 PM Eastern Daylight Time	08/06/2019 03:50:43 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Super Saver HMO (HMO)	1	1		1			H9001	32	4	2020	Massachusetts except Dukes and Nantucket Counties	Barnstable County	2	1877	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	32	5	1	1	1	H9001_032_5	9	1			07/11/2019	2020.01	07/11/2019 01:35:14 PM Eastern Daylight Time	08/06/2019 03:50:44 PM Eastern Daylight Time	08/06/2019 03:50:46 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Super Saver HMO (HMO)	1	1		1			H9001	32	5	2020	Massachusetts except Dukes and Nantucket Counties	Hampshire and Hampden Counties	2	584	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	32	6	1	1	1	H9001_032_6	9	1			07/11/2019	2020.01	07/11/2019 01:37:52 PM Eastern Daylight Time	08/06/2019 03:50:49 PM Eastern Daylight Time	08/06/2019 03:50:50 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Super Saver HMO (HMO)	1	1		1			H9001	32	6	2020	Massachusetts except Dukes and Nantucket Counties	Worcester and Franklin Counties	2	5525	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	32	7	1	1	1	H9001_032_7	8	1			07/11/2019	2020.01	07/11/2019 01:38:41 PM Eastern Daylight Time	08/06/2019 03:50:52 PM Eastern Daylight Time	08/06/2019 03:50:53 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Super Saver HMO (HMO)	1	1		1			H9001	32	7	2020	Massachusetts except Dukes and Nantucket Counties	Berkshire County	2	428	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	32	8	1	1	1	H9001_032_8	8	1			07/11/2019	2020.01	07/11/2019 01:39:24 PM Eastern Daylight Time	08/06/2019 03:50:55 PM Eastern Daylight Time	08/06/2019 03:50:56 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Super Saver HMO (HMO)	1	1		1			H9001	32	8	2020	Massachusetts except Dukes and Nantucket Counties	"Essex, Suffolk and Plymouth Counties"	2	1046	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	32	9	1	1	1	H9001_032_9	8	1			07/11/2019	2020.01	07/11/2019 01:40:30 PM Eastern Daylight Time	08/06/2019 03:50:57 PM Eastern Daylight Time	08/06/2019 03:51:00 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Super Saver HMO (HMO)	1	1		1			H9001	32	9	2020	Massachusetts except Dukes and Nantucket Counties	"Bristol, Middlesex and Norfolk Counties"	2	2163	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	34	5	1	1	1	H9001_034_5	10	1			08/04/2019	2020.01	08/04/2019 04:29:26 PM Eastern Daylight Time	08/06/2019 03:51:00 PM Eastern Daylight Time	08/06/2019 03:51:01 PM Eastern Daylight Time			09/12/2019 01:35:54 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Orange HMO (HMO)	1	1		1			H9001	34	5	2020	Massachusetts except Dukes and Nantucket Counties	Hampshire and Hampden Counties	2	3929	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	34	6	1	1	1	H9001_034_6	10	1			08/04/2019	2020.01	08/04/2019 04:31:19 PM Eastern Daylight Time	08/06/2019 03:51:03 PM Eastern Daylight Time	08/06/2019 03:51:05 PM Eastern Daylight Time			09/12/2019 01:35:54 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Orange HMO (HMO)	1	1		1			H9001	34	6	2020	Massachusetts except Dukes and Nantucket Counties	Worcester and Franklin Counties	2	24774	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	34	8	1	1	1	H9001_034_8	10	1			08/04/2019	2020.01	08/04/2019 04:32:23 PM Eastern Daylight Time	08/06/2019 03:51:05 PM Eastern Daylight Time	08/06/2019 03:51:05 PM Eastern Daylight Time			09/12/2019 01:35:54 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Orange HMO (HMO)	1	1		1			H9001	34	8	2020	Massachusetts except Dukes and Nantucket Counties	"Essex, Suffolk and Plymouth Counties"	2	3960	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	34	9	1	1	1	H9001_034_9	10	1			08/04/2019	2020.01	08/04/2019 04:33:27 PM Eastern Daylight Time	08/06/2019 03:51:05 PM Eastern Daylight Time	08/06/2019 03:51:07 PM Eastern Daylight Time			09/12/2019 01:35:54 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Orange HMO (HMO)	1	1		1			H9001	34	9	2020	Massachusetts except Dukes and Nantucket Counties	"Bristol, Middlesex and Norfolk Counties"	2	7918	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	34	12	1	1	1	H9001_034_12	10	1			08/04/2019	2020.01	08/04/2019 04:34:22 PM Eastern Daylight Time	08/06/2019 03:51:09 PM Eastern Daylight Time	08/06/2019 03:51:09 PM Eastern Daylight Time			09/12/2019 01:35:54 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Orange HMO (HMO)	1	1		1			H9001	34	12	2020	Massachusetts except Dukes and Nantucket Counties	Barnstable County	2	254	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	34	13	1	1	1	H9001_034_13	10	1			08/04/2019	2020.01	08/04/2019 04:35:11 PM Eastern Daylight Time	08/06/2019 03:51:10 PM Eastern Daylight Time	08/06/2019 03:51:11 PM Eastern Daylight Time			09/12/2019 01:35:54 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Orange HMO (HMO)	1	1		1			H9001	34	13	2020	Massachusetts except Dukes and Nantucket Counties	Berkshire County	2	55	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	35	0	1	1	1	H9001_035_0	8	1			07/12/2019	2020.01	07/12/2019 01:14:21 PM Eastern Daylight Time	08/06/2019 03:51:13 PM Eastern Daylight Time	08/06/2019 03:51:13 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Central Blue HMO (HMO)	1	1		1			H9001	35	0	2020	Worcester County		2	2025	2			2						www.fallonhealth.org/medicare-pharmacy	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/FindPhysician	(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	2			
H9001	36	0	1	1	1	H9001_036_0	8	1			07/12/2019	2020.01	07/12/2019 01:15:28 PM Eastern Daylight Time	08/06/2019 03:51:13 PM Eastern Daylight Time	08/06/2019 03:51:13 PM Eastern Daylight Time			08/06/2019 04:49:10 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Central Green HMO (HMO)	1	1		1			H9001	36	0	2020	Worcester County		2	2025	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	37	0	1	1	1	H9001_037_0	10	1			08/04/2019	2020.01	08/04/2019 04:36:01 PM Eastern Daylight Time	08/06/2019 03:51:15 PM Eastern Daylight Time	08/06/2019 03:51:16 PM Eastern Daylight Time			09/12/2019 01:35:54 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	Fallon Medicare Plus Central Orange HMO (HMO)	1	1		1			H9001	37	0	2020	Worcester County		2	9450	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	2			
H9001	803	0	1	1	1	H9001_803_0	5	1			06/03/2019	2020.01	06/03/2019 10:55:47 PM Eastern Daylight Time					06/04/2019 02:00:30 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-PD HMO (HMO)	1	1		1			H9001	803	0	2020	Full Service Area - Employer Groups		1	16046	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	1a;1b;2;5;6;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;12;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7j;8b1;8b2;8b3;9a1;9b;18a;	2					1				
H9001	804	0	1	1	1	H9001_804_0	5	1			06/03/2019	2020.01	06/03/2019 10:55:53 PM Eastern Daylight Time					06/04/2019 02:00:30 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-PD HMO PSP (HMO)	1	1		1			H9001	804	0	2020	Full Service Area - Employer Groups		1	24	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(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	1a;1b;2;5;6;7b;7c;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;12;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7j;8b1;8b2;8b3;9a1;9b;18a;	2					1				
H9001	805	0	1	1	1	H9001_805_0	5	1			06/03/2019	2020.01	06/03/2019 10:55:59 PM Eastern Daylight Time					06/04/2019 02:00:30 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-only HMO (HMO)	1	1		1			H9001	805	0	2020	Full Service Area - Employer Groups		1	24	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;12;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7j;8a;8b1;8b2;8b3;9a1;9b;18a;	1					1				
H9001	806	0	1	1	1	H9001_806_0	5	1			06/03/2019	2020.01	06/03/2019 10:56:06 PM Eastern Daylight Time					06/04/2019 02:00:30 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-only non-calendar HMO (HMO)	1	1		1			H9001	806	0	2020	Full Service Area - Employer Groups		1	24	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;12;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7j;8a;8b1;8b2;8b3;9a1;9b;18a;	1					1				
H9001	807	0	1	1	1	H9001_807_0	5	1			06/03/2019	2020.01	06/03/2019 10:56:12 PM Eastern Daylight Time					06/04/2019 02:00:30 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-only HMO PSP (HMO)	1	1		1			H9001	807	0	2020	Full Service Area - Employer Groups		1	24	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;12;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7j;8a;8b1;8b2;8b3;9a1;9b;18a;	1					1				
H9001	808	0	1	1	1	H9001_808_0	5	1			06/03/2019	2020.01	06/03/2019 10:56:18 PM Eastern Daylight Time					06/04/2019 02:00:30 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	fallonhealth.org/medicare	MA-only non-calendar HMO PSP (HMO)	1	1		1			H9001	808	0	2020	Full Service Area - Employer Groups		1	24	2			2						fallonhealth.org/medicare-pharmacy	fallonhealth.org/medicare-formulary	fallonhealth.org/FindPhysician	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7c;7d;7e;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9b;10a;11a;11b;11c;12;15;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7h;7i;7j;8a;8b1;8b2;8b3;9a1;9b;18a;	1					1				
H9003	1	0	1	1	1	H9003_001_0	11	1			05/31/2019	2020.01	05/31/2019 04:02:49 PM Pacific Daylight Time	08/01/2019 04:47:42 PM Pacific Daylight Time	08/01/2019 04:55:58 PM Pacific Daylight Time			08/02/2019 12:08:52 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	1	1		1			H9003	1	0	2020	"Portland-Vancouver Metro, Salem OR, Longview WA"		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H9003	6	0	1	1	1	H9003_006_0	11	1			05/31/2019	2020.01	05/31/2019 04:04:22 PM Pacific Daylight Time	08/01/2019 04:50:48 PM Pacific Daylight Time	08/01/2019 04:57:52 PM Pacific Daylight Time			08/02/2019 12:08:52 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic (HMO)	1	1		1			H9003	6	0	2020	"Portland-Vancouver Metro, Salem OR, Longview WA"		2		2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	2			
H9003	801	0	1	1	1	H9003_801_0	9	1			05/22/2019	2020.01	05/22/2019 03:34:08 PM Pacific Daylight Time					06/03/2019 03:06:07 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Employer Group Only with Part D (HMO)	1	1		1			H9003	801	0	2020	"Portland-Vancouver Metro, Salem OR, Longview WA"		1	252702	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;16b;	1					2				
H9003	802	0	1	1	1	H9003_802_0	9	1			05/22/2019	2020.01	05/22/2019 03:35:06 PM Pacific Daylight Time					06/03/2019 03:06:07 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Employer Group Only without Part D (HMO)	1	1		1			H9003	802	0	2020	"Portland-Vancouver Metro, Salem OR, Longview WA"		1	45161	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;16b;	1					2				
H9003	805	0	1	1	1	H9003_805_0	8	1			05/22/2019	2020.01	05/22/2019 03:35:52 PM Pacific Daylight Time					06/03/2019 03:06:07 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	1	1		1			H9003	805	0	2020	"Portland-Vancouver Metro, Salem OR, Longview WA"		1	51771	2			2						kp.org/directory	kp.org/seniorrx	kp.org/directory	(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	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;12;15;16b;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7f;7g;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;16b;	1					2				
H9047	13	0	2	1	1	H9047_013_0	12	1			08/01/2019	2020.01	08/01/2019 03:41:39 PM Pacific Daylight Time	08/06/2019 01:45:10 PM Pacific Daylight Time	08/05/2019 11:58:14 AM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Extra Part B Only + RX (HMO)	1	1		2	1		H9047	13	0	2020	Portland Metro and Willamette Valley		2	12	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	33	0	1	1	1	H9047_033_0	9	1			07/22/2019	2020.01	07/22/2019 03:50:33 PM Pacific Daylight Time	06/03/2019 08:53:40 AM Pacific Daylight Time				07/22/2019 05:20:30 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Focus Medical (HMO)	1	1		1			H9047	33	0	2020	"Portland Metro, Willamette Valley, Clark County"		2	7104	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9047	35	0	1	2	1	H9047_035_0	10	1			07/22/2019	2020.01	07/22/2019 09:28:07 AM Pacific Daylight Time	07/23/2019 09:06:04 AM Pacific Daylight Time				07/24/2019 12:44:28 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Select Medical (HMO-POS)	1	2		1			H9047	35	0	2020	"Portland Metro, Willamette Valley, Clark County"		2	12336	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9047	37	0	1	1	1	H9047_037_0	11	1			08/01/2019	2020.01	08/01/2019 03:42:08 PM Pacific Daylight Time	08/05/2019 12:19:26 PM Pacific Daylight Time	08/05/2019 12:01:44 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Prime + RX (HMO)	1	1		1			H9047	37	0	2020	Portland Metro		2	121524	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	38	0	1	2	1	H9047_038_0	10	1			08/02/2019	2020.01	08/02/2019 02:26:38 PM Pacific Daylight Time	08/05/2019 12:21:14 PM Pacific Daylight Time	08/05/2019 12:04:54 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Latitude + RX (HMO-POS)	1	2		1			H9047	38	0	2020	"Central OR, Hood River"		2	2952	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	39	0	1	2	1	H9047_039_0	10	1			08/05/2019	2020.01	08/05/2019 08:22:42 AM Pacific Daylight Time	08/06/2019 01:46:30 PM Pacific Daylight Time	08/05/2019 12:07:14 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Compass + RX (HMO-POS)	1	2		1			H9047	39	0	2020	"Central OR, Hood River"		2	8736	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	43	0	1	1	1	H9047_043_0	10	1	2	1	08/02/2019	2020.01	08/02/2019 02:27:50 PM Pacific Daylight Time	08/05/2019 12:38:46 PM Pacific Daylight Time	08/05/2019 12:08:46 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Dual Plus (HMO D-SNP)	1	1		1			H9047	43	0	2020	Portland Metro		2	27960	2			1	3		2		2	providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	45	0	1	1	1	H9047_045_0	9	1			08/02/2019	2020.01	08/02/2019 02:27:03 PM Pacific Daylight Time	08/05/2019 12:40:22 PM Pacific Daylight Time	08/06/2019 12:29:02 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Enrich + RX (HMO)	1	1		1			H9047	45	0	2020	Linn and Benton Counties		2	864	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	47	0	1	2	1	H9047_047_0	10	1			08/01/2019	2020.01	08/01/2019 03:46:20 PM Pacific Daylight Time	08/05/2019 12:42:58 PM Pacific Daylight Time	08/05/2019 12:38:54 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Summit + RX (HMO-POS)	1	2		1			H9047	47	0	2020	Snohomish County		2	2700	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	49	0	1	1	1	H9047_049_0	10	1			08/01/2019	2020.01	08/01/2019 03:47:14 PM Pacific Daylight Time	08/05/2019 12:45:46 PM Pacific Daylight Time	08/05/2019 12:53:48 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Harbor + RX (HMO)	1	1		1			H9047	49	0	2020	Snohomish County		2	8220	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	54	0	1	1	1	H9047_054_0	13	1			08/01/2019	2020.01	08/01/2019 03:47:41 PM Pacific Daylight Time	08/05/2019 12:47:48 PM Pacific Daylight Time	08/05/2019 01:42:14 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Timber + RX (HMO)	1	1		1			H9047	54	0	2020	"Columbia, Lane, Marion, Polk, Clark Counties"		2	39288	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	55	1	1	1	1	H9047_055_1	9	1			08/01/2019	2020.01	08/01/2019 03:48:09 PM Pacific Daylight Time	08/06/2019 01:48:54 PM Pacific Daylight Time	08/05/2019 12:44:00 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Extra + RX (HMO)	1	1		1			H9047	55	1	2020	"Portland Metro, Clark, Columbia, Lane, Marion,Polk"	Portland Metro Area	2	81937	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	55	2	1	1	1	H9047_055_2	9	1			08/01/2019	2020.01	08/01/2019 03:48:34 PM Pacific Daylight Time	08/06/2019 01:51:14 PM Pacific Daylight Time	08/05/2019 12:46:22 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Extra + RX (HMO)	1	1		1			H9047	55	2	2020	"Portland Metro, Clark, Columbia, Lane, Marion,Polk"	"Willamette Valley, Clark + Columbia Counties"	2	12442	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	56	1	1	2	1	H9047_056_1	7	1			08/01/2019	2020.01	08/01/2019 03:49:04 PM Pacific Daylight Time	08/06/2019 02:45:58 PM Pacific Daylight Time	08/05/2019 12:48:34 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Choice + RX (HMO-POS)	1	2		1			H9047	56	1	2020	"Portland Metro, Clark, Columbia, Lane, Marion,Polk"	Portland Metro Area	2	212989	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	56	2	1	2	1	H9047_056_2	8	1			08/01/2019	2020.01	08/01/2019 03:49:31 PM Pacific Daylight Time	08/06/2019 01:55:18 PM Pacific Daylight Time	08/05/2019 12:50:40 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Choice + RX (HMO-POS)	1	2		1			H9047	56	2	2020	"Portland Metro, Clark, Columbia, Lane, Marion,Polk"	"Columbia, Lane, Marion, Polk, Clark Counties"	2	56998	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	59	0	1	1	1	H9047_059_0	11	1			08/01/2019	2020.01	08/01/2019 03:50:02 PM Pacific Daylight Time	08/05/2019 12:58:44 PM Pacific Daylight Time	08/05/2019 01:45:10 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Bridge 1 + RX (HMO)	1	1		1			H9047	59	0	2020	Portland Metro Area		2	1200	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	60	0	1	1	1	H9047_060_0	11	1			08/01/2019	2020.01	08/01/2019 03:50:37 PM Pacific Daylight Time	08/05/2019 01:02:46 PM Pacific Daylight Time	08/05/2019 01:47:38 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Bridge 2 + RX (HMO)	1	1		1			H9047	60	0	2020	"Clark, Columbia, Lane, Marion, Polk Counties"		2	3600	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	62	0	1	1	1	H9047_062_0	12	1			08/01/2019	2020.01	08/01/2019 03:50:58 PM Pacific Daylight Time	08/05/2019 01:06:56 PM Pacific Daylight Time	08/05/2019 01:49:46 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Cottonwood + RX (HMO)	1	1		1			H9047	62	0	2020	Spokane		2	2400	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	63	0	1	1	1	H9047_063_0	11	1			08/01/2019	2020.01	08/01/2019 03:51:21 PM Pacific Daylight Time	08/05/2019 01:09:00 PM Pacific Daylight Time	08/05/2019 01:56:06 PM Pacific Daylight Time			08/06/2019 12:36:17 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Pine + RX (HMO)	1	1		1			H9047	63	0	2020	Spokane		2	5400	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	804	0	1	1	1	H9047_804_0	7	1			07/21/2019	2020.01	07/21/2019 09:51:34 AM Pacific Daylight Time					07/22/2019 05:20:30 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Align Group Plan + RX (HMO)	1	1		1			H9047	804	0	2020	"Portland, Willamette Valley,Central OR, Washington"		1	17460	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	805	0	1	2	1	H9047_805_0	6	1			05/31/2019	2020.01	05/31/2019 06:05:25 PM Pacific Daylight Time					06/03/2019 10:35:59 AM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Flex Group Plan + RX (HMO-POS)	1	2		1			H9047	805	0	2020	"Portland, Willamette Valley,Central OR, Washington"		1	24	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	808	0	1	1	1	H9047_808_0	7	1			07/21/2019	2020.01	07/21/2019 08:38:33 AM Pacific Daylight Time					07/22/2019 05:20:30 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Align Group Plan + RX (HMO)	1	1		1			H9047	808	0	2020	"Portland, Willamette Valley,Central OR, Washington"		1	99504	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9047	809	0	1	2	1	H9047_809_0	7	1			07/21/2019	2020.01	07/21/2019 08:38:46 AM Pacific Daylight Time					07/22/2019 05:20:30 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Flex Group Plan + RX (HMO-POS)	1	2		1			H9047	809	0	2020	"Portland, Willamette Valley,Central OR, Washington"		1	53004	2			2						providencehealthassurance.com	providencehealthassurance.com	www.providencehealthassurance.com/providerdirectory	(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	2			
H9065	1	0	1	1	1	H9065_001_0	7	1	2	1	07/23/2019	2020.01	07/23/2019 11:02:02 AM Eastern Daylight Time	08/05/2019 10:09:39 AM Eastern Daylight Time	07/30/2019 08:36:03 PM Eastern Daylight Time			08/05/2019 03:55:32 PM Eastern Daylight Time	"AMH HEALTH, LLC"	AMH Health	https://shop.anthem.com/medicare	Anthem | MaineHealth Advantage Dual (HMO D-SNP)	1	1		1			H9065	1	0	2020	State of Maine		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(844)887-6351		(844)887-6351		(844)296-3997		(844)296-3997		(844)887-6351		(844)887-6351		(844)296-7202		(844)296-7202		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9065	2	0	1	2	1	H9065_002_0	8	1			08/02/2019	2020.01	08/02/2019 11:43:57 AM Eastern Daylight Time	08/05/2019 10:09:40 AM Eastern Daylight Time	07/30/2019 08:37:31 PM Eastern Daylight Time			08/05/2019 03:55:32 PM Eastern Daylight Time	"AMH HEALTH, LLC"	AMH Health	https://shop.anthem.com/medicare	Anthem | MaineHealth Advantage Choice (HMO-POS)	1	2		1			H9065	2	0	2020	Cumberland and York Counties		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9065	3	0	1	2	1	H9065_003_0	7	1			08/02/2019	2020.01	08/02/2019 11:44:26 AM Eastern Daylight Time	08/05/2019 10:09:40 AM Eastern Daylight Time	07/30/2019 08:39:03 PM Eastern Daylight Time			08/05/2019 03:55:32 PM Eastern Daylight Time	"AMH HEALTH, LLC"	AMH Health	https://shop.anthem.com/medicare	Anthem | MaineHealth Advantage Choice (HMO-POS)	1	2		1			H9065	3	0	2020	Select Counties in ME		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9065	4	0	1	2	1	H9065_004_0	6	1			08/02/2019	2020.01	08/02/2019 11:44:42 AM Eastern Daylight Time	08/05/2019 10:09:40 AM Eastern Daylight Time	07/30/2019 08:40:34 PM Eastern Daylight Time			08/05/2019 03:55:32 PM Eastern Daylight Time	"AMH HEALTH, LLC"	AMH Health	https://shop.anthem.com/medicare	Anthem | MaineHealth Advantage Choice (HMO-POS)	1	2		1			H9065	4	0	2020	Select Counties in ME		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9065	5	0	1	1	1	H9065_005_0	6	1			06/25/2019	2020.01	06/25/2019 05:24:24 PM Eastern Daylight Time	08/05/2019 10:09:41 AM Eastern Daylight Time	07/30/2019 08:42:05 PM Eastern Daylight Time			08/05/2019 03:55:32 PM Eastern Daylight Time	"AMH HEALTH, LLC"	AMH Health	https://shop.anthem.com/medicare	Anthem | MaineHealth Advantage Extra (HMO)	1	1		1			H9065	5	0	2020	Cumberland and York Counties		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9065	6	0	1	1	1	H9065_006_0	6	1			06/25/2019	2020.01	06/25/2019 05:24:45 PM Eastern Daylight Time	08/05/2019 10:09:41 AM Eastern Daylight Time	07/30/2019 08:43:28 PM Eastern Daylight Time			08/05/2019 03:55:32 PM Eastern Daylight Time	"AMH HEALTH, LLC"	AMH Health	https://shop.anthem.com/medicare	Anthem | MaineHealth Advantage Extra (HMO)	1	1		1			H9065	6	0	2020	Select Counties in ME		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9065	7	0	1	1	1	H9065_007_0	7	1			06/25/2019	2020.01	06/25/2019 05:25:07 PM Eastern Daylight Time	08/05/2019 10:09:42 AM Eastern Daylight Time	07/30/2019 08:44:54 PM Eastern Daylight Time			08/05/2019 03:55:32 PM Eastern Daylight Time	"AMH HEALTH, LLC"	AMH Health	https://shop.anthem.com/medicare	Anthem | MaineHealth Advantage Extra (HMO)	1	1		1			H9065	7	0	2020	Select Counties in ME		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	(855)310-2472		(855)310-2472		(844)373-7109		(844)373-7109		(855)310-2472		(855)310-2472		(844)373-7108		(844)373-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9066	1	0	1	1	1	H9066_001_0	3	1	2	1	08/12/2019	2020.01	08/12/2019 05:53:42 PM Eastern Daylight Time	08/12/2019 06:00:56 PM Eastern Daylight Time	08/12/2019 06:01:02 PM Eastern Daylight Time			08/12/2019 06:11:01 PM Eastern Daylight Time	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Nascentia Health Plus	www.Nascentiahealth.org	Nascentia Health Plus (HMO D-SNP)	1	1		1			H9066	1	0	2020	Upstate New York		2	4497	2			1	3		1		1	www.envisionrx.com	www.envisionrx.com	www.Nascentiahealth.org	(888)477-4663		(315)477-4663		(888)477-4663		(315)477-4663		(833)459-4424		(833)459-4424		(888)477-4663		(315)477-4663		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9066	2	0	1	1	1	H9066_002_0	3	1		1	08/12/2019	2020.01	08/12/2019 05:53:47 PM Eastern Daylight Time	08/12/2019 06:00:56 PM Eastern Daylight Time	08/12/2019 06:01:01 PM Eastern Daylight Time			08/12/2019 06:11:01 PM Eastern Daylight Time	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Nascentia Health Plus	www.Nascentiahealth.org	Nascentia Health Institutional (HMO I-SNP)	1	1		1			H9066	2	0	2020	Upstate New York		2	1604	2			1	1	1				www.envisionrx.com	www.envisionrx.com	www.Nascentiahealth.org	(888)477-4663		(315)477-4663		(888)477-4663		(315)477-4663		(833)459-4424		(833)459-4424		(888)477-4663		(315)477-4663		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9066	3	0	1	1	1	H9066_003_0	3	1	2	1	08/12/2019	2020.01	08/12/2019 05:53:52 PM Eastern Daylight Time	08/12/2019 06:00:56 PM Eastern Daylight Time	08/12/2019 06:01:01 PM Eastern Daylight Time			08/12/2019 06:11:01 PM Eastern Daylight Time	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Nascentia Health Plus	www.Nascentiahealth.org	Nascentia Health Dual (HMO D-SNP)	1	1		1			H9066	3	0	2020	Upstate New York		2	21100	2			1	3		2		1	www.envisionrx.com	www.envisionrx.com	www.Nascentiahealth.org	(888)477-4663		(315)477-4663		(888)477-4663		(315)477-4663		(833)459-4424		(833)459-4424		(888)477-4663		(315)477-4663		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9068	1	0	1	20	8	H9068_001_0	1	1			05/22/2019	2020.01	05/22/2019 12:42:38 PM Eastern Daylight Time		05/22/2019 01:25:30 PM Eastern Daylight Time			05/22/2019 01:27:29 PM Eastern Daylight Time	ALBRIGHT CARE SERVICES	ALBRIGHT CARE SERVICES	www.albrightlife.org	Albright LIFE (PACE)	8	20		1			H9068	1	0	2020	"Lanc,Lebanon,Lyco,Union,19320Chester,17777North'd"		2		2			2						www.albrightcare.org	www.albrightcare.org										(888)791-0094		(570)522-3880		(888)791-0094		(570)522-3880										(711)-		(711)-		(711)-		(711)-																
H9068	2	0	1	20	8	H9068_002_0	1	1			05/22/2019	2020.01	05/22/2019 12:43:19 PM Eastern Daylight Time		05/22/2019 01:24:53 PM Eastern Daylight Time			05/22/2019 01:27:29 PM Eastern Daylight Time	ALBRIGHT CARE SERVICES	ALBRIGHT CARE SERVICES	www.albrightlife.org	Albright LIFE Medicare Only (PACE)	8	20		1			H9068	2	0	2020	"Lanc,Lebanon,Lyco,Union,19320Chester,17777North'd"		2		2			2						www.albrightcare.org	www.albrightcare.org										(888)791-0094		(570)522-3880		(888)791-0094		(570)522-3880										(711)-		(711)-		(711)-		(711)-																
H9070	1	0	1	4	1	H9070_001_0	4	1			08/01/2019	2020.01	08/01/2019 02:40:14 PM Eastern Daylight Time	08/02/2019 10:17:00 AM Eastern Daylight Time	08/02/2019 01:19:03 PM Eastern Daylight Time			08/05/2019 11:43:59 AM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-001 (PPO)	1	4		1			H9070	1	0	2020	Select Counties in Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9070	2	0	1	4	1	H9070_002_0	2	1			07/15/2019	2020.01	07/15/2019 12:13:50 PM Eastern Daylight Time	08/02/2019 09:48:54 AM Eastern Daylight Time	08/02/2019 01:19:03 PM Eastern Daylight Time			08/05/2019 11:43:59 AM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Value Plus H9070-002 (PPO)	1	4		1			H9070	2	0	2020	Select Counties in Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9070	3	0	1	4	1	H9070_003_0	2	1			08/01/2019	2020.01	08/01/2019 02:41:11 PM Eastern Daylight Time	08/02/2019 10:27:16 AM Eastern Daylight Time	08/02/2019 01:19:03 PM Eastern Daylight Time			08/05/2019 11:43:59 AM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-003 (PPO)	1	4		1			H9070	3	0	2020	Select Counties in Kansas and Missouri		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9070	4	0	1	4	1	H9070_004_0	2	1			08/01/2019	2020.01	08/01/2019 02:42:36 PM Eastern Daylight Time	08/02/2019 10:33:16 AM Eastern Daylight Time	08/02/2019 01:19:03 PM Eastern Daylight Time			08/05/2019 11:43:59 AM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-004 (PPO)	1	4		1			H9070	4	0	2020	Select Counties in Kansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9070	5	0	1	4	1	H9070_005_0	2	1			08/01/2019	2020.01	08/01/2019 02:43:37 PM Eastern Daylight Time	08/02/2019 10:34:41 AM Eastern Daylight Time	08/02/2019 01:19:03 PM Eastern Daylight Time			08/05/2019 11:43:59 AM Eastern Daylight Time	COMPBENEFITS INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice H9070-005 (PPO)	1	4		1			H9070	5	0	2020	Select Counties in Arkansas		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9082	7	0	1	1	1	H9082_007_0	7	1	2	1	08/02/2019	2020.01	08/02/2019 05:37:01 PM Pacific Daylight Time	08/05/2019 10:15:04 AM Pacific Daylight Time	07/31/2019 11:42:08 AM Pacific Daylight Time			08/05/2019 05:01:39 PM Pacific Daylight Time	"MOLINA HEALTHCARE OF NEW MEXICO, INC."	"Molina Healthcare of New Mexico, Inc."	www.molinahealthcare.com/medicare	Molina Medicare Complete Care (HMO D-SNP)	1	1		1			H9082	7	0	2020	Select Counties in New Mexico		2		2			1	3		2		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	2			
H9095	1	0	1	1	1	H9095_001_0	5	1		1	07/19/2019	2020.01	07/19/2019 03:26:13 PM Central Daylight Time	08/01/2019 10:03:17 AM Central Daylight Time	07/31/2019 12:48:21 PM Central Daylight Time			08/02/2019 12:26:08 PM Central Daylight Time	"LONGEVITY HEALTH PLAN OF OKLAHOMA, INC"	Longevity Health Plan	www.longevityhealthplan.com	Longevity Health Plan (HMO I-SNP)	1	1		1			H9095	1	0	2020	Oklahoma (partial)		2		2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	1	0	1	1	1	H9096_001_0	7	1			08/01/2019	2020.01	08/01/2019 04:46:50 PM Central Daylight Time	07/31/2019 08:48:49 AM Central Daylight Time	07/30/2019 06:43:13 PM Central Daylight Time			08/05/2019 01:34:54 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.deancare.com/medicare	Dean Advantage Assurance (HMO)	1	1		1			H9096	1	0	2020	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	2	0	1	1	1	H9096_002_0	7	1			06/03/2019	2020.01	06/03/2019 07:59:42 PM Central Daylight Time	07/31/2019 08:49:29 AM Central Daylight Time	07/30/2019 06:43:43 PM Central Daylight Time			08/05/2019 01:34:54 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.deancare.com/medicare	Dean Advantage Balance (HMO)	1	1		1			H9096	2	0	2020	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	3	0	1	2	1	H9096_003_0	7	1			06/03/2019	2020.01	06/03/2019 08:03:26 PM Central Daylight Time	07/31/2019 08:50:09 AM Central Daylight Time	07/30/2019 06:44:13 PM Central Daylight Time			08/05/2019 01:34:54 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.deancare.com/medicare	Dean Advantage Confidence (HMO-POS)	1	2		1			H9096	3	0	2020	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	4	0	1	1	1	H9096_004_0	7	1			06/03/2019	2020.01	06/03/2019 08:05:25 PM Central Daylight Time	07/31/2019 08:50:50 AM Central Daylight Time	07/30/2019 06:44:42 PM Central Daylight Time			08/05/2019 01:34:54 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.deancare.com/medicare	Dean Advantage Essential (HMO)	1	1		1			H9096	4	0	2020	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	5	0	1	1	1	H9096_005_0	7	1			06/03/2019	2020.01	06/03/2019 08:06:28 PM Central Daylight Time	07/31/2019 08:51:30 AM Central Daylight Time	07/30/2019 06:45:06 PM Central Daylight Time			08/05/2019 01:34:54 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.deancare.com/medicare	Dean Advantage Complete (HMO)	1	1		1			H9096	5	0	2020	South Central Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.deancare.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	6	0	1	1	1	H9096_006_0	7	1			06/03/2019	2020.01	06/03/2019 08:07:01 PM Central Daylight Time	07/31/2019 08:52:11 AM Central Daylight Time	07/31/2019 11:10:03 AM Central Daylight Time			08/05/2019 01:34:54 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.prevea360.com/medicare	Prevea360 Medicare Advantage Essential (HMO)	1	1		1			H9096	6	0	2020	North Eastern Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.prevea360.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	7	0	1	1	1	H9096_007_0	7	1			06/03/2019	2020.01	06/03/2019 08:07:32 PM Central Daylight Time	07/31/2019 08:52:53 AM Central Daylight Time	07/30/2019 07:48:02 PM Central Daylight Time			08/05/2019 01:34:54 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.prevea360.com/medicare	Prevea360 Medicare Advantage Assurance (HMO)	1	1		1			H9096	7	0	2020	North Eastern Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.prevea360.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	8	0	1	1	1	H9096_008_0	7	1			06/03/2019	2020.01	06/03/2019 08:08:08 PM Central Daylight Time	07/31/2019 08:53:34 AM Central Daylight Time	07/30/2019 07:48:32 PM Central Daylight Time			08/05/2019 01:34:54 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.prevea360.com/medicare	Prevea360 Medicare Advantage Balance (HMO)	1	1		1			H9096	8	0	2020	North Eastern Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.prevea360.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	9	0	1	1	1	H9096_009_0	7	1			06/03/2019	2020.01	06/03/2019 08:09:13 PM Central Daylight Time	07/31/2019 08:54:15 AM Central Daylight Time	07/30/2019 07:49:00 PM Central Daylight Time			08/05/2019 01:34:54 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.prevea360.com/medicare	Prevea360 Medicare Advantage Complete (HMO)	1	1		1			H9096	9	0	2020	North Eastern Wisconsin		2		2			2						www.deancare.com	www.deancare.com	www.prevea360.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	801	0	1	1	1	H9096_801_0	5	1			06/03/2019	2020.01	06/03/2019 10:56:49 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.exploreyouradvantage.com	Dean Advantage - EGWP MAPD CY (HMO)	1	1		1			H9096	801	0	2020	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	802	0	1	1	1	H9096_802_0	5	1			06/03/2019	2020.01	06/03/2019 10:53:25 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.exploreyouradvantage.com	Dean Advantage - EGWP MAPD Non CY (HMO)	1	1		1			H9096	802	0	2020	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	803	0	1	1	1	H9096_803_0	5	1			06/03/2019	2020.01	06/03/2019 10:50:29 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.exploreyouradvantage.com	Dean Advantage - EGWP MA only (HMO)	1	1		1			H9096	803	0	2020	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9096	804	0	1	2	1	H9096_804_0	5	1			06/03/2019	2020.01	06/03/2019 10:47:26 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.exploreyouradvantage.com	Dean Advantage EGWP CY HMOPOS (HMO-POS)	1	2		1			H9096	804	0	2020	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	805	0	1	2	1	H9096_805_0	5	1			06/03/2019	2020.01	06/03/2019 10:43:56 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.exploreyouradvantage.com	Dean Advantage EGWP Non CY HMOPOS (HMO-POS)	1	2		1			H9096	805	0	2020	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	806	0	1	2	1	H9096_806_0	5	1			06/03/2019	2020.01	06/03/2019 10:31:55 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.exploreyouradvantage.com	Dean Advantage EGWP MA Only HMOPOS (HMO-POS)	1	2		1			H9096	806	0	2020	South Central Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9096	807	0	1	1	1	H9096_807_0	5	1			06/03/2019	2020.01	06/03/2019 10:29:13 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.exploreyouradvantage.com	Prevea360 Medicare Advantage - EGWP MAPD CY (HMO)	1	1		1			H9096	807	0	2020	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	808	0	1	1	1	H9096_808_0	5	1			06/03/2019	2020.01	06/03/2019 10:26:12 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.exploreyouradvantage.com	Prevea360 Medicare Advantage - EGWP MAPD Non CY (HMO)	1	1		1			H9096	808	0	2020	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	809	0	1	1	1	H9096_809_0	5	1			06/03/2019	2020.01	06/03/2019 10:23:07 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.exploreyouradvantage.com	Prevea360 Medicare Advantage - EGWP MA Only (HMO)	1	1		1			H9096	809	0	2020	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9096	810	0	1	2	1	H9096_810_0	5	1			06/03/2019	2020.01	06/03/2019 10:19:25 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.exploreyouradvantage.com	Prevea360 Medicare Advantage EGWP CY HMOPOS (HMO-POS)	1	2		1			H9096	810	0	2020	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	811	0	1	2	1	H9096_811_0	5	1			06/03/2019	2020.01	06/03/2019 10:15:34 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.exploreyouradvantage.com	Prevea360 Medicare Advantage EGWP Non CY HMOPOS (HMO-POS)	1	2		1			H9096	811	0	2020	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9096	812	0	1	2	1	H9096_812_0	5	1			06/03/2019	2020.01	06/03/2019 10:11:40 AM Central Daylight Time					06/03/2019 08:21:51 PM Central Daylight Time	"DEAN HEALTH PLAN, INC."	"Dean Advantage, Prevea360 Medicare Advantage"	www.exploreyouradvantage.com	Prevea360 Medicare Advantage EGWP MA Only HMOPOS (HMO-POS)	1	2		1			H9096	812	0	2020	North Eastern Wisconsin		1	1	2			2						www.deancare.com	www.deancare.com	www.exploreyouradvantage.com/doctors	(877)232-7566		(608)828-1978		(877)234-0126		(608)828-1941										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9104	6	0	1	1	1	H9104_006_0	7	1		1	07/02/2019	2020.01	07/02/2019 03:02:47 PM Pacific Daylight Time	08/05/2019 02:41:03 PM Pacific Daylight Time	08/02/2019 04:19:39 PM Pacific Daylight Time			08/12/2019 09:27:16 AM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Healthy at Home (HMO I-SNP)	1	1		1			H9104	6	0	2020	"Los Angeles, Orange, and Inland Empire Areas"		2		2			1	1	2				www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(800)559-3500		(800)559-3500		(888)315-7226		(888)315-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9153	1	0	1	1	1	H9153_001_0	4	1		1	08/05/2019	2020.01	08/05/2019 09:33:27 AM Central Daylight Time	08/05/2019 08:44:16 AM Central Daylight Time	07/31/2019 02:25:25 PM Central Daylight Time			08/06/2019 10:17:27 AM Central Daylight Time	"WEST VIRGINIA SENIOR ADVANTAGE, INC."	West Virginia Senior Advantage	www.wvsenioradvantage.com	WV Senior Advantage (HMO I-SNP)	1	1		1			H9153	1	0	2020	West Virginia (partial)		2		2			1	1	1				www.wvsenioradvantage.com	www.wvsenioradvantage.com	www.wvsenioradvantage.com	(844)854-6888		(844)854-6888		(844)854-6888		(844)854-6888		(844)854-6888		(844)854-6888		(844)854-6888		(844)854-6888		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9185	1	0	1	20	8	H9185_001_0	2	1			05/20/2019	2020.01	05/20/2019 09:17:58 AM Eastern Daylight Time		06/03/2019 09:06:17 AM Eastern Daylight Time			06/03/2019 09:15:33 AM Eastern Daylight Time	"A&D CHARITABLE FOUNDATION, INC."	Great Lakes PACE	http://www.greatlakespace.org	Great Lakes PACE - Dual Eligible (PACE)	8	20		1			H9185	1	0	2020	"Great Lakes Bay Region: Saginaw, Midland, Bay, Tus"		2		2			2						www.a-dhomecare.com	www.a-dhomecare.com										(844)445-7223		(989)272-7610		(844)445-7223		(989)272-7610										(844)445-7223		(989)272-7610		(844)445-7223		(989)272-7619																
H9185	2	0	1	20	8	H9185_002_0	2	1			05/20/2019	2020.01	05/20/2019 09:18:22 AM Eastern Daylight Time		06/03/2019 09:06:54 AM Eastern Daylight Time			06/03/2019 09:15:33 AM Eastern Daylight Time	"A&D CHARITABLE FOUNDATION, INC."	Great Lakes PACE	http://www.greatlakespace.org	Great Lakes PACE (PACE)	8	20		1			H9185	2	0	2020	"Great Lakes Bay Region: Saginaw, Midland, Bay, Tus"		2		2			2						www.a-dhomecare.com	www.a-dhomecare.com										(844)445-7223		(989)272-7610		(844)445-7223		(989)272-7610										(844)445-7223		(989)272-7610		(844)445-7223		(989)272-7610																
H9207	2	0	1	2	1	H9207_002_0	10	1			08/02/2019	2020.01	08/02/2019 02:04:33 PM Eastern Daylight Time	08/01/2019 12:28:54 PM Eastern Daylight Time	08/01/2019 12:37:46 PM Eastern Daylight Time			08/06/2019 10:27:08 AM Eastern Daylight Time	"HEALTH PARTNERS PLANS, INC."	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Prime (HMO-POS)	1	2		1			H9207	2	0	2020	"Southeastern PA,Lehigh Capital PA,Carbon County PA"		2	57597	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9207	4	0	1	1	1	H9207_004_0	10	1	2	1	08/02/2019	2020.01	08/02/2019 02:04:50 PM Eastern Daylight Time	08/01/2019 12:27:14 PM Eastern Daylight Time	08/01/2019 12:38:46 PM Eastern Daylight Time			08/06/2019 10:27:08 AM Eastern Daylight Time	"HEALTH PARTNERS PLANS, INC."	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Special (HMO D-SNP)	1	1		1			H9207	4	0	2020	"Southeastern PA,Lehigh Capital PA,Carbon County PA"		2	192240	2			1	3		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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9207	11	0	1	2	1	H9207_011_0	8	1			08/02/2019	2020.01	08/02/2019 03:01:41 PM Eastern Daylight Time	08/01/2019 12:22:00 PM Eastern Daylight Time	08/01/2019 12:36:30 PM Eastern Daylight Time			08/06/2019 10:27:08 AM Eastern Daylight Time	"HEALTH PARTNERS PLANS, INC."	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Simple (HMO-POS)	1	2		1			H9207	11	0	2020	"Southeastern PA,Lehigh Capital PA,Carbon County PA"		2	192240	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		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9266	1	0	1	20	8	H9266_001_0	1	1			05/30/2019	2020.01	05/30/2019 03:56:08 PM Eastern Daylight Time		05/30/2019 02:40:50 PM Eastern Daylight Time			05/30/2019 05:19:09 PM Eastern Daylight Time	"PIEDMONT HEALTH SERVICES, INC."	Piedmont Health SeniorCare	http://www.piedmonthealthseniorcare.org/	Piedmont Health SeniorCare - Dual (PACE)	8	20		1			H9266	1	0	2020	"Alamance, Caswell, Lee, Chatham, & Orange counties"		2		2			2						no answer	no answer										(877)714-2100		(919)545-7341		(877)714-2100		(336)532-0000										(800)735-2962		(800)735-2962		(877)714-2100		(336)532-0000																
H9266	3	0	1	20	8	H9266_003_0	1	1			05/30/2019	2020.01	05/30/2019 03:56:46 PM Eastern Daylight Time		05/30/2019 02:39:41 PM Eastern Daylight Time			05/30/2019 05:19:09 PM Eastern Daylight Time	"PIEDMONT HEALTH SERVICES, INC."	Piedmont Health SeniorCare	http://www.piedmonthealthseniorcare.org/	Piedmont Health SeniorCare - Medicare-only (PACE)	8	20		1			H9266	3	0	2020	"Alamance, Caswell, Orange, Lee, & Chatham counties"		2		2			2						no answer	no answer										(877)714-2100		(919)545-7341		(877)714-2100		(336)532-0000										(800)735-2962		(800)735-2962		(877)714-2100		(336)532-0000																
H9276	2	0	1	1	1	H9276_002_0	4	1			08/01/2019	2020.01	08/01/2019 12:36:12 PM Eastern Daylight Time	08/05/2019 04:26:32 PM Central Daylight Time	08/05/2019 03:39:48 PM Central Daylight Time			08/06/2019 11:44:26 AM Central Daylight Time	"SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC."	Allwell	allwell.sunshinehealth.com	Allwell Medicare Premier (HMO)	1	1		1			H9276	2	0	2020	Duval County		2		2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9276	4	0	1	1	1	H9276_004_0	4	1			08/01/2019	2020.01	08/01/2019 12:36:20 PM Eastern Daylight Time	08/05/2019 04:26:36 PM Central Daylight Time	08/05/2019 03:40:01 PM Central Daylight Time			08/06/2019 11:44:26 AM Central Daylight Time	"SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC."	Allwell	allwell.sunshinehealth.com	Allwell Medicare (HMO)	1	1		1			H9276	4	0	2020	Miami-Dade County		2		2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9276	12	0	1	1	1	H9276_012_0	4	1			08/01/2019	2020.01	08/01/2019 12:36:35 PM Eastern Daylight Time	08/05/2019 04:26:24 PM Central Daylight Time	08/05/2019 03:39:26 PM Central Daylight Time			08/06/2019 11:44:26 AM Central Daylight Time	"SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC."	Allwell	allwell.sunshinehealth.com	Allwell Medicare (HMO)	1	1		1			H9276	12	0	2020	Broward County		2		2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9276	21	0	1	1	1	H9276_021_0	3	1			08/01/2019	2020.01	08/01/2019 12:36:46 PM Eastern Daylight Time	08/05/2019 04:26:28 PM Central Daylight Time	08/05/2019 03:39:35 PM Central Daylight Time			08/06/2019 11:44:26 AM Central Daylight Time	"SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC."	Allwell	allwell.sunshinehealth.com	Allwell Medicare (HMO)	1	1		1			H9276	21	0	2020	Palm Beach County		2		2			2						allwell.sunshinehealth.com/findadoctor	allwell.sunshinehealth.com/formulary	allwell.sunshinehealth.com/findadoctor	(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(877)935-8022		(877)935-8022		(877)826-3692		(877)826-3692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9287	1	0	1	1	1	H9287_001_0	6	1			08/01/2019	2020.01	08/01/2019 09:48:05 AM US Mountain Standard Time	08/05/2019 04:07:09 PM Central Daylight Time	08/05/2019 03:40:53 PM Central Daylight Time			08/06/2019 11:49:39 AM Central Daylight Time	"HEALTH NET COMMUNITY SOLUTIONS OF ARIZONA, INC."	Allwell	allwell.azcompletehealth.com	Allwell Medicare Premier (HMO)	1	1		1			H9287	1	0	2020	"Pima County, AZ"		2		2			2						allwell.azcompletehealth.com/findadoctor	allwell.azcompletehealth.com/formulary	allwell.azcompletehealth.com/findadoctor	(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	2			
H9302	3	0	1	1	1	H9302_003_0	8	1			07/16/2019	2020.01	07/16/2019 11:22:42 AM Pacific Daylight Time	08/01/2019 10:06:06 AM Pacific Daylight Time	08/01/2019 10:40:08 AM Pacific Daylight Time			08/02/2019 02:50:10 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Charter + Rx (HMO)	1	1		1			H9302	3	0	2020	Various Counties in Western WA		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(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	1	11	18a;	18a1;
H9302	4	0	1	1	1	H9302_004_0	6	1			07/09/2019	2020.01	07/09/2019 12:29:34 PM Pacific Daylight Time	06/03/2019 01:26:26 PM Pacific Daylight Time				07/09/2019 12:48:42 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Alpine (HMO)	1	1		1			H9302	4	0	2020	Various Counties in Western WA		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767										(711)-		(711)-		(711)-		(711)-										2					2					2	1	11	18a;	18a1;
H9302	7	0	1	1	1	H9302_007_0	7	1			07/16/2019	2020.01	07/16/2019 11:22:57 AM Pacific Daylight Time	08/01/2019 10:08:08 AM Pacific Daylight Time	08/01/2019 10:40:50 AM Pacific Daylight Time			08/02/2019 02:50:10 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Sound + Rx (HMO)	1	1		1			H9302	7	0	2020	Various Counties in Western WA		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(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	1	11	18a;	18a1;
H9302	11	0	1	1	1	H9302_011_0	7	1			07/16/2019	2020.01	07/16/2019 11:23:15 AM Pacific Daylight Time	08/01/2019 10:09:08 AM Pacific Daylight Time	08/01/2019 10:41:32 AM Pacific Daylight Time			08/02/2019 02:50:10 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage Peak + Rx (HMO)	1	1		1			H9302	11	0	2020	Various Counties in Western WA		2		2			2						premera.com/ma	premera.com/ma	premera.com/ma	(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	1	11	18a;	18a1;
H9302	801	0	1	1	1	H9302_801_0	4	1			05/31/2019	2020.01	05/31/2019 01:48:49 PM Pacific Daylight Time					06/03/2019 02:59:58 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	premera.com/ma	Premera Blue Cross Medicare Advantage + Rx (HMO)	1	1		1			H9302	801	0	2020	Various Counties in Western WA		1	0	2			2						premera.com/ma	premera.com/ma	premera.com/ma	(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	2			
H9323	1	0	1	20	8	H9323_001_0	2	1			07/15/2019	2020.01	07/15/2019 02:50:59 PM Eastern Daylight Time		07/15/2019 02:46:33 PM Eastern Daylight Time			07/15/2019 02:53:15 PM Eastern Daylight Time	"ACUTE CARE HEALTH SYSTEM, LLC"	Beacon of LIFE	beaconhss.com	Beacon of LIFE (PACE)	8	20		1			H9323	1	0	2020	Monmouth County		2		2			2						NA	NA										(732)592-3400		(732)592-3400		(732)592-3400		(732)592-3400										(732)532-3400		(732)592-3400		(732)592-3400		(732)592-3400																
H9323	2	0	1	20	8	H9323_002_0	2	1			07/15/2019	2020.01	07/15/2019 02:51:09 PM Eastern Daylight Time		07/15/2019 02:46:33 PM Eastern Daylight Time			07/15/2019 02:53:15 PM Eastern Daylight Time	"ACUTE CARE HEALTH SYSTEM, LLC"	Beacon of LIFE	beaconhss.com	Beacon of LIFE (PACE)	8	20		1			H9323	2	0	2020	Monmouth County		2		2			2						NA	NA										(732)592-3400		(732)592-3400		(732)592-3400		(732)592-3400										(732)532-3400		(732)592-3400		(732)592-3400		(732)592-3400																
H9364	1	0	1	1	1	H9364_001_0	7	1			07/12/2019	2020.01	07/12/2019 11:32:19 AM Eastern Daylight Time	08/02/2019 08:57:39 AM Eastern Daylight Time	07/30/2019 11:21:19 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	"WELLCARE OF MAINE, INC."	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H9364	1	0	2020	Select counties in ME		2	16555	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9364	2	0	1	1	1	H9364_002_0	7	1	2	1	08/02/2019	2020.01	08/02/2019 03:46:15 PM Eastern Daylight Time	08/02/2019 04:19:04 PM Eastern Daylight Time	07/30/2019 11:21:55 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	"WELLCARE OF MAINE, INC."	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H9364	2	0	2020	Select counties in ME		2	31801	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9364	3	0	1	1	1	H9364_003_0	7	1	2	1	08/02/2019	2020.01	08/02/2019 03:50:08 PM Eastern Daylight Time	08/02/2019 04:21:32 PM Eastern Daylight Time	07/30/2019 11:22:31 PM Eastern Daylight Time			08/05/2019 03:59:12 PM Eastern Daylight Time	"WELLCARE OF MAINE, INC."	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H9364	3	0	2020	Select counties in ME		2	17748	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9403	1	0	1	1	1	H9403_001_0	6	1	2	1	06/02/2019	2020.01	06/02/2019 11:13:40 PM Eastern Daylight Time	08/05/2019 12:03:25 PM Central Daylight Time	08/05/2019 12:04:21 PM Central Daylight Time			08/05/2019 12:18:43 PM Central Daylight Time	"EON HEALTH, INC. (SC)"	Eon Health	www.eonhealthplan.com	EON DELUXE (HMO D-SNP)	1	1		1			H9403	1	0	2020	Select South Carolina Counties		2	4245	2			1	3		1		1	www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9403	3	0	1	1	1	H9403_003_0	8	1		1	08/02/2019	2020.01	08/02/2019 01:12:30 PM Central Daylight Time	08/05/2019 12:03:26 PM Central Daylight Time	08/05/2019 12:04:21 PM Central Daylight Time			08/05/2019 12:18:43 PM Central Daylight Time	"EON HEALTH, INC. (SC)"	Eon Health	www.eonhealthplan.com	EON SILVER (HMO C-SNP)	1	1		1			H9403	3	0	2020	Select South Carolina Counties		2	3696	2			1	4			10		www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9403	4	0	1	1	1	H9403_004_0	6	1			08/02/2019	2020.01	08/02/2019 01:13:04 PM Central Daylight Time	08/05/2019 12:03:26 PM Central Daylight Time	08/05/2019 12:04:21 PM Central Daylight Time			08/05/2019 12:18:43 PM Central Daylight Time	"EON HEALTH, INC. (SC)"	Eon Health	www.eonhealthplan.com	EON SELECT (HMO)	1	1		1			H9403	4	0	2020	Select South Carolina Counties		2	8506	2			2						www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9408	1	0	1	4	1	H9408_001_0	5	1			07/08/2019	2020.01	07/08/2019 01:35:11 PM Eastern Daylight Time	07/31/2019 03:01:40 PM Eastern Daylight Time	07/31/2019 03:02:16 PM Eastern Daylight Time			08/02/2019 04:13:30 PM Eastern Daylight Time	"VIBRA HEALTH PLAN, INC."	Vibra Health Plan	www.vibrahealthplan.com	Vibra Health Plan Essential (PPO)	1	4		1			H9408	1	0	2020	Southcentral and Northeast Pennsylvania		2	32425	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9408	5	0	1	4	1	H9408_005_0	4	1			07/08/2019	2020.01	07/08/2019 01:36:23 PM Eastern Daylight Time	07/31/2019 03:03:14 PM Eastern Daylight Time	07/31/2019 03:03:52 PM Eastern Daylight Time			08/02/2019 04:13:30 PM Eastern Daylight Time	"VIBRA HEALTH PLAN, INC."	Vibra Health Plan	www.vibrahealthplan.com	Vibra Health Plan Enhanced Complete (PPO)	1	4		1			H9408	5	0	2020	Southcentral and Northeast Pennsylvania		2		2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9408	801	0	1	4	1	H9408_801_0	2	1			06/03/2019	2020.01	06/03/2019 12:49:57 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"VIBRA HEALTH PLAN, INC."	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Silver Rx (PPO)	1	4		1			H9408	801	0	2020	National		1	1259	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9408	802	0	1	4	1	H9408_802_0	2	1			06/03/2019	2020.01	06/03/2019 12:57:11 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"VIBRA HEALTH PLAN, INC."	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Bronze Rx FY (PPO)	1	4		1			H9408	802	0	2020	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9408	803	0	1	4	1	H9408_803_0	2	1			06/03/2019	2020.01	06/03/2019 12:51:46 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"VIBRA HEALTH PLAN, INC."	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Without Rx (PPO)	1	4		1			H9408	803	0	2020	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9408	804	0	1	4	1	H9408_804_0	2	1			06/03/2019	2020.01	06/03/2019 12:52:56 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"VIBRA HEALTH PLAN, INC."	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Without Rx FY (PPO)	1	4		1			H9408	804	0	2020	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9408	805	0	1	4	1	H9408_805_0	2	1			06/03/2019	2020.01	06/03/2019 12:57:25 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"VIBRA HEALTH PLAN, INC."	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Platinum Rx (PPO)	1	4		1			H9408	805	0	2020	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9408	806	0	1	4	1	H9408_806_0	2	1			06/03/2019	2020.01	06/03/2019 12:57:37 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"VIBRA HEALTH PLAN, INC."	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Gold Rx (PPO)	1	4		1			H9408	806	0	2020	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9408	807	0	1	4	1	H9408_807_0	2	1			06/03/2019	2020.01	06/03/2019 12:57:51 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"VIBRA HEALTH PLAN, INC."	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Bronze Rx (PPO)	1	4		1			H9408	807	0	2020	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9408	808	0	1	4	1	H9408_808_0	2	1			06/03/2019	2020.01	06/03/2019 12:58:02 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"VIBRA HEALTH PLAN, INC."	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Platinum Rx FY (PPO)	1	4		1			H9408	808	0	2020	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9408	809	0	1	4	1	H9408_809_0	2	1			06/03/2019	2020.01	06/03/2019 12:58:19 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"VIBRA HEALTH PLAN, INC."	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Gold Rx FY (PPO)	1	4		1			H9408	809	0	2020	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9408	810	0	1	4	1	H9408_810_0	2	1			06/03/2019	2020.01	06/03/2019 12:58:31 PM Eastern Daylight Time					06/03/2019 01:25:08 PM Eastern Daylight Time	"VIBRA HEALTH PLAN, INC."	Vibra Health Plan	www.vibrahealthplan.com	Vibra Group PPO Silver Rx FY (PPO)	1	4		1			H9408	810	0	2020	National		1	24	2			2						www.vibrahealthplan.com	www.vibrahealthplan.com	www.vibrahealthplan.com	(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(844)388-8268		(844)388-8268		(844)324-0691		(844)324-0691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9412	803	0	1	4	1	H9412_803_0	2	1			05/24/2019	2020.01	05/24/2019 09:15:52 PM Eastern Daylight Time					06/02/2019 04:14:25 PM Eastern Daylight Time	"GEISINGER QUALITY OPTIONS, INC."	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Rx (PPO) EGWP NJ (PPO)	1	4		1			H9412	803	0	2020	"Ocean & Monmouth Counties, NJ"		1	600	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)271-5673		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9428	1	0	1	4	1	H9428_001_0	5	1			07/16/2019	2020.01	07/16/2019 01:54:36 PM Eastern Daylight Time	08/02/2019 09:02:33 AM Eastern Daylight Time	07/30/2019 11:23:07 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE OF TENNESSEE, INC."	WellCare	www.wellcare.com/medicare	WellCare Premier (PPO)	1	4		1			H9428	1	0	2020	Selected Counties in TN		2	5920	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	1	0	1	4	1	H9431_001_0	4	1			07/31/2019	2020.01	07/31/2019 12:19:59 PM Eastern Daylight Time	08/01/2019 12:32:47 PM Pacific Daylight Time	07/31/2019 01:47:55 AM Pacific Daylight Time			08/02/2019 12:40:23 PM Pacific Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H9431	1	0	2020	Central New Mexico		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	2	0	1	4	1	H9431_002_0	3	1			07/03/2019	2020.01	07/03/2019 02:40:53 PM Eastern Daylight Time	08/01/2019 05:42:12 PM Eastern Daylight Time	07/31/2019 04:49:06 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H9431	2	0	2020	Kootenai County		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	3	0	1	4	1	H9431_003_0	3	1			07/03/2019	2020.01	07/03/2019 02:41:00 PM Eastern Daylight Time	08/01/2019 05:43:54 PM Eastern Daylight Time	07/31/2019 04:50:17 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	1	4		1			H9431	3	0	2020	Treasure Valley		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	4	0	1	4	1	H9431_004_0	3	1			07/03/2019	2020.01	07/03/2019 02:41:11 PM Eastern Daylight Time	08/01/2019 05:47:14 PM Eastern Daylight Time	07/31/2019 04:51:28 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H9431	4	0	2020	Southern Oregon		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	5	0	1	4	1	H9431_005_0	3	1			07/31/2019	2020.01	07/31/2019 03:37:00 PM Eastern Daylight Time	08/01/2019 05:51:01 PM Eastern Daylight Time	07/31/2019 04:52:42 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H9431	5	0	2020	Greater Portland Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	6	0	1	4	1	H9431_006_0	3	1			07/03/2019	2020.01	07/03/2019 02:41:30 PM Eastern Daylight Time	08/01/2019 05:52:36 PM Eastern Daylight Time	07/31/2019 04:53:54 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	1	4		1			H9431	6	0	2020	Treasure Valley		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	7	0	1	4	1	H9431_007_0	3	1			07/03/2019	2020.01	07/03/2019 02:41:39 PM Eastern Daylight Time	08/01/2019 05:54:01 PM Eastern Daylight Time	07/31/2019 04:55:05 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	1	4		1			H9431	7	0	2020	Southern Oregon		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	8	0	1	4	1	H9431_008_0	3	1			07/03/2019	2020.01	07/03/2019 02:41:47 PM Eastern Daylight Time	08/01/2019 05:56:01 PM Eastern Daylight Time	07/31/2019 04:56:16 AM Eastern Daylight Time			08/02/2019 04:52:57 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	1	4		1			H9431	8	0	2020	Greater Portland Metro Area		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	9	0	1	4	1	H9431_009_0	4	1			08/01/2019	2020.01	08/01/2019 03:17:20 PM Eastern Daylight Time	08/02/2019 10:17:30 AM Eastern Daylight Time	07/31/2019 04:57:28 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	1	4		1			H9431	9	0	2020	Rhode Island		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	10	0	1	4	1	H9431_010_0	5	1			07/03/2019	2020.01	07/03/2019 05:31:03 PM Eastern Daylight Time	08/02/2019 10:19:02 AM Eastern Daylight Time	07/31/2019 04:58:40 AM Eastern Daylight Time			08/02/2019 07:36:58 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier Plan (PPO)	1	4		1			H9431	10	0	2020	Rhode Island		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	11	0	1	4	1	H9431_011_0	4	1			08/01/2019	2020.01	08/01/2019 03:14:55 PM Eastern Daylight Time	08/02/2019 10:20:34 AM Eastern Daylight Time	07/31/2019 04:59:53 AM Eastern Daylight Time			08/02/2019 06:03:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Plan (PPO)	1	4		1			H9431	11	0	2020	New Hampshire		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	12	0	1	4	1	H9431_012_0	5	1			07/03/2019	2020.01	07/03/2019 05:31:33 PM Eastern Daylight Time	08/02/2019 10:22:04 AM Eastern Daylight Time	07/31/2019 05:01:03 AM Eastern Daylight Time			08/02/2019 07:36:58 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Explorer Premier Plan (PPO)	1	4		1			H9431	12	0	2020	New Hampshire		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(833)570-6670		(833)570-6670		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9431	801	0	1	4	1	H9431_801_0	1	1			05/24/2019	2020.01	05/24/2019 09:57:41 AM Eastern Daylight Time					05/30/2019 07:20:43 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna First Health Medicare Plan (PPO)	1	4		1			H9431	801	0	2020	Multi-State		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H9431	802	0	1	4	1	H9431_802_0	1	1			05/24/2019	2020.01	05/24/2019 09:57:51 AM Eastern Daylight Time					05/30/2019 07:20:43 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna First Health Medicare Plan w/Rx (PPO)	1	4		1			H9431	802	0	2020	Multi-State		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H9431	803	0	1	4	1	H9431_803_0	1	1			05/24/2019	2020.01	05/24/2019 09:58:12 AM Eastern Daylight Time					05/30/2019 07:20:43 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Aetna Medicare	https://www.aetnamedicare.com	Aetna First Health Medicare Plan w/Rx SH (PPO)	1	4		1			H9431	803	0	2020	Multi-State		1	120	2			2						https://www.aetnamedicare.com/findpharmacy	https://www.aetnaretireeplans.com	www.aetnamedicaredocfind.com	(888)267-2637		(888)267-2637		(800)307-4830		(800)307-4830		(855)287-7406		(855)287-7406		(800)307-4830		(800)307-4830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;5;6;7b;7c;7e;7h;7i;8a;8b1;8b2;8b3;9a1;9b;9c;10a;11a;11b;11c;12;15;16b;	2		1									
H9438	1	0	1	20	8	H9438_001_0	1	1			05/28/2019	2020.01	05/28/2019 01:02:18 PM Central Daylight Time		05/23/2019 03:02:26 PM Central Daylight Time			05/28/2019 01:04:27 PM Central Daylight Time	"BLUESTEM PACE, INC."	Bluestem PACE	www.bluestempace.org	Bluestem PACE (PACE)	8	20		1			H9438	1	0	2020	"Counties:  RC, HV, RN, MN, MP, SA, EW, DK, OT, LC"		2		2			2						NA	NA										(844)588-7223		(620)504-5900		(844)588-7223		(620)504-5674												(620)504-5900		(844)588-7223		(620)504-5674																
H9438	2	0	1	20	8	H9438_002_0	1	1			05/28/2019	2020.01	05/28/2019 01:02:45 PM Central Daylight Time		05/23/2019 03:02:44 PM Central Daylight Time			05/28/2019 01:04:27 PM Central Daylight Time	"BLUESTEM PACE, INC."	Bluestem PACE	www.bluestempace.org	Bluestem PACE (PACE)	8	20		1			H9438	2	0	2020	"Counties:  RC, HV, RN, MN, MP, SA, EW, DK, OT, LC"		2		2			2						NA	NA										(844)588-7223		(620)504-5900		(844)588-7223		(620)504-5900												(620)504-5900				(620)504-5900																
H9455	1	0	1	1	1	H9455_001_0	6	1	2	1	08/01/2019	2020.01	08/01/2019 09:33:37 AM Pacific Daylight Time	08/05/2019 09:42:55 AM Pacific Daylight Time	08/05/2019 09:43:48 AM Pacific Daylight Time			08/05/2019 09:55:02 AM Pacific Daylight Time	"HEALTH CHOICE UTAH, INC."	Steward Health Choice Utah	https://www.stewardhcgenerations.org/ut/	Steward Health Choice Generations (HMO D-SNP)	1	1		1			H9455	1	0	2020	"Counties: Salt Lake, Utah, Davis, Weber, Tooele"		2		2			1	3		2		2	www.hcgenerations.com	https://www.stewardhcgenerations.org/ut/members/prescription-drug-information/	https://www.stewardhcgenerations.org/ut/members/member-information/	(844)457-8943		(844)457-8943		(844)457-8943		(844)457-8943		(844)457-8943		(844)457-8943		(844)457-8943		(844)457-8943		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9460	1	0	1	1	1	H9460_001_0	4	1			07/08/2019	2020.01	07/08/2019 05:32:13 PM Central Daylight Time	07/31/2019 03:29:56 PM Central Daylight Time	07/30/2019 04:30:13 PM Central Daylight Time			08/02/2019 11:28:40 AM Central Daylight Time	"CIGNA HEALTHCARE OF ST LOUIS, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H9460	1	0	2020	Kansas City Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)612-0287		(866)612-0287		(800)668-3813		(800)668-3813		(866)612-0287		(866)612-0287		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9460	2	0	1	1	1	H9460_002_0	3	1			07/08/2019	2020.01	07/08/2019 05:32:55 PM Central Daylight Time	05/29/2019 03:17:38 PM Central Daylight Time				07/11/2019 09:31:32 PM Central Daylight Time	"CIGNA HEALTHCARE OF ST LOUIS, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	1	1		1			H9460	2	0	2020	Kansas City Area		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)612-0287		(866)612-0287										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9487	1	0	1	48	5	H9487_001_0	1	1			05/17/2019	2020.01	05/17/2019 02:10:55 PM Pacific Daylight Time					05/28/2019 11:43:06 PM Pacific Daylight Time	"MICHIGAN COMPLETE HEALTH, INC."	Michigan Complete Health	mmp.michigancompletehealth.com	Michigan Complete Health (Medicare-Medicaid Plan)	5	48		1			H9487	1	0	2020	Wayne and Macomb Counties		2	33526	2			2						mmp.michigancompletehealth.com/findadoctor	mmp.michigancompletehealth.com/formulary	mmp.michigancompletehealth.com/findadoctor	(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(844)239-7387		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H9516	1	0	1	4	1	H9516_001_0	7	1			07/16/2019	2020.01	07/16/2019 02:08:50 PM Central Daylight Time	08/02/2019 04:19:31 PM Central Daylight Time	08/02/2019 04:39:33 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex (PPO)	1	4		1			H9516	1	0	2020	"Kings, New York, and Queens Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9516	2	0	1	4	1	H9516_002_0	7	1			07/16/2019	2020.01	07/16/2019 02:09:47 PM Central Daylight Time	08/02/2019 04:19:25 PM Central Daylight Time	08/02/2019 04:39:01 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	BRIGHT HEALTH INSURANCE COMPANY OF NEW YORK	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex Plus (PPO)	1	4		1			H9516	2	0	2020	"Kings, New York, and Queens Counties"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(844)202-4974		(844)202-4974		(844)679-2030		(844)679-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9525	3	0	1	1	1	H9525_003_0	8	1	2	1	07/31/2019	2020.01	07/31/2019 05:56:04 PM Eastern Daylight Time	08/05/2019 10:09:42 AM Eastern Daylight Time	07/30/2019 08:46:21 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H9525	3	0	2020	Select Counties in Wisconsin		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(866)242-0251		(866)242-0251		(844)788-9046		(844)788-9046		(866)242-0251		(866)242-0251		(844)788-9047		(844)788-9047		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	4	0	1	1	1	H9525_004_0	7	1			07/31/2019	2020.01	07/31/2019 09:56:08 PM Eastern Daylight Time	08/05/2019 10:09:42 AM Eastern Daylight Time	07/30/2019 08:47:45 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Plus (HMO)	1	1		1			H9525	4	0	2020	Select Counties in Wisconsin		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)304-1774		(855)304-1774		(844)364-2130		(844)364-2130		(855)304-1774		(855)304-1774		(844)373-7115		(844)373-7115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	6	0	1	1	1	H9525_006_0	7	1			07/31/2019	2020.01	07/31/2019 09:56:56 PM Eastern Daylight Time	08/05/2019 10:09:43 AM Eastern Daylight Time	07/30/2019 08:49:09 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/shop	Anthem MediBlue Plus (HMO)	1	1		1			H9525	6	0	2020	Select Counties in Wisconsin		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)304-1774		(855)304-1774		(844)364-2130		(844)364-2130		(855)304-1774		(855)304-1774		(844)373-7115		(844)373-7115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	7	0	1	1	1	H9525_007_0	7	1	2	1	07/31/2019	2020.01	07/31/2019 05:56:42 PM Eastern Daylight Time	08/05/2019 10:09:43 AM Eastern Daylight Time	07/30/2019 08:50:37 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Dual Advantage (HMO D-SNP)	1	1		1			H9525	7	0	2020	Select Counties in Kentucky		2		2			1	3		1		1	https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(844)879-3601		(844)879-3601		(844)788-9046		(844)788-9046		(844)879-3601		(844)879-3601		(844)788-9047		(844)788-9047		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	8	0	1	1	1	H9525_008_0	7	1			08/02/2019	2020.01	08/02/2019 10:16:46 AM Eastern Daylight Time	08/05/2019 10:09:44 AM Eastern Daylight Time	07/30/2019 08:52:02 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com	Anthem MediBlue Plus (HMO)	1	1		1			H9525	8	0	2020	Select Counties in Kentucky		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare		(855)558-1439		(855)558-1439		(844)364-2130		(844)364-2130		(855)558-1439		(855)558-1439		(844)373-7115		(844)373-7115		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9525	801	0	1	1	1	H9525_801_0	3	1			05/22/2019	2020.01	05/22/2019 02:20:46 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	1	1		1			H9525	801	0	2020	Wisconsin select counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	802	0	1	1	1	H9525_802_0	3	1			05/22/2019	2020.01	05/22/2019 02:21:12 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	1	1		1			H9525	802	0	2020	Select counties in Wisconsin		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	803	0	2	1	1	H9525_803_0	3	1			05/30/2019	2020.01	05/30/2019 07:28:31 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	1	1		2	1		H9525	803	0	2020	Wisconsin - Select Counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	804	0	1	1	1	H9525_804_0	3	1			05/30/2019	2020.01	05/30/2019 06:50:10 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	1	1		1			H9525	804	0	2020	Kentucky - Select Counties		1	228	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	805	0	1	1	1	H9525_805_0	3	1			05/22/2019	2020.01	05/22/2019 02:28:52 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	1	1		1			H9525	805	0	2020	Kentucky - Select Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	806	0	2	1	1	H9525_806_0	3	1			05/30/2019	2020.01	05/30/2019 07:29:23 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	1	1		2	1		H9525	806	0	2020	Kentucky - Select Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	807	0	2	1	1	H9525_807_0	3	1			05/30/2019	2020.01	05/30/2019 07:28:41 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	1	1		2	1		H9525	807	0	2020	Select Wisconsin Coutnies		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	808	0	1	1	1	H9525_808_0	3	1			05/22/2019	2020.01	05/22/2019 02:23:46 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	1	1		1			H9525	808	0	2020	Select Wisconsin Counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	809	0	1	1	1	H9525_809_0	3	1			05/22/2019	2020.01	05/22/2019 02:24:17 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	1	1		1			H9525	809	0	2020	Select Wisconsin Counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	810	0	2	1	1	H9525_810_0	3	1			05/30/2019	2020.01	05/30/2019 07:28:54 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	1	1		2	1		H9525	810	0	2020	Select Wisconsin Counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	811	0	2	1	1	H9525_811_0	3	1			05/30/2019	2020.01	05/30/2019 07:29:17 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	1	1		2	1		H9525	811	0	2020	Select Kentucky Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	812	0	1	1	1	H9525_812_0	3	1			05/22/2019	2020.01	05/22/2019 02:30:36 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	1	1		1			H9525	812	0	2020	Select Kentucky Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	813	0	1	1	1	H9525_813_0	3	1			05/22/2019	2020.01	05/22/2019 02:30:56 PM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	1	1		1			H9525	813	0	2020	Select Kentucky Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	814	0	2	1	1	H9525_814_0	3	1			05/30/2019	2020.01	05/30/2019 07:29:41 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	1	1		2	1		H9525	814	0	2020	Select Kentucky Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	815	0	2	1	1	H9525_815_0	3	1			05/30/2019	2020.01	05/30/2019 07:29:01 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/wi/medicare	Anthem MediBlue (HMO)	1	1		2	1		H9525	815	0	2020	Select Wisconsin Counties		1	600	2			2						www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	www.anthem.com/wi/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9525	816	0	2	1	1	H9525_816_0	3	1			05/30/2019	2020.01	05/30/2019 07:29:49 AM Pacific Daylight Time					05/31/2019 12:31:08 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/ky/medicare	Anthem Senior Advantage (HMO)	1	1		2	1		H9525	816	0	2020	Select  KY Counties		1	600	2			2						www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	www.anthem.com/ky/medicare	(833)848-8730		(833)848-8730		(833)848-8729		(833)848-8729										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;10a;11a;11b;11c;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;18a;	2		1					1				
H9572	1	1	1	4	1	H9572_001_1	8	1			07/17/2019	2020.01	07/17/2019 01:31:35 PM Eastern Daylight Time	08/05/2019 08:34:11 AM Eastern Daylight Time	08/01/2019 11:23:34 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	1	1	2020	State of Michigan	Region 1	2	15246	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	1	2	1	4	1	H9572_001_2	8	1			07/17/2019	2020.01	07/17/2019 03:51:48 PM Eastern Daylight Time	08/05/2019 08:35:08 AM Eastern Daylight Time	08/01/2019 11:24:02 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	1	2	2020	State of Michigan	Region 2	2	40403	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	1	3	1	4	1	H9572_001_3	8	1			07/17/2019	2020.01	07/17/2019 03:52:03 PM Eastern Daylight Time	08/05/2019 08:36:09 AM Eastern Daylight Time	08/01/2019 11:24:30 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	1	3	2020	State of Michigan	Region 3	2	48252	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	1	4	1	4	1	H9572_001_4	8	1			07/17/2019	2020.01	07/17/2019 03:52:21 PM Eastern Daylight Time	08/05/2019 08:37:09 AM Eastern Daylight Time	08/01/2019 11:24:59 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	1	4	2020	State of Michigan	Region 4	2	83165	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	1	6	1	4	1	H9572_001_6	9	1			07/17/2019	2020.01	07/17/2019 03:52:37 PM Eastern Daylight Time	08/05/2019 08:38:03 AM Eastern Daylight Time	08/01/2019 11:25:27 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	1	6	2020	State of Michigan	Region 6	2	276931	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	2	1	1	4	1	H9572_002_1	8	1			07/17/2019	2020.01	07/17/2019 01:46:23 PM Eastern Daylight Time	08/05/2019 08:39:01 AM Eastern Daylight Time	08/01/2019 11:25:56 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	2	1	2020	State of Michigan	Region 1	2	12714	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	2	2	1	4	1	H9572_002_2	8	1			07/17/2019	2020.01	07/17/2019 03:52:53 PM Eastern Daylight Time	08/05/2019 08:40:00 AM Eastern Daylight Time	08/01/2019 11:26:25 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	2	2	2020	State of Michigan	Region 2	2	27395	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	2	3	1	4	1	H9572_002_3	8	1			07/17/2019	2020.01	07/17/2019 03:54:55 PM Eastern Daylight Time	08/05/2019 08:41:00 AM Eastern Daylight Time	08/01/2019 11:26:53 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	2	3	2020	State of Michigan	Region 3	2	25724	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	2	4	1	4	1	H9572_002_4	8	1			07/17/2019	2020.01	07/17/2019 03:55:09 PM Eastern Daylight Time	08/05/2019 08:42:00 AM Eastern Daylight Time	08/01/2019 11:27:22 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	2	4	2020	State of Michigan	Region 4	2	62412	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	2	6	1	4	1	H9572_002_6	9	1			07/17/2019	2020.01	07/17/2019 03:56:13 PM Eastern Daylight Time	08/05/2019 08:44:26 AM Eastern Daylight Time	08/01/2019 11:27:51 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	2	6	2020	State of Michigan	Region 6	2	84003	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	3	1	1	4	1	H9572_003_1	8	1			07/17/2019	2020.01	07/17/2019 01:51:50 PM Eastern Daylight Time	08/05/2019 08:46:01 AM Eastern Daylight Time	08/01/2019 11:28:19 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	3	1	2020	State of Michigan	Region 1	2	7076	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	3	2	1	4	1	H9572_003_2	8	1			07/17/2019	2020.01	07/17/2019 03:57:02 PM Eastern Daylight Time	08/05/2019 08:47:37 AM Eastern Daylight Time	08/01/2019 11:28:48 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	3	2	2020	State of Michigan	Region 2	2	15142	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	3	3	1	4	1	H9572_003_3	8	1			07/17/2019	2020.01	07/17/2019 03:57:16 PM Eastern Daylight Time	08/05/2019 08:49:15 AM Eastern Daylight Time	08/01/2019 11:29:17 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	3	3	2020	State of Michigan	Region 3	2	9183	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	3	4	1	4	1	H9572_003_4	8	1			07/17/2019	2020.01	07/17/2019 03:57:34 PM Eastern Daylight Time	08/05/2019 08:50:51 AM Eastern Daylight Time	08/01/2019 11:29:49 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	3	4	2020	State of Michigan	Region 4	2	26433	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	3	6	1	4	1	H9572_003_6	9	1			07/17/2019	2020.01	07/17/2019 03:58:19 PM Eastern Daylight Time	08/05/2019 08:52:26 AM Eastern Daylight Time	08/01/2019 11:30:17 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	3	6	2020	State of Michigan	Region 6	2	47845	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	4	1	1	4	1	H9572_004_1	8	1			07/17/2019	2020.01	07/17/2019 01:55:39 PM Eastern Daylight Time	08/05/2019 08:54:02 AM Eastern Daylight Time	08/01/2019 11:30:45 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	4	1	2020	State of Michigan	Region 1	2	6240	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	4	2	1	4	1	H9572_004_2	8	1			07/17/2019	2020.01	07/17/2019 03:59:28 PM Eastern Daylight Time	08/05/2019 08:55:39 AM Eastern Daylight Time	08/01/2019 11:31:14 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	4	2	2020	State of Michigan	Region 2	2	27696	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	4	3	1	4	1	H9572_004_3	8	1			07/17/2019	2020.01	07/17/2019 03:59:36 PM Eastern Daylight Time	08/05/2019 08:57:17 AM Eastern Daylight Time	08/01/2019 11:31:43 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	4	3	2020	State of Michigan	Region 3	2	37694	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	4	4	1	4	1	H9572_004_4	8	1			07/17/2019	2020.01	07/17/2019 03:59:43 PM Eastern Daylight Time	08/05/2019 08:58:55 AM Eastern Daylight Time	08/01/2019 11:32:11 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	4	4	2020	State of Michigan	Region 4	2	72465	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	4	6	1	4	1	H9572_004_6	9	1			07/17/2019	2020.01	07/17/2019 04:00:33 PM Eastern Daylight Time	08/05/2019 09:00:31 AM Eastern Daylight Time	08/01/2019 11:32:40 AM Eastern Daylight Time			08/05/2019 03:29:03 PM 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)	1	4		1			H9572	4	6	2020	State of Michigan	Region 6	2	120448	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9572	801	0	1	4	1	H9572_801_0	5	1			05/22/2019	2020.01	05/22/2019 06:39:00 PM Eastern Daylight Time					06/04/2019 12:09:30 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)	1	4		1			H9572	801	0	2020	State of Michigan		1	361341	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7f;7h;7i;7j;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9572	802	0	1	4	1	H9572_802_0	5	1			05/22/2019	2020.01	05/22/2019 07:48:17 PM Eastern Daylight Time					06/04/2019 12:09:30 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)	1	4		1			H9572	802	0	2020	State of Michigan		1	3953285	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7f;7h;7i;7j;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9572	803	0	1	4	1	H9572_803_0	5	1			05/14/2019	2020.01	05/14/2019 03:56:38 PM Eastern Daylight Time					06/04/2019 12:09:30 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 non-CY (PPO)	1	4		1			H9572	803	0	2020	State of Michigan		1	1200	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7f;7h;7i;7j;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9572	804	0	1	4	1	H9572_804_0	5	1			05/06/2019	2020.01	05/06/2019 09:08:02 AM Eastern Daylight Time					06/04/2019 12:09:30 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 non-CY (PPO)	1	4		1			H9572	804	0	2020	State of Michigan		1	1200	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7f;7h;7i;7j;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9572	805	0	1	4	1	H9572_805_0	5	1			05/06/2019	2020.01	05/06/2019 09:08:10 AM Eastern Daylight Time					06/04/2019 12:09:30 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 ASC (PPO)	1	4		1			H9572	805	0	2020	State of Michigan		1	1200	2			2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/providersmedicare	(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7e;7f;7h;7i;7j;7k;8a;8b1;8b2;9a1;9b;9c;10a;11a;11b;11c;12;15;	2		1									
H9576	1	0	1	48	5	H9576_001_0	5	1			08/16/2019	2020.01	08/16/2019 02:20:33 PM Eastern Daylight Time					08/16/2019 02:34:20 PM Eastern Daylight Time	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	www.nhpri.org/INTEGRITY	Neighborhood INTEGRITY (Medicare-Medicaid Plan)	5	48		1			H9576	1	0	2020	State of Rhode Island		2	162893	2			2						https://www.nhpri.org/Medicare-Medicaid/FindaProviderorPharmacy.aspx	https://www.nhpri.org/Medicare-Medicaid/PharmacyBenefits.aspx	www.nhpri.org/INTEGRITY	(844)812-6896		(401)427-8181		(844)812-6896		(401)427-8181		(844)812-6896		(401)427-8181		(844)812-6896		(401)427-8181		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H9585	1	0	1	1	1	H9585_001_0	4	1	2	1	08/08/2019	2020.01	08/08/2019 02:44:20 PM Eastern Daylight Time	08/05/2019 02:53:20 PM Eastern Daylight Time	07/31/2019 02:21:08 PM Eastern Daylight Time			08/09/2019 09:36:37 AM Eastern Daylight Time	"BOSTON MEDICAL CENTER HEALTH PLAN, INC."	BMC HealthNet Plan Senior Care Options	www.SeniorsGetMore.org	BMC HealthNet Plan Senior Care Options (HMO D-SNP)	1	1		1			H9585	1	0	2020	"Barnstable, Bristol, Hampden, Plymouth, Suffolk"		2	21970	2			1	3		1		1	www.SeniorsGetMore.org/pharmacy	www.SeniorsGetMore.org/pharmacy	www.SeniorsGetMore.org	(855)833-8125		(855)833-8125		(855)833-8125		(855)833-8125		(855)833-8125		(855)833-8125		(855)833-8125		(855)833-8125		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1	2			
H9589	1	0	1	4	1	H9589_001_0	9	1		1	08/02/2019	2020.01	08/02/2019 01:21:29 PM Central Daylight Time	08/05/2019 12:03:26 PM Central Daylight Time	08/05/2019 12:04:21 PM Central Daylight Time			08/05/2019 12:18:43 PM Central Daylight Time	"EON HEALTH, INC. (GA)"	Eon Health	www.eonhealthplan.com	EON GOLD (PPO C-SNP)	1	4		1			H9589	1	0	2020	Select Georgia Counties		2	1221	2			1	4			10		www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9589	3	0	1	4	1	H9589_003_0	9	1			08/02/2019	2020.01	08/02/2019 01:21:51 PM Central Daylight Time	08/05/2019 12:03:26 PM Central Daylight Time	08/05/2019 12:04:22 PM Central Daylight Time			08/05/2019 12:18:43 PM Central Daylight Time	"EON HEALTH, INC. (GA)"	Eon Health	www.eonhealthplan.com	EON CHOICE (PPO)	1	4		1			H9589	3	0	2020	Select Georgia Counties		2	1542	2			2						www.eonhealthplan.com	www.eonhealthplan.com	www.eonhealthplan.com	(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(888)906-3889		(888)906-3889		(888)912-8055		(888)912-8055		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9590	1	0	1	1	1	H9590_001_0	5	1		1	07/19/2019	2020.01	07/19/2019 03:26:03 PM Central Daylight Time	08/01/2019 10:07:18 AM Central Daylight Time	07/31/2019 12:48:59 PM Central Daylight Time			08/02/2019 12:26:08 PM Central Daylight Time	"LONGEVITY HEALTH PLAN OF ILLINOIS, INC."	Longevity Health	www.longevityhealthplan.com	Longevity Health Plan (HMO I-SNP)	1	1		1			H9590	1	0	2020	Illinois (partial)		2	2041	2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(888)886-9770		(888)886-9770		(888)886-9770		(888)886-9770		(888)886-9770		(888)886-9770		(888)886-9770		(888)886-9770		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9592	1	0	1	20	8	H9592_001_0	1	1			05/20/2019	2020.01	05/20/2019 10:13:12 AM Pacific Daylight Time		05/20/2019 10:04:24 AM Pacific Daylight Time			05/20/2019 10:15:00 AM Pacific Daylight Time	"INNOVATIVE INTEGRATED HEALTH, INC."	Fresno PACE	www.fresnopace.org	Fresno PACE (PACE)	8	20		1			H9592	1	0	2020	Fresno County Area		2		2			2						www.fresnopace.org	www.pharmastarpbm.com/										(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	2	0	1	20	8	H9592_002_0	1	1			05/20/2019	2020.01	05/20/2019 10:13:28 AM Pacific Daylight Time		05/20/2019 10:04:24 AM Pacific Daylight Time			05/20/2019 10:15:00 AM Pacific Daylight Time	"INNOVATIVE INTEGRATED HEALTH, INC."	Fresno PACE	www.fresnopace.org	Fresno PACE (PACE)	8	20		1			H9592	2	0	2020	Fresno County Area		2		2			2						www.fresnopace.org	www.pharmastarpbm.com/										(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	7	0	1	4	1	H9615_007_0	12	1			07/24/2019	2020.01	07/24/2019 07:47:59 AM Eastern Daylight Time	08/05/2019 11:17:30 AM Eastern Daylight Time	08/05/2019 11:18:12 AM Eastern Daylight Time			08/05/2019 12:51:56 PM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP Gold PPO with Part D (PPO)	1	4		1			H9615	7	0	2020	"Central NY, Eastern NY, Vermont"		2	12366	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2						2			
H9615	8	0	1	4	1	H9615_008_0	12	1			07/24/2019	2020.01	07/24/2019 07:47:31 AM Eastern Daylight Time	08/05/2019 11:17:30 AM Eastern Daylight Time	08/05/2019 11:18:12 AM Eastern Daylight Time			08/05/2019 12:51:56 PM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP WellSelect with Part D (PPO)	1	4		1			H9615	8	0	2020	"Central NY, Eastern NY, Vermont"		2	111447	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2						2			
H9615	9	0	1	4	1	H9615_009_0	12	1			07/24/2019	2020.01	07/24/2019 07:47:06 AM Eastern Daylight Time	08/05/2019 11:17:30 AM Eastern Daylight Time	08/05/2019 11:18:12 AM Eastern Daylight Time			08/05/2019 12:51:56 PM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP Gold PPO with Part D (PPO)	1	4		1			H9615	9	0	2020	Hudson Valley NY		2	6697	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2						2			
H9615	10	0	1	4	1	H9615_010_0	12	1			07/24/2019	2020.01	07/24/2019 07:46:43 AM Eastern Daylight Time	08/05/2019 11:17:31 AM Eastern Daylight Time	08/05/2019 11:18:13 AM Eastern Daylight Time			08/05/2019 12:51:56 PM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.joinMVPmedicare.com	MVP WellSelect with Part D (PPO)	1	4		1			H9615	10	0	2020	Hudson Valley NY		2	81128	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2						2			
H9615	12	0	1	4	1	H9615_012_0	12	1			07/24/2019	2020.01	07/24/2019 07:46:20 AM Eastern Daylight Time	08/05/2019 11:17:31 AM Eastern Daylight Time	08/05/2019 11:18:13 AM Eastern Daylight Time			08/05/2019 12:51:56 PM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.joinmvpmedicare.com	MVP WellSelect with Part D (PPO)	1	4		1			H9615	12	0	2020	Western NY (Rochester/Buffalo)		2	43530	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2						2			
H9615	802	0	1	4	1	H9615_802_0	5	1			05/28/2019	2020.01	05/28/2019 01:09:45 PM Eastern Daylight Time					05/30/2019 08:53:21 AM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.mvphealthcare.com	MVP GoldAnywhere Rx - Employer Group (PPO)	1	4		1			H9615	802	0	2020	"Employer Group East/West NY, Vermont"		1	109104	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9615	807	0	1	4	1	H9615_807_0	5	1			05/28/2019	2020.01	05/28/2019 01:10:40 PM Eastern Daylight Time					05/30/2019 08:53:21 AM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.mvphealthcare.com	MVP USA Care Rx - Employer Group (PPO)	1	4		1			H9615	807	0	2020	United States and Puerto Rico		1	21738	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899		(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9615	810	0	1	4	1	H9615_810_0	5	1			05/28/2019	2020.01	05/28/2019 01:16:28 PM Eastern Daylight Time					05/30/2019 08:53:21 AM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.mvphealthcare.com	MVP GoldAnywhere - Employer Group (PPO)	1	4		1			H9615	810	0	2020	"Employer Group East/West NY, Vermont"		1	0	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9615	811	0	1	4	1	H9615_811_0	5	1			05/28/2019	2020.01	05/28/2019 01:16:39 PM Eastern Daylight Time					05/30/2019 08:53:21 AM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP HEALTH CARE	www.mvphealthcare.com	MVP USA Care without Part D - Employer Group (PPO)	1	4		1			H9615	811	0	2020	United States and Puerto Rico		1	0	2			2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD	www.mvphealthcare.com	(800)665-7924		(800)665-7924		(800)324-3899		(800)324-3899										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	2		1									
H9616	1	0	1	20	8	H9616_001_0	1	1			05/22/2019	2020.01	05/22/2019 02:51:24 PM Pacific Daylight Time		05/22/2019 02:44:47 PM Pacific Daylight Time			05/22/2019 02:53:42 PM Pacific Daylight Time	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	San Diego PACE	http://www.syhc.org/sdpace/	San Diego PACE (Duals) (PACE)	8	20		1			H9616	1	0	2020	San Diego County		2		2			2						http://www.syhc.org/services/senior-services/san-diego-pace/	http://www.syhc.org/services/senior-services/san-diego-pace/										(844)473-7223		(619)205-4585		(844)473-7223		(619)205-4585										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H9616	2	0	1	20	8	H9616_002_0	1	1			05/22/2019	2020.01	05/22/2019 02:52:23 PM Pacific Daylight Time		05/22/2019 02:44:37 PM Pacific Daylight Time			05/22/2019 02:53:42 PM Pacific Daylight Time	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	San Diego PACE	http://www.syhc.org/sdpace/	San Diego PACE (Medicare Only) (PACE)	8	20		1			H9616	2	0	2020	San Diego County		2		2			2						http://www.syhc.org/services/senior-services/san-diego-pace/	http://www.syhc.org/services/senior-services/san-diego-pace/										(844)473-7223		(619)205-4585		(844)473-7223		(619)205-4585										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922																
H9630	1	0	1	1	1	H9630_001_0	4	1			08/01/2019	2020.01	08/01/2019 09:20:55 AM Pacific Daylight Time	08/05/2019 04:27:40 PM Central Daylight Time	08/05/2019 03:41:49 PM Central Daylight Time			08/06/2019 11:57:28 AM Central Daylight Time	"ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC"	Allwell	allwell.arhealthwellness.com	Allwell Medicare (HMO)	1	1		1			H9630	1	0	2020	Northwest Arkansas		2		2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	2	0	1	1	1	H9630_002_0	4	1			08/01/2019	2020.01	08/01/2019 09:21:51 AM Pacific Daylight Time	08/05/2019 04:27:16 PM Central Daylight Time	08/05/2019 03:41:33 PM Central Daylight Time			08/06/2019 11:57:28 AM Central Daylight Time	"ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC"	Allwell	allwell.arhealthwellness.com	Allwell Medicare (HMO)	1	1		1			H9630	2	0	2020	Little Rock Area		2		2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	3	0	1	1	1	H9630_003_0	4	1			08/01/2019	2020.01	08/01/2019 09:22:37 AM Pacific Daylight Time	08/05/2019 04:27:20 PM Central Daylight Time	08/05/2019 03:41:36 PM Central Daylight Time			08/06/2019 11:57:28 AM Central Daylight Time	"ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC"	Allwell	allwell.arhealthwellness.com	Allwell Medicare Select (HMO)	1	1		1			H9630	3	0	2020	"Benton, Washington Counties"		2		2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	4	0	1	1	1	H9630_004_0	2	1			08/01/2019	2020.01	08/01/2019 09:23:36 AM Pacific Daylight Time	08/05/2019 04:27:25 PM Central Daylight Time	08/05/2019 03:41:38 PM Central Daylight Time			08/06/2019 11:57:28 AM Central Daylight Time	"ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC"	Allwell	allwell.arhealthwellness.com	Allwell Medicare (HMO)	1	1		1			H9630	4	0	2020	Northern AR Counties		2		2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	5	0	1	1	1	H9630_005_0	2	1			08/01/2019	2020.01	08/01/2019 09:24:35 AM Pacific Daylight Time	08/05/2019 04:27:31 PM Central Daylight Time	08/05/2019 03:41:41 PM Central Daylight Time			08/06/2019 11:57:28 AM Central Daylight Time	"ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC"	Allwell	allwell.arhealthwellness.com	Allwell Medicare Premier (HMO)	1	1		1			H9630	5	0	2020	Northern AR Counties		2		2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	6	0	1	1	1	H9630_006_0	2	1			08/01/2019	2020.01	08/01/2019 09:25:15 AM Pacific Daylight Time	08/05/2019 04:27:35 PM Central Daylight Time	08/05/2019 03:41:45 PM Central Daylight Time			08/06/2019 11:57:28 AM Central Daylight Time	"ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC"	Allwell	allwell.arhealthwellness.com	Allwell Medicare Premier (HMO)	1	1		1			H9630	6	0	2020	Northwest Arkansas		2		2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9630	801	0	1	1	1	H9630_801_0	2	1			05/10/2019	2020.01	05/10/2019 12:38:20 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC"	Allwell	allwell.arhealthwellness.com	Allwell Group (HMO)	1	1		1			H9630	801	0	2020	Arkansas		1	100	2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H9630	802	0	1	1	1	H9630_802_0	2	1			05/03/2019	2020.01	05/03/2019 09:02:08 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC"	Allwell	allwell.arhealthwellness.com	Allwell Group (HMO)	1	1		1			H9630	802	0	2020	Arkansas		1	100	2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H9630	803	0	1	1	1	H9630_803_0	2	1			05/03/2019	2020.01	05/03/2019 09:02:53 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC"	Allwell	allwell.arhealthwellness.com	Allwell Group (HMO)	1	1		1			H9630	803	0	2020	Arkansas		1	100	2			2						allwell.arhealthwellness.com/findadoctor	allwell.arhealthwellness.com/formulary	allwell.arhealthwellness.com/findadoctor	(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(855)565-9518		(855)565-9518		(877)891-6091		(877)891-6091		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H9699	4	1	1	1	1	H9699_004_1	7	1			08/01/2019	2020.01	08/01/2019 12:06:38 PM Central Daylight Time	08/01/2019 03:45:25 PM Central Daylight Time	08/01/2019 08:51:32 AM Central Daylight Time			08/05/2019 09:30:47 AM Central Daylight Time	"HMO PARTNERS, INC."	Health Advantage	www.arkansasbluecross.com/medicare	Medi-Pak Advantage (HMO)	1	1		1			H9699	4	1	2020	State of Arkansas	Northwest and West Central AR counties	2	42547	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)349-9335		(877)349-9335		(844)298-2444		(844)298-2444		(877)349-9335		(877)349-9335		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9699	4	2	1	1	1	H9699_004_2	7	1			08/01/2019	2020.01	08/01/2019 12:06:52 PM Central Daylight Time	08/01/2019 03:46:34 PM Central Daylight Time	08/01/2019 08:52:11 AM Central Daylight Time			08/05/2019 09:30:47 AM Central Daylight Time	"HMO PARTNERS, INC."	Health Advantage	www.arkansasbluecross.com/medicare	Medi-Pak Advantage (HMO)	1	1		1			H9699	4	2	2020	State of Arkansas	East Central AR counties	2	31427	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)349-9335		(877)349-9335		(844)298-2444		(844)298-2444		(877)349-9335		(877)349-9335		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9699	4	3	1	1	1	H9699_004_3	7	1			08/01/2019	2020.01	08/01/2019 12:07:05 PM Central Daylight Time	08/01/2019 03:47:29 PM Central Daylight Time	08/01/2019 08:52:50 AM Central Daylight Time			08/05/2019 09:30:47 AM Central Daylight Time	"HMO PARTNERS, INC."	Health Advantage	www.arkansasbluecross.com/medicare	Medi-Pak Advantage (HMO)	1	1		1			H9699	4	3	2020	State of Arkansas	Central AR counties	2	7450	2			2						http://www.arkansasbluecross.com	www.arkansasbluecross.com/medicare	www.arkansasbluecross.com	(877)349-9335		(877)349-9335		(844)298-2444		(844)298-2444		(877)349-9335		(877)349-9335		(844)298-2444		(844)298-2444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9706	1	0	1	1	1	H9706_001_0	5	1			05/29/2019	2020.01	05/29/2019 03:44:56 PM Central Daylight Time	08/06/2019 02:24:30 PM Central Daylight Time	08/06/2019 02:24:34 PM Central Daylight Time			08/06/2019 05:03:07 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Value (HMO)	1	1		1			H9706	1	0	2020	"Collin, Dallas, Denton, Tarrant"		2	6871	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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	2			
H9706	2	0	1	1	1	H9706_002_0	5	1	2	1	08/06/2019	2020.01	08/06/2019 04:21:22 PM Central Daylight Time	08/06/2019 02:24:32 PM Central Daylight Time	08/06/2019 02:24:34 PM Central Daylight Time			08/06/2019 05:03:07 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)	1	1		1			H9706	2	0	2020	State of Texas		2	1223	2			1	3		1		2	www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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	2			
H9706	3	0	1	1	1	H9706_003_0	6	1			05/29/2019	2020.01	05/29/2019 03:45:30 PM Central Daylight Time	08/06/2019 02:24:32 PM Central Daylight Time	08/06/2019 02:24:34 PM Central Daylight Time			08/06/2019 05:03:07 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage Value (HMO)	1	1		1			H9706	3	0	2020	Travis County		2	2290	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(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	2			
H9706	801	0	1	1	1	H9706_801_0	2	1			05/30/2019	2020.01	05/30/2019 02:50:17 PM Central Daylight Time					06/03/2019 02:13:48 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage (HMO)	1	1		1			H9706	801	0	2020	Texas		1	1	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H9706	802	0	1	1	1	H9706_802_0	2	1			05/30/2019	2020.01	05/30/2019 03:09:35 PM Central Daylight Time					06/03/2019 02:13:48 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage (HMO)	1	1		1			H9706	802	0	2020	State of Texas		1	1	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(877)299-1008		(877)299-1008		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H9706	803	0	1	1	1	H9706_803_0	2	1			05/30/2019	2020.01	05/30/2019 03:11:01 PM Central Daylight Time					06/03/2019 02:13:48 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross and Blue Shield of Texas	www.getbluetx.com/mapd	Blue Cross Medicare Advantage (HMO)	1	1		1			H9706	803	0	2020	State of Texas		1	1	2			2						www.getbluetx.com/mapd/pharmacies	www.getbluetx.com/mapd/druglist	www.getbluetx.com/mapd/providers	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;	2		1					2				
H9712	1	0	1	48	5	H9712_001_0	7	1			08/08/2019	2020.01	08/08/2019 04:00:19 PM Eastern Daylight Time					08/08/2019 04:00:34 PM Eastern Daylight Time	"HAP MIDWEST HEALTH PLAN, INC."	HAP Empowered MI Health Link	www.hap.org/mihealthlink	HAP Empowered MI Health Link (Medicare-Medicaid Plan)	5	48		1			H9712	1	0	2020	HAP Midwest MI Health Link		2		1	1		2						www.hap.org/mihealthlink	www.hap.org/mihealthlink	www.hap.org/mihealthlink	(888)654-0706		(248)663-3800		(888)654-0706		(248)663-3800		(877)797-9698		(877)797-9698		(888)654-0706		(248)663-3800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-																
H9725	1	0	1	1	1	H9725_001_0	4	1			07/08/2019	2020.01	07/08/2019 04:20:32 PM Central Daylight Time	07/31/2019 06:24:08 PM Central Daylight Time	07/30/2019 04:30:27 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF NORTH CAROLINA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	1	1		1			H9725	1	0	2020	North Carolina		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	3	0	1	1	1	H9725_003_0	4	1	2	1	07/31/2019	2020.01	07/31/2019 03:19:42 PM Central Daylight Time	07/31/2019 06:24:30 PM Central Daylight Time	07/30/2019 04:30:45 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF NORTH CAROLINA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring TotalCare (HMO D-SNP)	1	1		1			H9725	3	0	2020	North Carolina		2		2			1	3		2		2	www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	5	0	1	1	1	H9725_005_0	3	1			07/08/2019	2020.01	07/08/2019 04:21:56 PM Central Daylight Time	05/30/2019 10:20:12 AM Central Daylight Time				07/11/2019 09:31:32 PM Central Daylight Time	"CIGNA HEALTHCARE OF NORTH CAROLINA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	1	1		1			H9725	5	0	2020	North Carolina		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9725	6	0	1	1	1	H9725_006_0	4	1			07/08/2019	2020.01	07/08/2019 04:22:46 PM Central Daylight Time	07/31/2019 06:24:51 PM Central Daylight Time	07/30/2019 04:30:58 PM Central Daylight Time			08/02/2019 11:15:43 AM Central Daylight Time	"CIGNA HEALTHCARE OF NORTH CAROLINA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring PreferredPlus (HMO)	1	1		1			H9725	6	0	2020	North Carolina		2		2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(800)668-3813		(800)668-3813		(866)625-2499		(866)625-2499		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9725	801	0	1	1	1	H9725_801_0	2	1			04/18/2019	2020.01	04/18/2019 02:25:57 PM Central Daylight Time					05/30/2019 06:10:28 PM Central Daylight Time	"CIGNA HEALTHCARE OF NORTH CAROLINA, INC."	Cigna-HealthSpring	www.cignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	1	1		1			H9725	801	0	2020	North Carolina		1	600	2			2						www.cignahealthspring.com	www.cignahealthspring.com	www.cignahealthspring.com	(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(888)281-7867		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H9730	2	0	1	1	1	H9730_002_0	5	1			07/11/2019	2020.01	07/11/2019 03:14:33 PM Eastern Daylight Time	08/02/2019 09:04:13 AM Eastern Daylight Time	07/30/2019 11:23:43 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC"	WellCare	www.wellcare.com/medicare	WellCare Value (HMO)	1	1		1			H9730	2	0	2020	Select counties in KY		2	23872	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	3	0	1	1	1	H9730_003_0	4	1	2	1	07/11/2019	2020.01	07/11/2019 01:41:48 PM Eastern Daylight Time	08/02/2019 09:06:09 AM Eastern Daylight Time	07/30/2019 11:24:20 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC"	WellCare	www.wellcare.com/medicare	WellCare Access (HMO D-SNP)	1	1		1			H9730	3	0	2020	Select counties in KY		2	51436	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	4	0	1	1	1	H9730_004_0	4	1	2	1	07/11/2019	2020.01	07/11/2019 01:39:07 PM Eastern Daylight Time	08/02/2019 09:08:04 AM Eastern Daylight Time	07/30/2019 11:24:56 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC"	WellCare	www.wellcare.com/medicare	WellCare Liberty (HMO D-SNP)	1	1		1			H9730	4	0	2020	Select counties in KY		2	31038	2			1	3		1		1	www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(833)444-9089		(833)444-9089		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	5	0	1	2	1	H9730_005_0	5	1			07/11/2019	2020.01	07/11/2019 01:43:11 PM Eastern Daylight Time	08/02/2019 09:09:59 AM Eastern Daylight Time	07/30/2019 11:25:32 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC"	WellCare	www.wellcare.com/medicare	WellCare Essential (HMO-POS)	1	2		1			H9730	5	0	2020	Select counties in KY		2	53750	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	6	0	1	2	1	H9730_006_0	4	1			07/11/2019	2020.01	07/11/2019 01:41:05 PM Eastern Daylight Time	06/02/2019 08:30:17 AM Eastern Daylight Time				07/12/2019 08:57:50 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC"	WellCare	www.wellcare.com/medicare	WellCare Advance (HMO-POS)	1	2		1			H9730	6	0	2020	Select counties in KY		2	1880	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056										(711)-		(711)-		(711)-		(711)-										2					2					2	2			
H9730	7	0	1	1	1	H9730_007_0	5	1			05/29/2019	2020.01	05/29/2019 09:25:10 AM Eastern Daylight Time	08/02/2019 09:13:45 AM Eastern Daylight Time	07/30/2019 11:26:08 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC"	WellCare	www.wellcare.com/medicare	WellCare Dividend (HMO)	1	1		1			H9730	7	0	2020	Select counties in KY		2	1308	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9730	9	0	1	1	1	H9730_009_0	5	1			07/12/2019	2020.01	07/12/2019 02:17:10 PM Eastern Daylight Time	08/02/2019 09:15:43 AM Eastern Daylight Time	07/30/2019 11:26:44 PM Eastern Daylight Time			08/05/2019 04:16:16 PM Eastern Daylight Time	"WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC"	WellCare	www.wellcare.com/medicare	WellCare Elite (HMO)	1	1		1			H9730	9	0	2020	Select counties in KY		2	39520	2			2						www.wellcare.com/medicare	www.wellcare.com/medicare	www.wellcare.com/medicare	(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(833)444-9088		(833)444-9088		(866)527-0056		(866)527-0056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9808	4	0	1	4	1	H9808_004_0	5	1			07/10/2019	2020.01	07/10/2019 01:01:07 PM Eastern Daylight Time	07/31/2019 02:34:00 PM Eastern Daylight Time	07/31/2019 04:36:20 PM Eastern Daylight Time			08/05/2019 02:42:41 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.healthteamadvantage.com	HealthTeam Advantage Plan I (PPO)	1	4		1			H9808	4	0	2020	AL GL RA RO FOR DV DVS		2	211000	2			2						www.healthteamadvantage.com	www.healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	5	0	1	4	1	H9808_005_0	5	1			07/10/2019	2020.01	07/10/2019 01:00:46 PM Eastern Daylight Time	07/31/2019 02:43:22 PM Eastern Daylight Time	07/31/2019 04:38:58 PM Eastern Daylight Time			08/05/2019 02:42:41 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.healthteamadvantage.com	HealthTeam Advantage Plan II (PPO)	1	4		1			H9808	5	0	2020	AL GL RA RO FOR DV DVS		2	21000	2			2						www.healthteamadvantage.com	www.healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	6	0	1	4	1	H9808_006_0	5	1			07/10/2019	2020.01	07/10/2019 01:00:14 PM Eastern Daylight Time	07/31/2019 02:48:01 PM Eastern Daylight Time	07/31/2019 04:40:58 PM Eastern Daylight Time			08/05/2019 02:42:41 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.tealpremier.com	Teal Premier Pro (PPO)	1	4		1			H9808	6	0	2020	AN BU CL LN ST UN		2	21000	2			2						www.tealpremier.com	www.tealpremier.com	www.tealpremier.com	(833)338-8325		(833)338-8325		(888)272-0202		(888)272-0202		(833)338-8325		(833)338-8325		(888)272-0202		(888)272-0202		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	7	0	1	4	1	H9808_007_0	5	1			07/10/2019	2020.01	07/10/2019 12:59:54 PM Eastern Daylight Time	07/31/2019 02:57:14 PM Eastern Daylight Time	07/31/2019 04:44:19 PM Eastern Daylight Time			08/05/2019 02:42:41 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.tealpremier.com	Teal Premier Pro Plus (PPO)	1	4		1			H9808	7	0	2020	AN BU CL LN ST UN		2	2000	2			2						www.tealpremier.com	www.tealpremier.com	www.tealpremier.com	(833)338-8325		(833)338-8325		(888)272-0202		(888)272-0202		(833)338-8325		(833)338-8325		(888)272-0202		(888)272-0202		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	804	0	1	4	1	H9808_804_0	1	1			06/03/2019	2020.01	06/03/2019 03:33:01 PM Eastern Daylight Time					06/03/2019 03:50:03 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.healthteamadvantage.com	HealthTeam Advantage Employer Group (PPO)	1	4		1			H9808	804	0	2020	AL GL RA RO FOR DV DAV		1	1	2			2						www.healthteamadvantage.com	www.healthteamadvantage.com	www.healthteamadvantage.com	(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(888)965-1965		(888)965-1965		(877)905-9216		(877)905-9216		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9808	805	0	1	4	1	H9808_805_0	1	1			06/03/2019	2020.01	06/03/2019 03:36:05 PM Eastern Daylight Time					06/03/2019 03:50:03 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	www.tealpremier.com	Teal Premier Pro Employer Plan (PPO)	1	4		1			H9808	805	0	2020	AN BU CL LN ST UN		1	1	2			2						www.tealpremier.com	www.tealpremier.com	www.tealpremier.com	(888)965-1965		(888)965-1965		(888)272-0202		(888)272-0202		(888)965-1965		(888)965-1965		(888)272-0202		(888)272-0202		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9811	1	0	1	1	1	H9811_001_0	5	1			08/01/2019	2020.01	08/01/2019 01:07:28 PM Eastern Daylight Time	08/05/2019 04:08:04 PM Central Daylight Time	08/05/2019 03:42:45 PM Central Daylight Time			08/06/2019 12:07:40 PM Central Daylight Time	"MAGNOLIA HEALTH PLAN, INC."	Allwell	allwell.magnoliahealthplan.com	Allwell Medicare (HMO)	1	1		1			H9811	1	0	2020	"Counties: GE, HA, HR, HI, JA, MD, RA, ST"		2		2			2						allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9811	5	0	1	1	1	H9811_005_0	3	1			08/01/2019	2020.01	08/01/2019 01:07:47 PM Eastern Daylight Time	08/05/2019 04:08:08 PM Central Daylight Time	08/05/2019 03:42:49 PM Central Daylight Time			08/06/2019 12:07:40 PM Central Daylight Time	"MAGNOLIA HEALTH PLAN, INC."	Allwell	allwell.magnoliahealthplan.com	Allwell Medicare (HMO)	1	1		1			H9811	5	0	2020	"Counties: DS, LA, PA, TA"		2		2			2						allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9811	6	0	1	1	1	H9811_006_0	4	1	2	1	08/01/2019	2020.01	08/01/2019 01:08:08 PM Eastern Daylight Time	08/05/2019 04:07:57 PM Central Daylight Time	08/05/2019 03:42:37 PM Central Daylight Time			08/06/2019 12:07:40 PM Central Daylight Time	"MAGNOLIA HEALTH PLAN, INC."	Allwell	allwell.magnoliahealthplan.com	Allwell Dual Medicare (HMO D-SNP)	1	1		1			H9811	6	0	2020	"Counties: GE,HA, HR, HI, JA, MD, RA, ST"		2		2			1	3		1		1	allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(833)260-4124		(833)260-4124		(877)826-5517		(877)826-5517		(833)260-4124		(833)260-4124		(877)826-5517		(877)826-5517		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9811	7	0	1	1	1	H9811_007_0	6	1	2	1	08/01/2019	2020.01	08/01/2019 01:08:53 PM Eastern Daylight Time	08/05/2019 04:08:00 PM Central Daylight Time	08/05/2019 03:42:40 PM Central Daylight Time			08/06/2019 12:07:40 PM Central Daylight Time	"MAGNOLIA HEALTH PLAN, INC."	Allwell	allwell.magnoliahealthplan.com	Allwell Dual Medicare Essentials (HMO D-SNP)	1	1		1			H9811	7	0	2020	"Counties: GE, HA, HR, HI, JA, MD, RA, ST"		2		2			1	3		2		2	allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(833)260-4124		(833)260-4124		(877)826-5517		(877)826-5517		(833)260-4124		(833)260-4124		(877)826-5517		(877)826-5517		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9811	801	0	1	1	1	H9811_801_0	3	1			05/06/2019	2020.01	05/06/2019 09:29:54 AM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"MAGNOLIA HEALTH PLAN, INC."	Allwell	allwell.magnoliahealthplan.com	Allwell Group (HMO)	1	1		1			H9811	801	0	2020	Statewide		1	100	2			2						allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H9811	802	0	1	1	1	H9811_802_0	3	1			05/03/2019	2020.01	05/03/2019 02:30:48 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"MAGNOLIA HEALTH PLAN, INC."	Allwell	allwell.magnoliahealthplan.com	Allwell Group (HMO)	1	1		1			H9811	802	0	2020	Statewide		1	100	2			2						allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H9811	803	0	1	1	1	H9811_803_0	3	1			05/03/2019	2020.01	05/03/2019 02:32:11 PM Pacific Daylight Time					05/31/2019 05:46:20 PM Pacific Daylight Time	"MAGNOLIA HEALTH PLAN, INC."	Allwell	allwell.magnoliahealthplan.com	Allwell Group (HMO)	1	1		1			H9811	803	0	2020	Statewide		1	100	2			2						allwell.magnoliahealthplan.com/findadoctor	allwell.magnoliahealthplan.com/formulary	allwell.magnoliahealthplan.com/findadoctor	(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(844)786-7711		(844)786-7711		(877)826-5517		(877)826-5517		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;3-1;3-2;3-3;3-4;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1					1				
H9826	1	0	1	1	1	H9826_001_0	9	1	2	1	08/06/2019	2020.01	08/06/2019 12:51:33 PM Central Daylight Time	08/05/2019 10:19:50 AM Central Daylight Time	07/31/2019 11:47:14 AM Central Daylight Time			08/06/2019 02:22:22 PM Central Daylight Time	"COMMUNITY HEALTH CHOICE TEXAS, INC."	Community Health Choice	www.communityhealthchoice.org	Community Health Choice (HMO D-SNP)	1	1		1			H9826	1	0	2020	Southeast Texas		2	12000	2			1	3		1		1	www.communityhealthchoice.org	www.communityhealthchoice.org	www.communityhealthchoice.org	(833)276-8306		(713)295-5007		(833)276-8306		(713)295-5007		(833)276-8306		(713)295-5007		(833)276-8306		(713)295-5007		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9830	1	0	1	20	8	H9830_001_0	1	1			05/16/2019	2020.01	05/16/2019 03:41:54 PM Mountain Daylight Time		05/16/2019 02:32:54 PM Mountain Daylight Time			05/16/2019 03:42:46 PM Mountain Daylight Time	"INNOVAGE PENNSYLVANIA LIFE, LLC"	InnovAge Pennsylvania LIFE	www.MyInnovAge.com	NewCourtland LIFE  - Dual (PACE)	8	20		1			H9830	1	0	2020	"NewCourtland LIFE - North, NW, NE Phila Svc Area"		2		2			2						https://www.granerx.com/	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H9830	2	0	1	20	8	H9830_002_0	1	1			05/16/2019	2020.01	05/16/2019 03:42:06 PM Mountain Daylight Time		05/16/2019 02:32:55 PM Mountain Daylight Time			05/16/2019 03:42:46 PM Mountain Daylight Time	"INNOVAGE PENNSYLVANIA LIFE, LLC"	InnovAge Pennsylvania LIFE	www.MyInnovAge.com	NewCourland LIFE - Medicare Only (PACE)	8	20		1			H9830	2	0	2020	"NewCourtland LIFE - North, NW, NE Phila Svc Area"		2		2			2						https://www.granerx.com/	N/A										(844)704-9613	711	(844)704-9613		(844)704-9613		(844)704-9613										(844)704-9613	711	(844)704-9613	711	(844)704-9613		(844)704-9613																
H9834	1	0	1	1	1	H9834_001_0	2	1			05/28/2019	2020.01	05/28/2019 10:59:16 AM Central Daylight Time	06/03/2019 09:54:41 PM Central Daylight Time	06/03/2019 09:54:10 PM Central Daylight Time			06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN MN CORPORATION	Senior Preferred	www.seniorpreferred.org	Gundersen MN Senior Preferred Elite (w/Rx) (HMO)	1	1		1			H9834	1	0	2020	"Counties: Fillmore, Houston, Winona"		2		2			2						https://www.seniorpreferred.org/seniorpreferredgundersenmn/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersenmn/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredgundersenmn/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H9834	3	0	1	1	1	H9834_003_0	2	1			05/28/2019	2020.01	05/28/2019 11:02:41 AM Central Daylight Time	06/03/2019 09:54:43 PM Central Daylight Time	06/03/2019 09:54:12 PM Central Daylight Time			06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN MN CORPORATION	Senior Preferred	www.seniorpreferred.org	Gundersen MN Senior Preferred Value (w/Rx) (HMO)	1	1		1			H9834	3	0	2020	"Counties: Fillmore, Houston, Winona"		2		2			2						https://www.seniorpreferred.org/seniorpreferredgundersenmn/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersenmn/DrugCoverage/PartDDrugFormulary	https://www.seniorpreferred.org/seniorpreferredgundersenmn/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H9834	4	0	1	1	1	H9834_004_0	2	1			05/23/2019	2020.01	05/23/2019 10:20:41 AM Central Daylight Time	06/03/2019 09:54:44 PM Central Daylight Time				06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN MN CORPORATION	Senior Preferred	www.seniorpreferred.org	Gundersen MN Senior Preferred Value (no Rx) (HMO)	1	1		1			H9834	4	0	2020	"Counties: Fillmore, Houston, Winona"		2		2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferredgundersenmn/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H9834	5	0	1	1	1	H9834_005_0	2	1			05/23/2019	2020.01	05/23/2019 10:20:53 AM Central Daylight Time	06/03/2019 09:54:45 PM Central Daylight Time				06/03/2019 09:58:43 PM Central Daylight Time	QUARTZ HEALTH PLAN MN CORPORATION	Senior Preferred	www.seniorpreferred.org	Gundersen MN Senior Preferred Elite (no Rx) (HMO)	1	1		1			H9834	5	0	2020	"Counties: Fillmore, Houston, Winona"		2		2			2						N/A	N/A	https://www.seniorpreferred.org/seniorpreferredgundersenmn/FindaDoctor	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2	2			
H9834	6	0	1	1	1	H9834_006_0	3	1			08/06/2019	2020.01	08/06/2019 10:36:24 AM Central Daylight Time	08/06/2019 03:57:43 PM Central Daylight Time	08/06/2019 03:57:43 PM Central Daylight Time			08/06/2019 04:06:55 PM Central Daylight Time	QUARTZ HEALTH PLAN MN CORPORATION	Senior Preferred	www.seniorpreferred.org	Gundersen MN Senior Preferred Core (w/Rx) (HMO)	1	1		1			H9834	6	0	2020	"Counties: Fillmore, Houston, Winona"		2		2			2						https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/FindaPharmacy	https://www.seniorpreferred.org/seniorpreferredgundersen/DrugCoverage/PartDDrugFormulary	http://www.seniorpreferred.org/	(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)394-5566		(608)881-8275		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2	2			
H9842	1	0	1	20	8	H9842_001_0	1	1			05/30/2019	2020.01	05/30/2019 02:43:34 PM Eastern Daylight Time		05/30/2019 02:30:12 PM Eastern Daylight Time			05/30/2019 02:45:12 PM Eastern Daylight Time	SAINT JOSEPH PACE	Saint Joseph PACE	sjmed.com\PACE	Saint Joseph PACE (PACE)	8	20		1			H9842	1	0	2020	"Partial Saint Joseph, Marshall & Elkhart counties"		2		2			2						TBD	TBD												(574)247-8700				(574)247-8700												(574)247-8701				(574)247-8701																
H9842	2	0	1	20	8	H9842_002_0	1	1			05/30/2019	2020.01	05/30/2019 02:44:05 PM Eastern Daylight Time		05/30/2019 02:30:02 PM Eastern Daylight Time			05/30/2019 02:45:12 PM Eastern Daylight Time	SAINT JOSEPH PACE	Saint Joseph PACE	sjmed.com\PACE	Saint Joseph PACE - Medicare Only (PACE)	8	20		1			H9842	2	0	2020	"Partial St. Joseph, Marshall & Elkhart Counties"		2		2			2						TBD	TBD												(574)247-8700				(574)247-8700												(574)247-8701				(574)247-8701																
H9861	1	0	1	1	1	H9861_001_0	16	1			07/16/2019	2020.01	07/16/2019 10:31:32 AM Eastern Daylight Time	08/01/2019 11:37:02 AM Eastern Daylight Time	08/01/2019 11:37:02 AM Eastern Daylight Time			08/02/2019 08:32:40 AM Eastern Daylight Time	"RELIANCE HMO, INC."	Reliance Medicare Advantage	RelianceMedicareAdvantage.org	Principle (HMO)	1	1		1			H9861	1	0	2020	"Wayne, Oakland, Macomb, Genesee, St. Clair, Monroe"		2		2			2						RelianceMedicareAdvantage.org	RelianceMedicareAdvantage.org	RelianceMedicareAdvantage.org			(855)959-5855				(248)715-5410		(855)959-5855		(855)959-5855		(248)715-5410		(248)715-5410		(855)959-5855		(855)959-5855		(248)715-5410		(248)715-5410		(855)959-5855		(855)959-5855		(248)715-5410		(248)715-5410		2					2					2	1	1	8b1;8b3;	
H9861	2	0	1	1	1	H9861_002_0	12	1			07/16/2019	2020.01	07/16/2019 10:32:26 AM Eastern Daylight Time	08/01/2019 11:37:02 AM Eastern Daylight Time	08/01/2019 11:37:02 AM Eastern Daylight Time			08/02/2019 08:32:40 AM Eastern Daylight Time	"RELIANCE HMO, INC."	Reliance Medicare Advantage	RelianceMedicareAdvantage.org	Cardinal (HMO)	1	1		1			H9861	2	0	2020	"Wayne, Oakland, Macomb, Genesee, St. Clair, Monroe"		2		2			2						RelianceMedicareAdvantage.org	RelianceMedicareAdvantage.org	RelianceMedicareAdvantage.org	(855)959-5855		(855)959-5855		(248)715-5410		(248)715-5410		(855)959-5855		(855)959-5855		(248)715-5410		(248)715-5410		(855)959-5855		(855)959-5855		(248)715-5410		(248)715-5410		(855)959-5855		(855)959-5855		(248)715-5410		(248)715-5410		2					2					2	1	1	8b1;8b3;	
H9869	1	0	1	48	5	H9869_001_0	4	1			06/19/2019	2020.01	06/19/2019 03:46:51 PM Central Daylight Time					06/19/2019 05:01:01 PM Central Daylight Time	"PARTNERS HEALTH PLAN, INC."	Partners Health Plan	www.phpcares.org	PHP Care Complete FIDA-IDD Plan (Medicare-Medicaid Plan)	5	48		1			H9869	1	0	2020	"Counties: Ki, Qu, Brx, NY, Ri, Wes, Suf, Na, Rck"		2		2			2						www.phpcares.org	www.phpcares.org	www.phpcares.org	(855)747-5483		(855)747-5483		(855)747-5483		(855)747-5483		(855)508-1718		(855)508-1718		(855)508-1718		(855)508-1718		(800)662-1220		(711)-		(800)662-1220		(711)-		(800)662-1220		(711)-		(800)662-1220		(711)-																
H9870	1	0	1	1	1	H9870_001_0	11	1	2	1	08/01/2019	2020.01	08/01/2019 01:32:57 PM Eastern Daylight Time	08/02/2019 11:44:36 AM Eastern Daylight Time	08/02/2019 11:44:58 AM Eastern Daylight Time			08/02/2019 11:58:01 AM Eastern Daylight Time	"UNIVERSITY HEALTH CARE, INC."	Passport Advantage	www.passportadvantage.com	Passport Advantage (HMO D-SNP)	1	1		1			H9870	1	0	2020	Jefferson and fifteen surrounding counties		2	35063	2			1	3		1		1	www.passportadvantage.com	www.passportadvantage.com	www.passportadvantage.com	(844)859-6152		(844)859-6152		(844)643-2780		(844)643-2780		(844)859-6152		(844)859-6152		(844)643-2780		(844)643-2780		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9877	1	0	1	1	1	H9877_001_0	8	1	2	1	09/19/2019	2020.01	09/19/2019 11:28:26 AM Eastern Daylight Time	08/06/2019 08:03:54 AM Eastern Daylight Time	08/06/2019 08:03:53 AM Eastern Daylight Time			09/19/2019 11:28:57 AM Eastern Daylight Time	"VIRGINIA PREMIER HEALTH PLAN, INC."	Virginia Premier	www.virginiapremier.com	Virginia Premier Advantage Elite (HMO D-SNP)	1	1		1			H9877	1	0	2020	"Central, Tidewater, Western, Roanoke, NOVA"		2	60000	2			1	3		1		1	www.virginiapremier.com	www.virginiapremier.com	www.virginiapremier.com	(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9877	2	0	1	1	1	H9877_002_0	4	1			08/01/2019	2020.01	08/01/2019 11:17:13 AM Eastern Daylight Time	08/06/2019 08:03:54 AM Eastern Daylight Time	08/06/2019 08:03:54 AM Eastern Daylight Time			08/06/2019 08:10:03 AM Eastern Daylight Time	"VIRGINIA PREMIER HEALTH PLAN, INC."	Virginia Premier	www.virginiapremier.com	Virginia Premier Advantage Gold (HMO)	1	1		1			H9877	2	0	2020	Central Virginia and Tidewater		2	24000	2			2						www.virginiapremier.com	www.virginiapremier.com	www.virginiapremier.com	(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9877	3	0	1	1	1	H9877_003_0	4	1			08/01/2019	2020.01	08/01/2019 11:17:29 AM Eastern Daylight Time	08/06/2019 08:03:54 AM Eastern Daylight Time	08/06/2019 08:03:54 AM Eastern Daylight Time			08/06/2019 08:12:46 AM Eastern Daylight Time	"VIRGINIA PREMIER HEALTH PLAN, INC."	Virginia Premier	www.virginiapremier.com	Virginia Premier Advantage Platinum (HMO)	1	1		1			H9877	3	0	2020	Central Virginia and Tidewater		2	24000	2			2						www.virginiapremier.com	www.virginiapremier.com	www.virginiapremier.com	(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(877)739-1370		(804)819-5151		(833)228-0051		(833)228-0051		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9878	1	0	1	4	1	H9878_001_0	6	1			07/16/2019	2020.01	07/16/2019 02:13:53 PM Central Daylight Time	08/02/2019 04:18:53 PM Central Daylight Time	08/02/2019 04:38:26 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF OHIO, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex (PPO)	1	4		1			H9878	1	0	2020	"Cincinnati, Toledo, and Youngstown Metro Areas"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9878	2	0	1	4	1	H9878_002_0	7	1			07/16/2019	2020.01	07/16/2019 02:15:10 PM Central Daylight Time	08/02/2019 04:19:20 PM Central Daylight Time	08/02/2019 04:37:30 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF OHIO, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex Plus (PPO)	1	4		1			H9878	2	0	2020	"Cincinnati, Toledo, and Youngstown Metro Areas"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9878	3	0	1	4	1	H9878_003_0	7	1			07/16/2019	2020.01	07/16/2019 12:45:43 PM Central Daylight Time	08/02/2019 04:19:14 PM Central Daylight Time	08/02/2019 04:37:18 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF OHIO, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex (PPO)	1	4		1			H9878	3	0	2020	Cleveland and Akron Metro Areas		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)221-5484		(844)221-5484		(833)412-7707		(833)412-7707		(844)221-5484		(844)221-5484		(833)412-7707		(833)412-7707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9878	6	0	1	4	1	H9878_006_0	7	1			08/08/2019	2020.01	08/08/2019 02:19:04 PM Central Daylight Time	08/02/2019 04:19:08 PM Central Daylight Time	08/02/2019 04:36:44 PM Central Daylight Time			08/08/2019 02:20:54 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF OHIO, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Flex Choice (PPO)	1	4		1			H9878	6	0	2020	"Cincinnati, Toledo, and Youngstown Metro Areas"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9878	7	0	1	4	1	H9878_007_0	7	1			07/16/2019	2020.01	07/16/2019 02:18:37 PM Central Daylight Time	08/02/2019 04:19:05 PM Central Daylight Time	08/02/2019 04:36:07 PM Central Daylight Time			08/05/2019 04:12:10 PM Central Daylight Time	"BRIGHT HEALTH INSURANCE COMPANY OF OHIO, INC."	Bright Health	https://brighthealthplan.com/medicare-advantage	Bright Advantage Access (PPO)	1	4		1			H9878	7	0	2020	"Cincinnati, Toledo, and Youngstown Metro Areas"		2		2			2						https://brighthealthplan.com/provider-finder/ma/	https://brighthealthplan.com/drug-search/ma/	https://brighthealthplan.com/provider-finder/ma/	(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(844)202-4031		(844)202-4031		(844)713-0099		(844)713-0099		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9909	1	0	1	1	1	H9909_001_0	3	1		1	08/01/2019	2020.01	08/01/2019 05:56:03 PM Central Daylight Time	08/01/2019 02:22:29 PM Central Daylight Time	07/30/2019 05:14:34 PM Central Daylight Time			08/05/2019 04:59:22 PM Central Daylight Time	"AMERICAN HEALTH PLAN OF MS, INC."	American Health Advantage of MS	ms.amhealthplans.com	American Health Advantage of Mississippi (HMO I-SNP)	1	1		1			H9909	1	0	2020	Mississippi		2	3282	2			1	1	3				ms.amhealthplans.com	ms.amhealthplans.com	ms.amhealthplans.com	(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(844)321-1763		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2	2			
H9942	1	0	1	4	1	H9942_001_0	6	1		1	08/01/2019	2020.01	08/01/2019 12:14:34 PM Central Daylight Time	08/01/2019 04:07:28 PM Central Daylight Time	08/01/2019 10:35:21 AM Central Daylight Time			08/02/2019 12:26:08 PM Central Daylight Time	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Longevity Health Plan	www.longevityhealthplan.com	Longevity Health Plan (PPO I-SNP)	1	4		1			H9942	1	0	2020	New Jersey (partial)		2		2			1	1	1				www.longevityhealthplan.com	www.longevityhealthplan.com	www.longevityhealthplan.com	(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(888)885-7337		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
H9952	1	0	1	1	1	H9952_001_0	7	1	2	1	08/05/2019	2020.01	08/05/2019 08:03:06 PM Central Daylight Time	08/07/2019 11:24:18 AM Central Daylight Time	08/05/2019 04:56:17 PM Central Daylight Time			08/07/2019 11:31:42 AM Central Daylight Time	MEDICA HEALTH PLANS	Medica	medica.com	Medica AccessAbility Solution Enhanced (HMO D-SNP)	1	1		1			H9952	1	0	2020	Minneapolis/St. Paul Metro Area		2		2			1	3		1		1	medica.com/Members	medica.com/Members	medica.com/Members	(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2	2			
H9998	1	0	1	20	8	H9998_001_0	1	1			05/22/2019	2020.01	05/22/2019 04:40:02 PM Central Daylight Time		05/22/2019 04:07:46 PM Central Daylight Time			05/22/2019 04:42:21 PM Central Daylight Time	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	Silver Star	www.silverstar.org	Silver Star - Dual (PACE)	8	20		1			H9998	1	0	2020	Lubbock County		2		2			2						http://www.seniorscript.com/	www.silverstarlubbock.org										(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	2	0	1	20	8	H9998_002_0	1	1			05/22/2019	2020.01	05/22/2019 04:40:36 PM Central Daylight Time		05/22/2019 04:08:00 PM Central Daylight Time			05/22/2019 04:42:21 PM Central Daylight Time	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	Silver Star	www.silverstar.org	Silver Star - Medicare only (PACE)	8	20		1			H9998	2	0	2020	Lubbock County		2		2			2						http://www.seniorscript.com/	www.silverstarlubbock.org										(806)767-1736		(806)740-1500		(806)767-1736		(806)740-1500										(806)767-1736		(806)740-1500		(806)767-1736		(806)740-1500																
R0110	1	0	1	31	11	R0110_001_0	6	1			08/06/2019	2020.01	08/06/2019 11:39:05 AM Eastern Daylight Time	08/03/2019 10:20:26 AM Eastern Daylight Time				08/06/2019 01:33:07 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0110-001 (Regional PPO)	11	31		1			R0110	1	0	2020	States of Louisiana and Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R0110	2	0	1	31	11	R0110_002_0	4	1			07/15/2019	2020.01	07/15/2019 01:32:51 PM Eastern Daylight Time	08/03/2019 10:28:39 AM Eastern Daylight Time	08/02/2019 01:19:03 PM Eastern Daylight Time			08/05/2019 11:17:46 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0110-002 (Regional PPO)	11	31		1			R0110	2	0	2020	States of Louisiana and Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R0110	3	0	1	31	11	R0110_003_0	6	1			08/06/2019	2020.01	08/06/2019 11:41:02 AM Eastern Daylight Time	08/03/2019 11:57:30 AM Eastern Daylight Time	08/02/2019 01:19:03 PM Eastern Daylight Time			08/06/2019 01:33:07 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0110-003 (Regional PPO)	11	31		1			R0110	3	0	2020	States of Louisiana and Mississippi		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R0110	801	0	1	31	11	R0110_801_0	2	1			05/28/2019	2020.01	05/28/2019 11:51:19 AM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0110	801	0	2020	States of Louisiana and Mississippi		1	2036	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R0110	802	0	1	31	11	R0110_802_0	1	1			05/28/2019	2020.01	05/28/2019 12:05:28 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0110	802	0	2020	States of Louisiana and Mississippi		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R0759	1	0	1	31	11	R0759_001_0	4	1			08/02/2019	2020.01	08/02/2019 12:36:55 PM Central Daylight Time	08/02/2019 10:15:06 AM Central Daylight Time	07/30/2019 10:16:44 PM Central Daylight Time			08/06/2019 12:41:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Choice Plan 2 (Regional PPO)	11	31		1			R0759	1	0	2020	Entire state of Florida		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R0759	2	0	1	31	11	R0759_002_0	5	1			08/05/2019	2020.01	08/05/2019 09:26:45 AM Central Daylight Time	08/02/2019 10:18:27 AM Central Daylight Time				08/06/2019 12:41:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP Medicare Advantage Choice Essential (Regional PPO)	11	31		1			R0759	2	0	2020	Entire state of Florida		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
R0759	3	0	1	31	11	R0759_003_0	3	1	2	1	08/06/2019	2020.01	08/06/2019 11:56:13 AM Central Daylight Time	08/02/2019 10:23:22 AM Central Daylight Time	07/30/2019 10:17:22 PM Central Daylight Time			08/06/2019 03:47:42 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)	11	31		1			R0759	3	0	2020	State of Florida		2		2			1	3		2		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(866)842-4968		(866)842-4968		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R0802	1	0	1	31	11	R0802_001_0	7	1			08/08/2019	2020.01	08/08/2019 02:10:28 PM Eastern Daylight Time	08/05/2019 01:19:47 PM Eastern Daylight Time	08/05/2019 01:19:48 PM Eastern Daylight Time			08/08/2019 03:46:34 PM Eastern Daylight Time	"MARTIN'S POINT GENERATIONS ADVANTAGE, INC."	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Flex (Regional PPO)	11	31		1			R0802	1	0	2020	Northern New England (New Hampshire and 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		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R0865	1	0	1	31	11	R0865_001_0	6	1			08/05/2019	2020.01	08/05/2019 01:33:04 PM Eastern Daylight Time	08/04/2019 06:13:29 PM Eastern Daylight Time				08/05/2019 01:36:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0865-001 (Regional PPO)	11	31		1			R0865	1	0	2020	States of Indiana and Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R0865	3	0	1	31	11	R0865_003_0	3	1			07/16/2019	2020.01	07/16/2019 06:05:14 PM Eastern Daylight Time	08/04/2019 07:51:08 PM Eastern Daylight Time	08/02/2019 01:19:03 PM Eastern Daylight Time			08/05/2019 11:26:04 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0865-003 (Regional PPO)	11	31		1			R0865	3	0	2020	States of Indiana and Kentucky		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R0865	801	0	1	31	11	R0865_801_0	1	1			05/28/2019	2020.01	05/28/2019 12:07:56 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0865	801	0	2020	States of Indiana and Kentucky		1	5750	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R0865	802	0	1	31	11	R0865_802_0	1	1			05/28/2019	2020.01	05/28/2019 12:10:11 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0865	802	0	2020	States of Indiana and Kentucky		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R0923	1	0	1	31	11	R0923_001_0	3	1			08/02/2019	2020.01	08/02/2019 05:16:17 PM Eastern Daylight Time	08/04/2019 06:11:30 PM Eastern Daylight Time				08/05/2019 11:27:24 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0923-001 (Regional PPO)	11	31		1			R0923	1	0	2020	States of Pennsylvania and West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R0923	2	0	1	31	11	R0923_002_0	5	1			07/15/2019	2020.01	07/15/2019 03:30:39 PM Eastern Daylight Time	08/04/2019 07:49:08 PM Eastern Daylight Time	08/02/2019 01:19:04 PM Eastern Daylight Time			08/05/2019 11:27:24 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R0923-002 (Regional PPO)	11	31		1			R0923	2	0	2020	States of Pennsylvania and West Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R0923	801	0	1	31	11	R0923_801_0	1	1			05/28/2019	2020.01	05/28/2019 12:13:52 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0923	801	0	2020	States of Pennsylvania and West Verginia		1	1802	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R0923	802	0	1	31	11	R0923_802_0	1	1			05/28/2019	2020.01	05/28/2019 12:16:08 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R0923	802	0	2020	States of Pennsylvania and West Verginia		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R1390	1	0	1	31	11	R1390_001_0	4	1			07/15/2019	2020.01	07/15/2019 11:09:57 AM Eastern Daylight Time	08/04/2019 04:25:16 PM Eastern Daylight Time				08/05/2019 11:23:32 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1390-001 (Regional PPO)	11	31		1			R1390	1	0	2020	States of North Carolina and Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R1390	2	0	1	31	11	R1390_002_0	4	1			07/15/2019	2020.01	07/15/2019 11:11:22 AM Eastern Daylight Time	08/04/2019 04:26:51 PM Eastern Daylight Time	08/02/2019 01:19:04 PM Eastern Daylight Time			08/05/2019 11:13:56 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1390-002 (Regional PPO)	11	31		1			R1390	2	0	2020	States of North Carolina and Virginia		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R1390	801	0	1	31	11	R1390_801_0	1	1			05/28/2019	2020.01	05/28/2019 12:20:04 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1390	801	0	2020	States of North Carolina and Virginia		1	2122	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R1390	802	0	1	31	11	R1390_802_0	1	1			05/28/2019	2020.01	05/28/2019 12:23:41 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1390	802	0	2020	States of North Carolina and Virginia		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R1532	1	0	1	31	11	R1532_001_0	3	1			08/01/2019	2020.01	08/01/2019 02:46:13 PM Eastern Daylight Time	08/02/2019 09:23:47 AM Eastern Daylight Time				08/05/2019 11:43:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1532-001 (Regional PPO)	11	31		1			R1532	1	0	2020	States of Arkansas and Missouri		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription-drugs/medicare_drug_tools/medicare_drug_list	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R1532	2	0	1	31	11	R1532_002_0	3	1			07/15/2019	2020.01	07/15/2019 12:23:37 PM Eastern Daylight Time	08/02/2019 10:38:57 AM Eastern Daylight Time	08/02/2019 01:19:04 PM Eastern Daylight Time			08/05/2019 11:43:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R1532-002 (Regional PPO)	11	31		1			R1532	2	0	2020	States of Arkansas and Missouri		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription-drugs/medicare_drug_tools/medicare_drug_list	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R1532	801	0	1	31	11	R1532_801_0	2	1			05/28/2019	2020.01	05/28/2019 03:55:17 PM Eastern Daylight Time					05/28/2019 03:56:30 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1532	801	0	2020	States of Arkansas and Missouri		1	1481	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription-drugs/medicare_drug_tools/medicare_drug_list	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R1532	802	0	1	31	11	R1532_802_0	1	1			05/28/2019	2020.01	05/28/2019 12:26:42 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R1532	802	0	2020	States of Arkansas and Missouri		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription-drugs/medicare_drug_tools/medicare_drug_list	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R1548	1	0	1	31	11	R1548_001_0	4	1	2	1	08/02/2019	2020.01	08/02/2019 03:40:54 PM Central Daylight Time	08/02/2019 10:28:23 AM Central Daylight Time	07/30/2019 10:17:57 PM Central Daylight Time			08/06/2019 03:47:42 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE CO OF THE RIVER VALLEY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)	11	31		1			R1548	1	0	2020	North Carolina and Virginia		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(844)368-7151		(844)368-7151		(888)834-3721		(888)834-3721		(844)368-7151		(844)368-7151		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R2604	1	0	1	31	11	R2604_001_0	3	1			08/02/2019	2020.01	08/02/2019 01:39:35 PM Central Daylight Time	08/02/2019 10:33:32 AM Central Daylight Time	07/30/2019 10:18:30 PM Central Daylight Time			08/06/2019 09:57:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice (Regional PPO)	11	31		1			R2604	1	0	2020	Georgia and South Carolina		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R2604	2	0	1	31	11	R2604_002_0	4	1		1	08/02/2019	2020.01	08/02/2019 01:41:06 PM Central Daylight Time	08/02/2019 10:37:49 AM Central Daylight Time	07/30/2019 10:19:03 PM Central Daylight Time			08/06/2019 09:57:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Silver (Regional PPO C-SNP)	11	31		1			R2604	2	0	2020	Georgia and South Carolina		2		2			1	4			100		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R2604	3	0	1	31	11	R2604_003_0	3	1		1	08/05/2019	2020.01	08/05/2019 03:43:38 PM Central Daylight Time	08/02/2019 10:42:12 AM Central Daylight Time	07/30/2019 10:19:37 PM Central Daylight Time			08/06/2019 09:57:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Gold (Regional PPO C-SNP)	11	31		1			R2604	3	0	2020	Georgia and South Carolina		2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R2604	4	0	1	31	11	R2604_004_0	3	1	2	1	08/05/2019	2020.01	08/05/2019 04:30:12 PM Central Daylight Time	08/02/2019 10:46:32 AM Central Daylight Time	07/30/2019 10:20:10 PM Central Daylight Time			08/06/2019 09:57:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP)	11	31		1			R2604	4	0	2020	Georgia and South Carolina		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R2604	5	0	1	31	11	R2604_005_0	3	1			08/05/2019	2020.01	08/05/2019 03:44:38 PM Central Daylight Time	08/02/2019 10:51:30 AM Central Daylight Time				08/06/2019 09:57:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Essential (Regional PPO)	11	31		1			R2604	5	0	2020	Georgia and South Carolina		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2						2			
R3175	3	0	1	31	11	R3175_003_0	2	1	2	1	08/06/2019	2020.01	08/06/2019 09:15:25 AM Central Daylight Time	08/02/2019 10:53:27 AM Central Daylight Time	07/30/2019 10:20:48 PM Central Daylight Time			08/06/2019 09:21:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO D-SNP)	11	31		1			R3175	3	0	2020	State of Hawaii		2		2			1	3		1		1	www.UHCCommunityPlan.com	www.UHCCommunityPlan.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						2			
R3175	801	0	1	31	11	R3175_801_0	1	1			05/11/2019	2020.01	05/11/2019 07:44:22 AM Central Daylight Time					06/02/2019 05:56:05 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R3175	801	0	2020	State of Hawaii		1	0	2			2						www.UHCCommunityPlan.com	www.UHCCommunityPlan.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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
R3175	802	0	1	31	11	R3175_802_0	1	1			05/11/2019	2020.01	05/11/2019 07:44:59 AM Central Daylight Time					06/02/2019 05:56:05 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R3175	802	0	2020	State of Hawaii		1	0	2			2						www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R3332	1	0	1	31	11	R3332_001_0	9	1			07/15/2019	2020.01	07/15/2019 11:16:10 AM Eastern Daylight Time	08/01/2019 02:52:00 PM Eastern Daylight Time	07/30/2019 05:39:18 PM Eastern Daylight Time			08/02/2019 11:51:49 AM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Choice (Regional PPO)	11	31		1			R3332	1	0	2020	State of Florida		2		2			2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare	(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			
R3392	1	0	1	31	11	R3392_001_0	3	1			08/01/2019	2020.01	08/01/2019 06:59:53 PM Eastern Daylight Time	08/04/2019 11:33:00 AM Eastern Daylight Time				08/05/2019 11:13:01 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3392-001 (Regional PPO)	11	31		1			R3392	1	0	2020	States of Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R3392	2	0	1	31	11	R3392_002_0	4	1			08/02/2019	2020.01	08/02/2019 11:13:21 AM Eastern Daylight Time	08/04/2019 11:35:25 AM Eastern Daylight Time	08/02/2019 01:19:04 PM Eastern Daylight Time			08/05/2019 11:13:01 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3392-002 (Regional PPO)	11	31		1			R3392	2	0	2020	States of Georgia and South Carolina		2		2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3392	801	0	1	31	11	R3392_801_0	1	1			05/28/2019	2020.01	05/28/2019 12:28:15 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3392	801	0	2020	States of Georgia and South Carolina		1	3332	2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R3392	802	0	1	31	11	R3392_802_0	1	1			05/28/2019	2020.01	05/28/2019 12:35:02 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3392	802	0	2020	States of Georgia and South Carolina		1	1200	2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R3444	8	0	1	31	11	R3444_008_0	4	1		1	08/05/2019	2020.01	08/05/2019 08:52:37 AM Central Daylight Time	08/02/2019 11:12:18 AM Central Daylight Time	07/31/2019 10:57:40 AM Central Daylight Time			08/05/2019 05:47:16 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Silver (Regional PPO C-SNP)	11	31		1			R3444	8	0	2020	Arkansas and Missouri		2		2			1	4			100		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3444	9	0	1	31	11	R3444_009_0	3	1		1	08/05/2019	2020.01	08/05/2019 05:41:57 PM Central Daylight Time	08/02/2019 11:15:46 AM Central Daylight Time	07/30/2019 10:22:00 PM Central Daylight Time			08/05/2019 05:47:16 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Gold (Regional PPO C-SNP)	11	31		1			R3444	9	0	2020	Arkansas and Missouri		2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3444	11	0	1	31	11	R3444_011_0	4	1	2	1	08/05/2019	2020.01	08/05/2019 05:18:22 PM Central Daylight Time	08/02/2019 11:19:19 AM Central Daylight Time	07/30/2019 10:22:33 PM Central Daylight Time			08/05/2019 05:47:16 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP)	11	31		1			R3444	11	0	2020	Arkansas and Missouri		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3444	12	0	1	31	11	R3444_012_0	3	1			08/05/2019	2020.01	08/05/2019 05:42:25 PM Central Daylight Time	08/02/2019 11:22:43 AM Central Daylight Time	07/30/2019 10:23:06 PM Central Daylight Time			08/05/2019 05:47:16 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 2 (Regional PPO)	11	31		1			R3444	12	0	2020	Arkansas and Missouri		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3444	23	0	1	31	11	R3444_023_0	4	1			08/05/2019	2020.01	08/05/2019 05:44:18 PM Central Daylight Time	08/02/2019 11:26:08 AM Central Daylight Time	07/30/2019 10:23:39 PM Central Daylight Time			08/05/2019 05:47:16 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)	11	31		1			R3444	23	0	2020	Arkansas and Missouri		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3887	1	0	1	31	11	R3887_001_0	4	1			08/05/2019	2020.01	08/05/2019 02:52:04 PM Eastern Daylight Time	08/04/2019 02:33:21 PM Eastern Daylight Time				08/05/2019 02:52:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3887-001 (Regional PPO)	11	31		1			R3887	1	0	2020	State of Michigan		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tool/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R3887	2	0	1	31	11	R3887_002_0	3	1			08/02/2019	2020.01	08/02/2019 02:03:06 PM Eastern Daylight Time	08/04/2019 03:18:40 PM Eastern Daylight Time	08/02/2019 01:19:04 PM Eastern Daylight Time			08/05/2019 11:09:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R3887-002 (Regional PPO)	11	31		1			R3887	2	0	2020	State of Michigan		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tool/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R3887	801	0	1	31	11	R3887_801_0	1	1			05/28/2019	2020.01	05/28/2019 12:38:31 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3887	801	0	2020	State of Michigan		1	4072	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tool/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R3887	802	0	1	31	11	R3887_802_0	1	1			05/28/2019	2020.01	05/28/2019 12:40:11 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R3887	802	0	2020	State of Michigan		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tool/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R4182	1	0	1	31	11	R4182_001_0	3	1			08/01/2019	2020.01	08/01/2019 06:52:57 PM Eastern Daylight Time	08/04/2019 04:11:00 PM Eastern Daylight Time				08/05/2019 11:25:37 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4182-001 (Regional PPO)	11	31		1			R4182	1	0	2020	State of Texas		2		2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R4182	3	0	1	31	11	R4182_003_0	3	1			07/15/2019	2020.01	07/15/2019 10:34:29 AM Eastern Daylight Time	08/04/2019 04:14:59 PM Eastern Daylight Time	08/02/2019 01:19:04 PM Eastern Daylight Time			08/05/2019 11:25:37 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4182-003 (Regional PPO)	11	31		1			R4182	3	0	2020	State of Texas		2		2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R4182	4	0	1	31	11	R4182_004_0	3	1			08/01/2019	2020.01	08/01/2019 06:58:22 PM Eastern Daylight Time	08/04/2019 04:13:43 PM Eastern Daylight Time	08/02/2019 01:19:04 PM Eastern Daylight Time			08/05/2019 11:25:37 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4182-004 (Regional PPO)	11	31		1			R4182	4	0	2020	State of Texas		2		2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R4182	801	0	1	31	11	R4182_801_0	1	1			05/28/2019	2020.01	05/28/2019 12:41:47 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4182	801	0	2020	State of Texas		1	3319	2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R4182	802	0	1	31	11	R4182_802_0	1	1			05/28/2019	2020.01	05/28/2019 12:44:52 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4182	802	0	2020	State of Texas		1	1200	2			2						https://www.humana.com/pharmacy/	http:www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R4487	1	0	1	31	11	R4487_001_0	7	1			06/25/2019	2020.01	06/25/2019 05:24:39 PM Eastern Daylight Time	08/05/2019 10:09:44 AM Eastern Daylight Time	07/30/2019 08:53:28 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	www.anthem.com	Anthem MediBlue Access Basic (Regional PPO)	11	31		1			R4487	1	0	2020	Indiana and Kentucky		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(844)364-2116		(844)364-2116		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R4845	1	0	1	31	11	R4845_001_0	3	1			07/15/2019	2020.01	07/15/2019 11:46:12 AM Eastern Daylight Time	08/02/2019 09:25:07 AM Eastern Daylight Time				08/05/2019 11:43:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4845-001 (Regional PPO)	11	31		1			R4845	1	0	2020	States of Kansas and Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R4845	2	0	1	31	11	R4845_002_0	3	1			07/15/2019	2020.01	07/15/2019 03:52:26 PM Eastern Daylight Time	08/02/2019 10:37:25 AM Eastern Daylight Time	08/02/2019 01:19:04 PM Eastern Daylight Time			08/05/2019 11:43:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R4845-002 (Regional PPO)	11	31		1			R4845	2	0	2020	States of Kansas and Oklahoma		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R4845	801	0	1	31	11	R4845_801_0	1	1			05/28/2019	2020.01	05/28/2019 12:46:24 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4845	801	0	2020	States of Kansas and Oklahoma		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R4845	802	0	1	31	11	R4845_802_0	1	1			05/28/2019	2020.01	05/28/2019 12:48:16 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R4845	802	0	2020	States of Kansas and Oklahoma		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5329	1	0	1	31	11	R5329_001_0	4	1			08/02/2019	2020.01	08/02/2019 10:10:49 AM Central Daylight Time	08/02/2019 11:17:25 AM Central Daylight Time	07/30/2019 10:24:15 PM Central Daylight Time			08/06/2019 01:46:00 PM Central Daylight Time	"SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC."	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (Regional PPO)	11	31		1			R5329	1	0	2020	Rural ME and NH		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5342	1	0	1	31	11	R5342_001_0	3	1			08/02/2019	2020.01	08/02/2019 01:37:34 PM Central Daylight Time	08/02/2019 11:22:03 AM Central Daylight Time	07/30/2019 10:24:50 PM Central Daylight Time			08/06/2019 09:57:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO)	11	31		1			R5342	1	0	2020	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						2			
R5342	2	0	1	31	11	R5342_002_0	3	1			07/11/2019	2020.01	07/11/2019 11:35:18 AM Central Daylight Time	08/02/2019 11:22:41 AM Central Daylight Time				08/07/2019 04:22:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Essential (Regional PPO)	11	31		1			R5342	2	0	2020	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						2			
R5342	5	0	1	31	11	R5342_005_0	3	1			08/02/2019	2020.01	08/02/2019 01:38:04 PM Central Daylight Time	08/02/2019 11:23:18 AM Central Daylight Time	07/30/2019 10:25:22 PM Central Daylight Time			08/06/2019 09:57:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 3 (Regional PPO)	11	31		1			R5342	5	0	2020	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						2			
R5342	6	0	1	31	11	R5342_006_0	3	1			08/02/2019	2020.01	08/02/2019 01:38:27 PM Central Daylight Time	08/02/2019 11:23:54 AM Central Daylight Time	07/30/2019 10:25:57 PM Central Daylight Time			08/06/2019 09:57:12 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice Plan 4 (Regional PPO)	11	31		1			R5342	6	0	2020	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						2			
R5342	801	0	1	31	11	R5342_801_0	1	1			05/11/2019	2020.01	05/11/2019 07:45:49 AM Central Daylight Time					06/02/2019 05:57:36 PM 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	2020	State of New York		1	732	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
R5342	802	0	1	31	11	R5342_802_0	1	1			05/11/2019	2020.01	05/11/2019 07:46:27 AM Central Daylight Time					06/02/2019 05:57:36 PM 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	2020	State of New York		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
R5342	803	0	1	31	11	R5342_803_0	1	1			05/11/2019	2020.01	05/11/2019 07:47:06 AM Central Daylight Time					06/02/2019 05:57:36 PM 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	2020	New York		1	0	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	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;15;16b;17a;18a;	2		1									
R5361	1	0	1	31	11	R5361_001_0	3	1			07/15/2019	2020.01	07/15/2019 03:49:25 PM Eastern Daylight Time	08/04/2019 02:48:06 PM Eastern Daylight Time				08/05/2019 10:56:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5361-001 (Regional PPO)	11	31		1			R5361	1	0	2020	States of Illinois and Wisconsin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5361	2	0	1	31	11	R5361_002_0	2	1			05/27/2019	2020.01	05/27/2019 09:12:06 AM Eastern Daylight Time	08/04/2019 03:38:03 PM Eastern Daylight Time	08/02/2019 01:19:05 PM Eastern Daylight Time			08/05/2019 10:56:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5361-002 (Regional PPO)	11	31		1			R5361	2	0	2020	States of Illinois and Wisconsin		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5361	801	0	1	31	11	R5361_801_0	1	1			05/28/2019	2020.01	05/28/2019 12:50:19 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5361	801	0	2020	States of Illinois and Wisconsin		1	9674	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5361	802	0	1	31	11	R5361_802_0	1	1			05/28/2019	2020.01	05/28/2019 12:51:32 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5361	802	0	2020	States of Illnois and Wisconsin		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5495	1	0	1	31	11	R5495_001_0	4	1			08/01/2019	2020.01	08/01/2019 06:32:22 PM Eastern Daylight Time	08/04/2019 02:31:04 PM Eastern Daylight Time				08/05/2019 11:09:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5495-001 (Regional PPO)	11	31		1			R5495	1	0	2020	State of Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5495	2	0	1	31	11	R5495_002_0	3	1			07/15/2019	2020.01	07/15/2019 04:10:49 PM Eastern Daylight Time	08/04/2019 03:19:25 PM Eastern Daylight Time	08/02/2019 01:19:05 PM Eastern Daylight Time			08/05/2019 11:09:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5495-002 (Regional PPO)	11	31		1			R5495	2	0	2020	State of Ohio		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5495	801	0	1	31	11	R5495_801_0	1	1			05/28/2019	2020.01	05/28/2019 12:53:14 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5495	801	0	2020	State of Ohio		1	3689	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5495	802	0	1	31	11	R5495_802_0	1	1			05/28/2019	2020.01	05/28/2019 12:55:37 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5495	802	0	2020	State of Ohio		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5826	5	0	1	31	11	R5826_005_0	3	1			07/16/2019	2020.01	07/16/2019 01:33:52 PM Eastern Daylight Time	08/04/2019 05:21:11 PM Eastern Daylight Time	08/02/2019 01:19:05 PM Eastern Daylight Time			08/05/2019 11:10:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5826-005 (Regional PPO)	11	31		1			R5826	5	0	2020	State of Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	18	0	1	31	11	R5826_018_0	3	1			08/01/2019	2020.01	08/01/2019 07:08:49 PM Eastern Daylight Time	08/04/2019 05:03:38 PM Eastern Daylight Time				08/05/2019 11:10:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5826-018 (Regional PPO)	11	31		1			R5826	18	0	2020	State of Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5826	74	0	1	31	11	R5826_074_0	3	1			08/02/2019	2020.01	08/02/2019 01:10:03 PM Eastern Daylight Time	08/04/2019 05:04:54 PM Eastern Daylight Time	08/02/2019 01:19:05 PM Eastern Daylight Time			08/05/2019 11:10:23 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R5826-074 (Regional PPO)	11	31		1			R5826	74	0	2020	State of Florida		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R5826	805	0	1	31	11	R5826_805_0	1	1			05/28/2019	2020.01	05/28/2019 12:57:33 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	805	0	2020	State of Florida		1	8452	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5826	819	0	1	31	11	R5826_819_0	1	1			05/28/2019	2020.01	05/28/2019 12:58:52 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	819	0	2020	State of Florida		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R5941	13	0	1	31	11	R5941_013_0	6	1			06/03/2019	2020.01	06/03/2019 03:49:16 PM Eastern Daylight Time	08/05/2019 10:09:45 AM Eastern Daylight Time				08/05/2019 04:12:19 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Core (Regional PPO)	11	31		1			R5941	13	0	2020	Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(800)467-1199		(800)467-1199		(800)797-0560		(800)797-0560										(711)-		(711)-		(711)-		(711)-										2					2						2			
R5941	14	0	1	31	11	R5941_014_0	6	1			06/25/2019	2020.01	06/25/2019 05:24:53 PM Eastern Daylight Time	08/05/2019 10:09:45 AM Eastern Daylight Time	07/30/2019 08:54:56 PM Eastern Daylight Time			08/05/2019 04:12:19 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	Anthem Blue Cross and Blue Shield	https://shop.anthem.com/medicare	Anthem MediBlue Access Basic (Regional PPO)	11	31		1			R5941	14	0	2020	Ohio		2		2			2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare	www.anthem.com	(800)467-1199		(800)467-1199		(800)797-0560		(800)797-0560		(800)467-1199		(800)467-1199		(844)364-2126		(844)364-2126		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6694	3	0	1	31	11	R6694_003_0	4	1			07/03/2019	2020.01	07/03/2019 06:00:17 PM Eastern Daylight Time	08/02/2019 10:57:33 AM Eastern Daylight Time	07/31/2019 05:02:14 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus 1 (Regional PPO)	11	31		1			R6694	3	0	2020	Ohio		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6694	5	0	1	31	11	R6694_005_0	4	1			07/03/2019	2020.01	07/03/2019 06:00:38 PM Eastern Daylight Time	08/02/2019 10:58:18 AM Eastern Daylight Time	07/31/2019 05:03:25 AM Eastern Daylight Time			08/02/2019 03:37:10 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plus 2 (Regional PPO)	11	31		1			R6694	5	0	2020	Ohio		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6694	6	0	1	31	11	R6694_006_0	3	1			07/03/2019	2020.01	07/03/2019 07:30:13 PM Eastern Daylight Time	08/01/2019 06:01:31 PM Eastern Daylight Time	07/31/2019 05:04:36 AM Eastern Daylight Time			08/02/2019 04:43:06 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier (Regional PPO)	11	31		1			R6694	6	0	2020	New Jersey		2		2			2						www.aetnamedicare.com/findpharmacy	www.aetnamedicare.com/formulary	www.aetnamedicare.com/findprovider	(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(800)282-5366		(800)282-5366		(855)275-6627		(855)275-6627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6801	8	0	1	31	11	R6801_008_0	2	1		1	08/05/2019	2020.01	08/05/2019 05:26:45 PM Central Daylight Time	08/02/2019 11:23:11 AM Central Daylight Time	07/31/2019 09:35:50 AM Central Daylight Time			08/06/2019 08:15:53 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Silver (Regional PPO C-SNP)	11	31		1			R6801	8	0	2020	Texas		2		2			1	4			100		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6801	9	0	1	31	11	R6801_009_0	3	1		1	08/05/2019	2020.01	08/05/2019 05:35:40 PM Central Daylight Time	08/02/2019 11:23:57 AM Central Daylight Time	07/30/2019 10:27:01 PM Central Daylight Time			08/06/2019 08:15:53 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Gold (Regional PPO C-SNP)	11	31		1			R6801	9	0	2020	Texas		2		2			1	4			10		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6801	11	0	1	31	11	R6801_011_0	2	1	2	1	08/02/2019	2020.01	08/02/2019 10:34:05 AM Central Daylight Time	08/02/2019 11:24:45 AM Central Daylight Time	07/30/2019 10:27:36 PM Central Daylight Time			08/06/2019 08:15:53 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Choice (Regional PPO D-SNP)	11	31		1			R6801	11	0	2020	Texas		2		2			1	3		1		1	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(866)480-1086		(866)480-1086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R6801	12	0	1	31	11	R6801_012_0	4	1			08/06/2019	2020.01	08/06/2019 08:40:21 AM Central Daylight Time	08/02/2019 11:25:31 AM Central Daylight Time	07/30/2019 10:28:08 PM Central Daylight Time			08/06/2019 08:56:31 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Medicare Advantage Choice (Regional PPO)	11	31		1			R6801	12	0	2020	Texas		2		2			2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(800)204-1002		(800)204-1002		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7220	1	0	1	31	11	R7220_001_0	4	1			05/25/2019	2020.01	05/25/2019 02:27:13 PM Eastern Daylight Time	08/04/2019 10:38:17 AM Eastern Daylight Time				08/05/2019 11:46:17 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7220-001 (Regional PPO)	11	31		1			R7220	1	0	2020	State of Arizona		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R7220	2	0	1	31	11	R7220_002_0	2	1			05/26/2019	2020.01	05/26/2019 05:11:28 PM Eastern Daylight Time	08/04/2019 10:42:44 AM Eastern Daylight Time	08/02/2019 01:19:05 PM Eastern Daylight Time			08/05/2019 11:46:17 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7220-002 (Regional PPO)	11	31		1			R7220	2	0	2020	State of Arizona		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7220	801	0	1	31	11	R7220_801_0	1	1			05/28/2019	2020.01	05/28/2019 01:00:44 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7220	801	0	2020	State of Arizona		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R7220	802	0	1	31	11	R7220_802_0	1	1			05/28/2019	2020.01	05/28/2019 01:01:41 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7220	802	0	2020	State of Arizona		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R7315	1	0	1	31	11	R7315_001_0	3	1			07/15/2019	2020.01	07/15/2019 03:27:29 PM Eastern Daylight Time	08/02/2019 05:22:00 PM Eastern Daylight Time				08/05/2019 10:49:51 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Honor (Regional PPO)	11	31		1			R7315	1	0	2020	States of Alabama and Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2						2			
R7315	2	0	1	31	11	R7315_002_0	3	1			07/15/2019	2020.01	07/15/2019 03:28:33 PM Eastern Daylight Time	08/02/2019 05:55:04 PM Eastern Daylight Time	08/02/2019 01:19:05 PM Eastern Daylight Time			08/05/2019 10:49:51 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	HumanaChoice R7315-002 (Regional PPO)	11	31		1			R7315	2	0	2020	States of Alabama and Tennessee		2		2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
R7315	801	0	1	31	11	R7315_801_0	1	1			05/28/2019	2020.01	05/28/2019 01:03:00 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7315	801	0	2020	States of Alabama and Tennessee		1	2542	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R7315	802	0	1	31	11	R7315_802_0	1	1			05/28/2019	2020.01	05/28/2019 01:05:26 PM Eastern Daylight Time					05/28/2019 01:26:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (Regional PPO)	11	31		1			R7315	802	0	2020	States of Alabama and Tennessee		1	1200	2			2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/members/tools	(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-										1	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;10a;11a;11b;11c;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;15;16b;17a;17b;18a;	1	1a;1b;2;3-1;3-2;3-3;3-4;5;6;7b;7c;7d;7e;7f;7g;7h;7i;7j;7k;8a;8b1;8b2;8b3;9a1;9a2;9b;9c;9d;12;14a;14d;14e1;14e2;14e3;14e4;14e5;14e6;16b;17a;17b;18a;	1									
R7444	1	0	1	31	11	R7444_001_0	4	1			08/05/2019	2020.01	08/05/2019 09:26:06 AM Central Daylight Time	08/02/2019 11:00:14 AM Central Daylight Time	07/30/2019 10:28:43 PM Central Daylight Time			08/06/2019 12:41:19 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP Medicare Advantage Choice (Regional PPO)	11	31		1			R7444	1	0	2020	New England		2		2			2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(800)643-4845		(800)643-4845		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2						2			
S0586	801	0		29	10	S0586_801_0	5	1			05/28/2019	2020.01	05/28/2019 01:17:21 PM Eastern Daylight Time					05/30/2019 08:53:21 AM Eastern Daylight Time	"MVP HEALTH PLAN, INC."	MVP Health Care	www.mvphealthcare.com	MVP RxCare - Employer Group (PDP)	10	29					S0586	801	0	2020	United States and Puerto Rico		1					2						https://www.mvphealthcare.com/partD	https://www.mvphealthcare.com/partD										(866)494-8829		(866)494-8829		(800)324-3899		(800)324-3899										(711)-		(711)-		(800)662-1220		(800)662-1220																
S0655	801	0		29	10	S0655_801_0	1	1			05/28/2019	2020.01	05/28/2019 05:21:45 PM Eastern Daylight Time					05/28/2019 05:25:59 PM Eastern Daylight Time	TUFTS INSURANCE COMPANY	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred PDP Group (PDP)	10	29					S0655	801	0	2020	Massachusetts and Nationwide		1					2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage										(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-																
S0655	802	0		29	10	S0655_802_0	1	1			05/24/2019	2020.01	05/24/2019 03:32:07 PM Eastern Daylight Time					05/28/2019 05:25:59 PM Eastern Daylight Time	TUFTS INSURANCE COMPANY	Tufts Health Plan	tuftsmedicarepreferred.org/plans/employer-plans	Tufts Medicare Preferred PDP Group (PDP)	10	29					S0655	802	0	2020	Massachusetts and Nationwide		1					2						tuftsmedicarepreferred.org/find-doctor	tuftsmedicarepreferred.org/drug-coverage										(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(711)-		(711)-		(711)-		(711)-																
S1030	1	0		29	10	S1030_001_0	1	1			05/30/2019	2020.01	05/30/2019 01:43:58 PM Central Daylight Time		06/01/2019 10:33:26 AM Central Daylight Time			06/01/2019 10:54:24 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Enhanced Plus (PDP)	10	29					S1030	1	0	2020	"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	6	0		29	10	S1030_006_0	1	1			05/30/2019	2020.01	05/30/2019 11:02:23 AM Central Daylight Time		06/01/2019 10:33:27 AM Central Daylight Time			06/01/2019 10:58:15 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Essential (PDP)	10	29					S1030	6	0	2020	"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	10	0		29	10	S1030_010_0	1	1			05/30/2019	2020.01	05/30/2019 11:04:17 AM Central Daylight Time		06/01/2019 10:33:27 AM Central Daylight Time			06/01/2019 10:58:15 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Enhanced (PDP)	10	29					S1030	10	0	2020	"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			04/16/2019	2020.01	04/16/2019 12:30:56 PM Central Daylight Time					05/31/2019 12:21:59 PM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 801 (PDP)	10	29					S1030	801	0	2020	"State of Alabama, State of Tennessee"		1					2						www.bluerxalatenn.com	www.bluerxalatenn.com										(800)377-3998		(800)377-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1030	802	0		29	10	S1030_802_0	1	1			05/21/2019	2020.01	05/21/2019 01:37:57 PM Central Daylight Time					05/31/2019 03:20:35 PM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 802 (PDP)	10	29					S1030	802	0	2020	"State of Alabama, State of Tennessee"		1					2						www.bluerxalatenn.com	www.bluerxalatenn.com										(800)377-3998		(800)377-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-																
S1030	803	0		29	10	S1030_803_0	1	1			04/16/2019	2020.01	04/16/2019 12:31:00 PM Central Daylight Time					05/31/2019 12:21:59 PM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 803 (PDP)	10	29					S1030	803	0	2020	"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			05/21/2019	2020.01	05/21/2019 01:38:03 PM Central Daylight Time					05/31/2019 03:20:35 PM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 804 (PDP)	10	29					S1030	804	0	2020	"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	805	0		29	10	S1030_805_0	2	1			06/01/2019	2020.01	06/01/2019 11:02:05 AM Central Daylight Time					06/01/2019 11:02:11 AM Central Daylight Time	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 805 (PDP)	10	29					S1030	805	0	2020	"State of Alabama, State of Tennessee"		1					2						www.bluerxalatenn.com	www.bluerxalatenn.com										(855)453-5185		(855)453-5185		(855)453-5185		(855)453-5185										(711)-		(711)-		(711)-		(711)-																
S1140	801	0		29	10	S1140_801_0	1	1			05/30/2019	2020.01	05/30/2019 04:10:44 PM Eastern Daylight Time					05/31/2019 02:55:28 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	Group PDP (PDP)	10	29					S1140	801	0	2020	New York State		1					2						www.nymedicare.com	www.nymedicare.com	www.nymedicare.com									(888)787-2390		(888)787-2390		(888)989-9905		(888)989-9905										(711)-		(711)-		(711)-		(711)-																
S1140	802	0		29	10	S1140_802_0	1	1			05/30/2019	2020.01	05/30/2019 04:10:29 PM Eastern Daylight Time					05/31/2019 02:55:28 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BlueCross BlueShield of WNY and BlueShield of NENY	www.nymedicare.com	Group PDP Enhanced (PDP)	10	29					S1140	802	0	2020	New York State		1					2						www.nymedicare.com	www.nymedicare.com	www.nymedicare.com									(877)461-9218		(877)461-9218		(888)989-9905		(888)989-9905										(711)-		(711)-		(711)-		(711)-																
S1822	801	0		29	10	S1822_801_0	2	1			05/29/2019	2020.01	05/29/2019 07:36:55 AM Central Daylight Time					05/31/2019 07:27:13 AM Central Daylight Time	"HEALTHPARTNERS, INC."	HealthPartners	healthpartners.com/medicare	HealthPartners Retiree National Choice CY (PDP)	10	29					S1822	801	0	2020	Nationwide		1					2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx										(877)816-9539		(952)883-7373		(866)993-7428		(952)883-7428										(711)-		(711)-		(711)-		(711)-																
S1822	802	0		29	10	S1822_802_0	2	1			05/29/2019	2020.01	05/29/2019 07:37:02 AM Central Daylight Time					05/31/2019 07:27:13 AM Central Daylight Time	"HEALTHPARTNERS, INC."	HealthPartners	healthpartners.com/medicare	HealthPartners Retiree National Choice NCY (PDP)	10	29					S1822	802	0	2020	Nationwide		1					2						healthpartners.com/partdpharmacy	healthpartners.com/medicarerx										(877)816-9539		(952)883-7373		(866)993-7428		(952)883-7428										(711)-		(711)-		(711)-		(711)-																
S1894	1	0		29	10	S1894_001_0	3	1			05/31/2019	2020.01	05/31/2019 07:13:36 AM Eastern Daylight Time		06/02/2019 11:06:56 PM Eastern Daylight Time			06/03/2019 05:40:11 AM Eastern Daylight Time	"COMMUNITYCARE GOVERNMENT PROGRAMS, INC."	CommunityCare Prescription Drug Plan (PDP)	www.ccokadvantage.com	CommunityCare Prescription Drug Plan (PDP)	10	29					S1894	1	0	2020	State of Oklahoma		2					2						www.ccokadvantage.com	www.ccokadvantage.com										(800)333-3275		(918)594-5211		(800)333-3275		(918)594-5202										(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353																
S2468	3	0		29	10	S2468_003_0	3	1			05/30/2019	2020.01	05/30/2019 01:52:58 PM Pacific Daylight Time		06/03/2019 07:38:06 AM Pacific Daylight Time			06/03/2019 09:51:06 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield Rx Plus (PDP)	10	29					S2468	3	0	2020	State of California		2					2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary										(888)239-6469		(888)239-6469		(888)292-7591		(888)292-7591										(711)-		(711)-		(711)-		(711)-																
S2468	4	0		29	10	S2468_004_0	3	1			05/29/2019	2020.01	05/29/2019 10:16:03 AM Pacific Daylight Time		05/29/2019 11:36:00 PM Pacific Daylight Time			06/07/2019 10:01:57 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/medicare	Blue Shield Rx Enhanced (PDP)	10	29					S2468	4	0	2020	State of California		2					2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary										(888)239-6469		(888)239-6469		(888)292-7591		(888)292-7591										(711)-		(711)-		(711)-		(711)-																
S2468	801	0		29	10	S2468_801_0	2	1			05/02/2019	2020.01	05/02/2019 11:37:44 AM Pacific Daylight Time					05/31/2019 01:51:42 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield of California Medicare Rx Plan (PDP)	10	29					S2468	801	0	2020	PDP Employer Group Plan		1					2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary										(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			05/02/2019	2020.01	05/02/2019 11:37:55 AM Pacific Daylight Time					05/31/2019 01:51:42 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield of California Medicare Rx Plan (PDP)	10	29					S2468	802	0	2020	PDP Employer Group Plan		1					2						www.blueshieldca.com/med_pharmacy	www.blueshieldca.com/med_formulary										(888)239-6469		(888)239-6469		(888)239-6469		(888)239-6469										(711)-		(711)-		(711)-		(711)-																
S2668	5	0		29	10	S2668_005_0	3	1			07/23/2019	2020.01	07/23/2019 01:35:55 PM Central Daylight Time		07/23/2019 12:48:38 PM Central Daylight Time			07/23/2019 01:38:34 PM Central Daylight Time	MEMBERS HEALTH INSURANCE COMPANY	Farm Bureau Health Plans	www.fbhealthplans.com/part-d	Farm Bureau Essential Rx (PDP)	10	29					S2668	5	0	2020	Alabama and Tennessee		2					2						fbhealthplans.com placeholder	www.fbhealthplans.com/part-d/essentialrx										(866)643-6924		(866)643-6924		(844)368-8738		(844)368-8738										(711)-		(711)-		(711)-		(711)-																
S2668	6	0		29	10	S2668_006_0	3	1			07/23/2019	2020.01	07/23/2019 01:37:04 PM Central Daylight Time		07/23/2019 12:48:42 PM Central Daylight Time			07/23/2019 01:38:34 PM Central Daylight Time	MEMBERS HEALTH INSURANCE COMPANY	Farm Bureau Health Plans	www.fbhealthplans.com/part-d/	Farm Bureau Select Rx (PDP)	10	29					S2668	6	0	2020	Alabama and Tennessee		2					2						fbhealthplans.com placeholder	www.fbhealthplans.com/part-d/selectrx										(866)643-6924		(866)643-6924		(844)368-8738		(844)368-8738										(711)-		(711)-		(711)-		(711)-																
S2874	1	0		29	10	S2874_001_0	2	1			05/31/2019	2020.01	05/31/2019 12:23:35 PM Eastern Daylight Time		06/01/2019 02:02:45 PM Eastern Daylight Time			06/01/2019 04:35:53 PM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S2874	1	0	2020	Puerto Rico - Island Wide		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-																
S2874	4	0		29	10	S2874_004_0	2	1			06/01/2019	2020.01	06/01/2019 03:44:30 PM Eastern Daylight Time		06/01/2019 02:02:47 PM Eastern Daylight Time			06/01/2019 04:35:53 PM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S2874	4	0	2020	Puerto Rico - Island Wide		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-																
S2874	801	0		29	10	S2874_801_0	2	1			05/28/2019	2020.01	05/28/2019 08:08:07 AM Eastern Daylight Time					05/28/2019 08:08:43 AM Eastern Daylight Time	"HUMANA INSURANCE OF PUERTO RICO, INC."	Humana	www.humana.com/medicare	Humana Medicare Employer (PDP)	10	29					S2874	801	0	2020	Puerto Rico - Island Wide		1					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(866)773-5959		(866)773-5959		(866)773-5959		(866)773-5959										(711)-		(711)-		(711)-		(711)-																
S2893	1	0		29	10	S2893_001_0	5	1			06/03/2019	2020.01	06/03/2019 10:23:48 AM Eastern Daylight Time		06/03/2019 01:18:11 PM Eastern Daylight Time			06/03/2019 01:22:17 PM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx Value Plus (PDP)	10	29					S2893	1	0	2020	"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										(711)-		(711)-		(711)-		(711)-																
S2893	3	0		29	10	S2893_003_0	6	1			06/03/2019	2020.01	06/03/2019 10:26:27 AM Eastern Daylight Time		06/03/2019 01:18:12 PM Eastern Daylight Time			06/03/2019 01:29:39 PM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx Premier (PDP)	10	29					S2893	3	0	2020	"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										(711)-		(711)-		(711)-		(711)-																
S2893	801	0		29	10	S2893_801_0	1	1			05/30/2019	2020.01	05/30/2019 11:07:23 AM Eastern Daylight Time					05/30/2019 11:09:08 AM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	Groups.RxMedicareplans.com	Blue MedicareRx (PDP)	10	29					S2893	801	0	2020	"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										(711)-		(711)-		(711)-		(711)-																
S2893	802	0		29	10	S2893_802_0	1	1			05/30/2019	2020.01	05/30/2019 11:08:04 AM Eastern Daylight Time					05/30/2019 11:24:32 AM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	Groups.RxMedicareplans.com	Blue MedicareRx (PDP)	10	29					S2893	802	0	2020	"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										(711)-		(711)-		(711)-		(711)-																
S3285	801	0		29	10	S3285_801_0	1	1			05/31/2019	2020.01	05/31/2019 05:16:18 PM Pacific Daylight Time					05/31/2019 06:01:54 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	801	0	2020	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	802	0		29	10	S3285_802_0	1	1			05/31/2019	2020.01	05/31/2019 05:17:35 PM Pacific Daylight Time					05/31/2019 06:01:54 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	802	0	2020	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	803	0		29	10	S3285_803_0	1	1			05/31/2019	2020.01	05/31/2019 05:18:31 PM Pacific Daylight Time					05/31/2019 06:01:54 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	803	0	2020	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	804	0		29	10	S3285_804_0	1	1			05/31/2019	2020.01	05/31/2019 05:19:11 PM Pacific Daylight Time					05/31/2019 06:01:54 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	804	0	2020	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	805	0		29	10	S3285_805_0	1	1			05/31/2019	2020.01	05/31/2019 05:19:58 PM Pacific Daylight Time					05/31/2019 06:01:54 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	805	0	2020	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	806	0		29	10	S3285_806_0	1	1			05/31/2019	2020.01	05/31/2019 05:20:43 PM Pacific Daylight Time					05/31/2019 06:01:54 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	806	0	2020	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3285	807	0		29	10	S3285_807_0	1	1			05/31/2019	2020.01	05/31/2019 05:22:20 PM Pacific Daylight Time					05/31/2019 06:01:54 PM Pacific Daylight Time	MG INSURANCE COMPANY	MG Insurance Company	https://www.medimpact.com	VibrantRx (PDP)	10	29					S3285	807	0	2020	VibrantRx - National		1					2						https://www.medimpact.com	https://www.medimpact.com										(844)826-3451		(844)826-3451		(844)826-3451		(844)826-3451										(711)-		(711)-		(711)-		(711)-																
S3389	802	0		29	10	S3389_802_0	5	1			05/28/2019	2020.01	05/28/2019 01:58:47 PM Eastern Daylight Time					06/02/2019 04:00:18 PM Eastern Daylight Time	"UPMC HEALTH BENEFITS, INC."	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PDP)	10	29					S3389	802	0	2020	States of Pennsylvania and West Virginia		1					2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/										(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(711)-		(711)-		(711)-		(711)-																
S3389	803	0		29	10	S3389_803_0	5	1			05/28/2019	2020.01	05/28/2019 02:05:12 PM Eastern Daylight Time					06/02/2019 04:00:18 PM Eastern Daylight Time	"UPMC HEALTH BENEFITS, INC."	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PDP)	10	29					S3389	803	0	2020	States of Pennsylvania and West Virginia		1					2						https://www.upmchealthplan.com/medicare/documents-and-forms/	https://www.upmchealthplan.com/medicare/documents-and-forms/										(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(711)-		(711)-		(711)-		(711)-																
S3521	801	0		29	10	S3521_801_0	4	1			05/20/2019	2020.01	05/20/2019 02:13:19 PM Eastern Daylight Time					06/03/2019 04:51:17 PM Eastern Daylight Time	"EXCELLUS HEALTH PLAN, INC."	"Excellus Health Plan, Inc"	www.SimplyPrescriptions.com	Simply Prescriptions- Employer Group (PDP)	10	29					S3521	801	0	2020	National and US Territories		1					2						www.SimplyPrescriptions.com	www.SimplyPrescriptions.com	www.SimplyPrescriptions.com									(877)883-9577		(877)883-9577		(877)883-9577		(877)883-9577										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220																
S3875	802	0		29	10	S3875_802_0	1	1			05/28/2019	2020.01	05/28/2019 11:56:36 AM Mountain Daylight Time					05/28/2019 12:00:52 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance (PDP)	10	29					S3875	802	0	2020	Granite Alliance National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	803	0		29	10	S3875_803_0	2	1			05/28/2019	2020.01	05/28/2019 11:57:12 AM Mountain Daylight Time					05/28/2019 12:00:52 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance non-CY (PDP)	10	29					S3875	803	0	2020	Granite Alliance non-CY National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	804	0		29	10	S3875_804_0	1	1			05/28/2019	2020.01	05/28/2019 11:57:44 AM Mountain Daylight Time					05/28/2019 12:00:52 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other (PDP)	10	29					S3875	804	0	2020	Granite Alliance - Other National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	805	0		29	10	S3875_805_0	1	1			05/28/2019	2020.01	05/28/2019 11:58:01 AM Mountain Daylight Time					05/28/2019 12:00:52 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other non-CY (PDP)	10	29					S3875	805	0	2020	Granite Alliance - Other Non-CY National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	806	0		29	10	S3875_806_0	1	1			05/28/2019	2020.01	05/28/2019 11:58:20 AM Mountain Daylight Time					05/28/2019 12:00:52 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other (PDP)	10	29					S3875	806	0	2020	Granite Alliance - Other National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	807	0		29	10	S3875_807_0	1	1			05/28/2019	2020.01	05/28/2019 11:58:40 AM Mountain Daylight Time					05/28/2019 12:00:52 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other Non-CY (PDP)	10	29					S3875	807	0	2020	Granite Alliance - Other Non-CY National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	808	0		29	10	S3875_808_0	1	1			05/28/2019	2020.01	05/28/2019 11:59:11 AM Mountain Daylight Time					05/28/2019 12:00:52 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other (PDP)	10	29					S3875	808	0	2020	Granite Alliance - Other National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	809	0		29	10	S3875_809_0	1	1			05/28/2019	2020.01	05/28/2019 11:59:39 AM Mountain Daylight Time					05/28/2019 12:00:52 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other Non-CY (PDP)	10	29					S3875	809	0	2020	Granite Alliance - Other Non-CY National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	810	0		29	10	S3875_810_0	1	1			05/28/2019	2020.01	05/28/2019 11:59:53 AM Mountain Daylight Time					05/28/2019 12:00:52 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other (PDP)	10	29					S3875	810	0	2020	Granite Alliance - Other National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3875	811	0		29	10	S3875_811_0	1	1			05/28/2019	2020.01	05/28/2019 12:00:07 PM Mountain Daylight Time					05/28/2019 12:00:52 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance - Other Non-CY (PDP)	10	29					S3875	811	0	2020	Granite Alliance - Other Non-CY National EGWP		1					2						www.mygraniterx.com	www.mygraniterx.com										(855)586-2573		(855)586-2573		(855)586-2573		(855)586-2573										(711)-		(711)-		(711)-		(711)-																
S3994	801	0		29	10	S3994_801_0	2	1			05/24/2019	2020.01	05/24/2019 12:31:39 PM Hawaiian Standard Time					05/30/2019 11:08:56 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	HMSAs Medicare Rx Plan	www.hmsa.com	Medicare Rx EGWP CY (PDP)	10	29					S3994	801	0	2020	National		1					2						www.hmsa.com	www.hmsa.com										(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555										(711)-		(711)-		(711)-		(711)-																
S3994	802	0		29	10	S3994_802_0	2	1			05/24/2019	2020.01	05/24/2019 12:33:55 PM Hawaiian Standard Time					05/30/2019 11:11:39 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	HMSAs Medicare Rx Plan	www.hmsa.com	Medicare Rx EGWP NCY (PDP)	10	29					S3994	802	0	2020	National		1					2						www.hmsa.com	www.hmsa.com										(800)660-4672		(808)948-6000		(800)620-4672		(808)948-5555										(711)-		(711)-		(711)-		(711)-																
S4219	801	0		29	10	S4219_801_0	2	1			05/13/2019	2020.01	05/13/2019 04:41:51 PM Central Daylight Time					05/31/2019 03:31:14 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	2020	United States		1					2						www.Healthalliancemedicare.org	www.Healthalliancemedicare.org	www.Healthalliancemedicare.org									(855)291-9311		(855)291-9311		(888)382-9771		(888)382-9771										(711)-		(711)-		(711)-		(711)-																
S4219	802	0		29	10	S4219_802_0	2	1			05/13/2019	2020.01	05/13/2019 04:41:59 PM Central Daylight Time					05/31/2019 03:31:14 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	2020	United States		1					2						www.Healthalliancemedicare.org	www.Healthalliancemedicare.org	www.Healthalliancemedicare.org									(855)291-9311		(855)291-9311		(888)382-9771		(888)382-9771										(711)-		(711)-		(711)-		(711)-																
S4501	801	0		29	10	S4501_801_0	1	1			05/29/2019	2020.01	05/29/2019 10:39:28 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	independenthealth.com/medicare	Pharmacy Benefit Dimensions PDP-1 (LMHF) (PDP)	10	29					S4501	801	0	2020	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(711)-		(711)-		(711)-		(711)-																
S4501	802	0		29	10	S4501_802_0	1	1			05/14/2019	2020.01	05/14/2019 08:54:22 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.independenthealth.com	Pharmacy Benefit Dimensions PDP-2 (PDP)	10	29					S4501	802	0	2020	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4501	803	0		29	10	S4501_803_0	1	1			05/03/2019	2020.01	05/03/2019 08:21:44 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	independenthealth.com	Pharmacy Benefit Dimensions PDP-3 (PDP)	10	29					S4501	803	0	2020	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4501	804	0		29	10	S4501_804_0	1	1			05/03/2019	2020.01	05/03/2019 08:21:55 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.independenthealth.com	Pharmacy Benefit Dimensions PDP-4 (PDP)	10	29					S4501	804	0	2020	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4501	805	0		29	10	S4501_805_0	1	1			05/03/2019	2020.01	05/03/2019 08:22:16 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.independenthealth.com	Pharmacy Benefit Dimensions PDP-5 (PDP)	10	29					S4501	805	0	2020	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4501	806	0		29	10	S4501_806_0	1	1			05/03/2019	2020.01	05/03/2019 08:22:29 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.independenthealth.com	Pharmacy Benefit Dimensions PDP-6 (PDP)	10	29					S4501	806	0	2020	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4501	807	0		29	10	S4501_807_0	1	1			05/03/2019	2020.01	05/03/2019 08:22:38 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.independenthealth.com	Pharmacy Benefit Dimensions PDP-7 (PDP)	10	29					S4501	807	0	2020	All regions		1					2						www.pbdrx.com	www.pbdrx.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4501	808	0		29	10	S4501_808_0	1	1			05/03/2019	2020.01	05/03/2019 08:22:48 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.PBDRx.com	Pharmacy Benefit Dimemsions PDP-8 (PDP)	10	29					S4501	808	0	2020	All regions		1					2						www.pbdrx.com	www.independenthealth.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4501	809	0		29	10	S4501_809_0	1	1			05/14/2019	2020.01	05/14/2019 08:53:04 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.PBDRx.com	Pharmacy Benefit Dimensions PDP- 9 (PDP)	10	29					S4501	809	0	2020	All regions		1					2						www.pbdrx.com	www.independenthealth.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4501	810	0		29	10	S4501_810_0	1	1			05/03/2019	2020.01	05/03/2019 08:20:48 AM Eastern Daylight Time					06/02/2019 07:07:10 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Pharmacy Benefit Dimensions PDP	www.PBDRx.com	Pharmacy Benefit Dimensions PBP-10 (PDP)	10	29					S4501	810	0	2020	All regions		1					2						www.pbdrx.com	www.independenthealth.com										(800)665-1502		(716)250-4401		(800)665-1502		(716)250-4401										(800)432-1110		(716)631-3108		(800)432-1110		(716)631-3108																
S4607	2	0		29	10	S4607_002_0	3	1			06/03/2019	2020.01	06/03/2019 11:21:34 AM Mountain Daylight Time		06/02/2019 05:46:29 PM Mountain Daylight Time			06/03/2019 11:23:54 AM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	2	0	2020	Magellan Rx Medicare Basic (PDP)		2					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	3	0		29	10	S4607_003_0	2	1			06/03/2019	2020.01	06/03/2019 11:21:49 AM Mountain Daylight Time		06/02/2019 05:46:29 PM Mountain Daylight Time			06/03/2019 11:23:54 AM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	3	0	2020	Magellan Rx Medicare Basic (PDP)		2					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	9	0		29	10	S4607_009_0	2	1			06/03/2019	2020.01	06/03/2019 11:22:02 AM Mountain Daylight Time		06/02/2019 05:46:29 PM Mountain Daylight Time			06/03/2019 11:23:54 AM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	9	0	2020	Magellan Rx Medicare Basic (PDP)		2					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	23	0		29	10	S4607_023_0	2	1			06/03/2019	2020.01	06/03/2019 11:22:28 AM Mountain Daylight Time		06/02/2019 05:46:29 PM Mountain Daylight Time			06/03/2019 11:23:54 AM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	23	0	2020	Magellan Rx Medicare Basic (PDP)		2					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	801	0		29	10	S4607_801_0	1	1			05/31/2019	2020.01	05/31/2019 05:42:33 PM Mountain Daylight Time					06/02/2019 06:45:12 PM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	801	0	2020	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	802	0		29	10	S4607_802_0	1	1			05/31/2019	2020.01	05/31/2019 05:42:48 PM Mountain Daylight Time					06/02/2019 06:45:12 PM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	802	0	2020	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	803	0		29	10	S4607_803_0	1	1			05/31/2019	2020.01	05/31/2019 05:43:01 PM Mountain Daylight Time					06/02/2019 06:45:12 PM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	803	0	2020	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	804	0		29	10	S4607_804_0	1	1			05/31/2019	2020.01	05/31/2019 05:43:19 PM Mountain Daylight Time					06/02/2019 06:45:12 PM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	804	0	2020	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	805	0		29	10	S4607_805_0	1	1			05/31/2019	2020.01	05/31/2019 05:43:31 PM Mountain Daylight Time					06/02/2019 06:45:12 PM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	805	0	2020	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	806	0		29	10	S4607_806_0	1	1			05/31/2019	2020.01	05/31/2019 05:43:42 PM Mountain Daylight Time					06/02/2019 06:45:12 PM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	806	0	2020	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	807	0		29	10	S4607_807_0	1	1			05/31/2019	2020.01	05/31/2019 05:43:52 PM Mountain Daylight Time					06/02/2019 06:45:12 PM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	https://medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	807	0	2020	Magellan Rx Medicare Basic (PDP)		1					2						https://medicare.magellanrx.com	https://medicare.magellanrx.com	https://medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	808	0		29	10	S4607_808_0	1	1			05/31/2019	2020.01	05/31/2019 05:44:04 PM Mountain Daylight Time					06/02/2019 06:45:12 PM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	808	0	2020	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	809	0		29	10	S4607_809_0	1	1			05/31/2019	2020.01	05/31/2019 05:44:14 PM Mountain Daylight Time					06/02/2019 06:45:12 PM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	809	0	2020	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4607	810	0		29	10	S4607_810_0	1	1			05/31/2019	2020.01	05/31/2019 05:44:30 PM Mountain Daylight Time					06/02/2019 06:45:12 PM Mountain Daylight Time	MERIT HEALTH INSURANCE COMPANY	Magellan Rx Medicare	medicare.magellanrx.com	Magellan Rx Medicare Basic (PDP)	10	29					S4607	810	0	2020	Magellan Rx Medicare Basic (PDP)		1					2						medicare.magellanrx.com	medicare.magellanrx.com	medicare.magellanrx.com									(800)424-5870		(800)424-5870		(800)424-5759		(800)424-5759										(711)-		(711)-		(711)-		(711)-																
S4802	12	0		29	10	S4802_012_0	9	1			05/31/2019	2020.01	05/31/2019 09:49:40 PM Eastern Daylight Time		07/25/2019 11:48:21 AM Central Daylight Time			07/25/2019 12:15:43 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	12	0	2020	Louisiana		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	13	0		29	10	S4802_013_0	7	1			05/29/2019	2020.01	05/29/2019 12:32:51 PM Eastern Daylight Time		07/11/2019 08:39:22 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	13	0	2020	Texas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	14	0		29	10	S4802_014_0	5	1			05/29/2019	2020.01	05/29/2019 12:32:55 PM Eastern Daylight Time		07/06/2019 08:38:17 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	14	0	2020	Oklahoma		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	20	0		29	10	S4802_020_0	5	1			05/29/2019	2020.01	05/29/2019 12:32:59 PM Eastern Daylight Time		07/06/2019 08:38:52 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	20	0	2020	Oregon and Washington		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	21	0		29	10	S4802_021_0	4	1			05/29/2019	2020.01	05/29/2019 12:40:03 PM Eastern Daylight Time		07/11/2019 08:40:01 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	21	0	2020	Idaho and Utah		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	69	0		29	10	S4802_069_0	5	1			05/29/2019	2020.01	05/29/2019 12:39:59 PM Eastern Daylight Time		07/25/2019 11:48:58 AM Central Daylight Time			07/25/2019 12:15:43 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	69	0	2020	Virginia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	70	0		29	10	S4802_070_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:56 PM Eastern Daylight Time		07/11/2019 08:41:17 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	70	0	2020	South Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	71	0		29	10	S4802_071_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:53 PM Eastern Daylight Time		07/06/2019 08:41:11 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	71	0	2020	"Alabama, Tennessee"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	72	0		29	10	S4802_072_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:49 PM Eastern Daylight Time		07/11/2019 08:41:56 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	72	0	2020	Missouri		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	73	0		29	10	S4802_073_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:46 PM Eastern Daylight Time		07/06/2019 08:42:21 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	73	0	2020	Arkansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	74	0		29	10	S4802_074_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:43 PM Eastern Daylight Time		07/06/2019 08:42:56 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	74	0	2020	Mississippi		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	75	0		29	10	S4802_075_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:40 PM Eastern Daylight Time		07/11/2019 08:42:35 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	75	0	2020	"Maine, New Hampshire"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	76	0		29	10	S4802_076_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:35 PM Eastern Daylight Time		07/11/2019 08:43:13 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	76	0	2020	"Connecticut, Massachusetts, Rhode Island, Vermont"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	77	0		29	10	S4802_077_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:30 PM Eastern Daylight Time		07/11/2019 08:43:51 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	77	0	2020	New York		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	78	0		29	10	S4802_078_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:26 PM Eastern Daylight Time		07/11/2019 08:44:31 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	78	0	2020	New Jersey		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	79	0		29	10	S4802_079_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:22 PM Eastern Daylight Time		07/06/2019 08:45:50 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	79	0	2020	"District of Columbia, Delaware, Maryland"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	80	0		29	10	S4802_080_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:19 PM Eastern Daylight Time		07/06/2019 08:46:25 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	80	0	2020	"Pennsylvania, West Virginia"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	81	0		29	10	S4802_081_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:16 PM Eastern Daylight Time		07/06/2019 08:47:00 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	81	0	2020	North Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	82	0		29	10	S4802_082_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:13 PM Eastern Daylight Time		07/06/2019 08:47:34 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	82	0	2020	Georgia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	83	0		29	10	S4802_083_0	5	1			05/29/2019	2020.01	05/29/2019 12:39:09 PM Eastern Daylight Time		07/25/2019 11:49:34 AM Central Daylight Time			07/25/2019 12:15:43 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	83	0	2020	Florida		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	84	0		29	10	S4802_084_0	4	1			05/29/2019	2020.01	05/29/2019 12:39:01 PM Eastern Daylight Time		07/06/2019 08:48:43 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	84	0	2020	Michigan		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	85	0		29	10	S4802_085_0	4	1			05/29/2019	2020.01	05/29/2019 12:38:54 PM Eastern Daylight Time		07/06/2019 08:49:19 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	85	0	2020	Ohio		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	86	0		29	10	S4802_086_0	4	1			05/29/2019	2020.01	05/29/2019 12:38:43 PM Eastern Daylight Time		07/06/2019 08:49:53 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	86	0	2020	"Indiana, Kentucky"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	87	0		29	10	S4802_087_0	4	1			05/29/2019	2020.01	05/29/2019 12:38:39 PM Eastern Daylight Time		07/06/2019 08:50:28 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	87	0	2020	Illinois		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	88	0		29	10	S4802_088_0	4	1			05/29/2019	2020.01	05/29/2019 12:38:36 PM Eastern Daylight Time		07/11/2019 08:45:46 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	88	0	2020	Kansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	89	0		29	10	S4802_089_0	5	1			05/29/2019	2020.01	05/29/2019 12:38:32 PM Eastern Daylight Time		07/25/2019 11:50:11 AM Central Daylight Time			07/25/2019 12:15:43 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S4802	89	0	2020	"IA, MN, MT, NE, ND, SD, WY"		2					2						www.wellcarepdp.com	www.wellcarepdp.com										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	90	0		29	10	S4802_090_0	4	1			05/29/2019	2020.01	05/29/2019 12:38:29 PM Eastern Daylight Time		07/11/2019 08:46:33 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	90	0	2020	New Mexico		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	91	0		29	10	S4802_091_0	4	1			05/29/2019	2020.01	05/29/2019 12:38:25 PM Eastern Daylight Time		07/11/2019 08:47:11 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	91	0	2020	Colorado		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	92	0		29	10	S4802_092_0	5	1			05/29/2019	2020.01	05/29/2019 12:38:21 PM Eastern Daylight Time		07/25/2019 11:50:47 AM Central Daylight Time			07/25/2019 12:15:43 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	92	0	2020	Arizona		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	93	0		29	10	S4802_093_0	4	1			05/29/2019	2020.01	05/29/2019 12:38:17 PM Eastern Daylight Time		07/06/2019 08:53:56 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	93	0	2020	Nevada		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	94	0		29	10	S4802_094_0	4	1			05/29/2019	2020.01	05/29/2019 12:38:14 PM Eastern Daylight Time		07/06/2019 08:54:31 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	94	0	2020	California		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	95	0		29	10	S4802_095_0	4	1			05/29/2019	2020.01	05/29/2019 12:38:10 PM Eastern Daylight Time		07/11/2019 08:47:49 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	95	0	2020	Hawaii		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	96	0		29	10	S4802_096_0	4	1			05/29/2019	2020.01	05/29/2019 12:38:07 PM Eastern Daylight Time		07/06/2019 08:55:41 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	96	0	2020	Alaska		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	97	0		29	10	S4802_097_0	4	1			05/29/2019	2020.01	05/29/2019 12:38:03 PM Eastern Daylight Time		07/06/2019 08:56:16 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Classic (PDP)	10	29					S4802	97	0	2020	Wisconsin		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	132	0		29	10	S4802_132_0	7	1			05/29/2019	2020.01	05/29/2019 12:38:00 PM Eastern Daylight Time		07/14/2019 07:31:19 AM Central Daylight Time			07/17/2019 08:40:04 AM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	132	0	2020	Wisconsin		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	133	0		29	10	S4802_133_0	6	1			05/29/2019	2020.01	05/29/2019 12:37:56 PM Eastern Daylight Time		07/14/2019 07:31:59 AM Central Daylight Time			07/17/2019 08:40:04 AM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	133	0	2020	Louisiana		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	134	0		29	10	S4802_134_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:53 PM Eastern Daylight Time		07/14/2019 07:32:40 AM Central Daylight Time			07/17/2019 08:40:04 AM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	134	0	2020	Arizona		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	135	0		29	10	S4802_135_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:47 PM Eastern Daylight Time		07/14/2019 07:33:21 AM Central Daylight Time			07/17/2019 08:40:04 AM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	135	0	2020	"Oregon, Washington"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	136	0		29	10	S4802_136_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:42 PM Eastern Daylight Time		07/06/2019 08:59:08 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	136	0	2020	"Maine, New Hampshire"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	137	0		29	10	S4802_137_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:38 PM Eastern Daylight Time		07/06/2019 08:59:43 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	137	0	2020	"Connecticut, Massachusetts, Rhode Island, Vermont"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	138	0		29	10	S4802_138_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:34 PM Eastern Daylight Time		07/06/2019 09:00:18 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	138	0	2020	New York		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	139	0		29	10	S4802_139_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:31 PM Eastern Daylight Time		07/06/2019 09:00:53 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	139	0	2020	New Jersey		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	140	0		29	10	S4802_140_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:27 PM Eastern Daylight Time		07/06/2019 09:01:27 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	140	0	2020	"District of Columbia, Delaware, Maryland"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	141	0		29	10	S4802_141_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:23 PM Eastern Daylight Time		07/06/2019 09:02:01 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	141	0	2020	"Pennsylvania, West Virginia"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	142	0		29	10	S4802_142_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:20 PM Eastern Daylight Time		07/06/2019 09:02:37 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	142	0	2020	Virginia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	143	0		29	10	S4802_143_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:16 PM Eastern Daylight Time		07/06/2019 09:03:12 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	143	0	2020	North Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	144	0		29	10	S4802_144_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:11 PM Eastern Daylight Time		07/06/2019 09:03:46 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	144	0	2020	South Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	145	0		29	10	S4802_145_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:08 PM Eastern Daylight Time		07/06/2019 09:04:21 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	145	0	2020	Georgia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	146	0		29	10	S4802_146_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:04 PM Eastern Daylight Time		07/11/2019 02:33:43 PM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	146	0	2020	Florida		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	147	0		29	10	S4802_147_0	4	1			05/29/2019	2020.01	05/29/2019 12:37:00 PM Eastern Daylight Time		07/06/2019 09:05:32 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	147	0	2020	"Alabama, Tennessee"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	148	0		29	10	S4802_148_0	4	1			05/29/2019	2020.01	05/29/2019 12:36:55 PM Eastern Daylight Time		07/06/2019 09:06:06 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	148	0	2020	Michigan		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	149	0		29	10	S4802_149_0	4	1			05/29/2019	2020.01	05/29/2019 12:36:51 PM Eastern Daylight Time		07/06/2019 09:06:41 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	149	0	2020	Ohio		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	150	0		29	10	S4802_150_0	4	1			05/29/2019	2020.01	05/29/2019 12:36:48 PM Eastern Daylight Time		07/06/2019 09:07:16 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	150	0	2020	"Indiana, Kentucky"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	151	0		29	10	S4802_151_0	4	1			05/29/2019	2020.01	05/29/2019 12:36:44 PM Eastern Daylight Time		07/06/2019 09:07:51 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	151	0	2020	Illinois		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	152	0		29	10	S4802_152_0	4	1			05/29/2019	2020.01	05/29/2019 12:36:41 PM Eastern Daylight Time		07/06/2019 09:08:26 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	152	0	2020	Missouri		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	153	0		29	10	S4802_153_0	4	1			05/29/2019	2020.01	05/29/2019 12:36:36 PM Eastern Daylight Time		07/06/2019 09:09:01 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	153	0	2020	Arkansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	154	0		29	10	S4802_154_0	4	1			05/29/2019	2020.01	05/29/2019 12:36:32 PM Eastern Daylight Time		07/06/2019 09:09:36 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	154	0	2020	Mississippi		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	155	0		29	10	S4802_155_0	4	1			05/29/2019	2020.01	05/29/2019 12:36:28 PM Eastern Daylight Time		07/06/2019 09:10:11 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	155	0	2020	Texas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	156	0		29	10	S4802_156_0	4	1			05/29/2019	2020.01	05/29/2019 12:36:23 PM Eastern Daylight Time		07/06/2019 09:10:45 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	156	0	2020	Oklahoma		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	157	0		29	10	S4802_157_0	4	1			05/29/2019	2020.01	05/29/2019 12:36:19 PM Eastern Daylight Time		07/06/2019 09:11:21 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	157	0	2020	Kansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	158	0		29	10	S4802_158_0	4	1			05/29/2019	2020.01	05/29/2019 12:36:14 PM Eastern Daylight Time		07/06/2019 09:11:56 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	158	0	2020	"IA, MN, MT, ND, NE, SD, WY"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	159	0		29	10	S4802_159_0	4	1			05/29/2019	2020.01	05/29/2019 12:36:09 PM Eastern Daylight Time		07/06/2019 09:12:31 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	159	0	2020	New Mexico		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	160	0		29	10	S4802_160_0	4	1			05/29/2019	2020.01	05/29/2019 12:36:04 PM Eastern Daylight Time		07/06/2019 09:13:05 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	160	0	2020	Colorado		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	161	0		29	10	S4802_161_0	4	1			05/29/2019	2020.01	05/29/2019 12:35:59 PM Eastern Daylight Time		07/06/2019 09:13:40 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	161	0	2020	Nevada		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	162	0		29	10	S4802_162_0	4	1			05/29/2019	2020.01	05/29/2019 12:35:56 PM Eastern Daylight Time		07/06/2019 09:14:14 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	162	0	2020	"Idaho, Utah"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	163	0		29	10	S4802_163_0	4	1			05/29/2019	2020.01	05/29/2019 12:35:52 PM Eastern Daylight Time		07/06/2019 09:14:49 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	163	0	2020	California		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	164	0		29	10	S4802_164_0	4	1			05/29/2019	2020.01	05/29/2019 12:35:27 PM Eastern Daylight Time		07/06/2019 09:15:24 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	164	0	2020	Hawaii		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	165	0		29	10	S4802_165_0	4	1			05/29/2019	2020.01	05/29/2019 12:35:23 PM Eastern Daylight Time		07/06/2019 09:15:59 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Value Script (PDP)	10	29					S4802	165	0	2020	Alaska		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	170	0		29	10	S4802_170_0	4	1			05/29/2019	2020.01	05/29/2019 12:35:19 PM Eastern Daylight Time		07/06/2019 09:16:33 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	170	0	2020	"Maine, New Hampshire"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	171	0		29	10	S4802_171_0	4	1			05/29/2019	2020.01	05/29/2019 12:35:16 PM Eastern Daylight Time		07/06/2019 09:17:08 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	171	0	2020	"Connecticut, Massachusetts, Rhode Island, Vermont"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	172	0		29	10	S4802_172_0	4	1			05/29/2019	2020.01	05/29/2019 12:35:12 PM Eastern Daylight Time		07/06/2019 09:17:43 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	172	0	2020	New York		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	173	0		29	10	S4802_173_0	4	1			05/29/2019	2020.01	05/29/2019 12:35:08 PM Eastern Daylight Time		07/06/2019 09:18:18 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	173	0	2020	New Jersey		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	174	0		29	10	S4802_174_0	4	1			05/29/2019	2020.01	05/29/2019 12:35:04 PM Eastern Daylight Time		07/06/2019 09:18:53 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	174	0	2020	"Delaware, District of Columbia, Maryland"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	175	0		29	10	S4802_175_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:59 PM Eastern Daylight Time		07/06/2019 09:19:28 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	175	0	2020	"Pennsylvania, West Virginia"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	176	0		29	10	S4802_176_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:55 PM Eastern Daylight Time		07/06/2019 09:20:02 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	176	0	2020	Virginia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	177	0		29	10	S4802_177_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:51 PM Eastern Daylight Time		07/06/2019 09:20:38 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	177	0	2020	North Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	178	0		29	10	S4802_178_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:47 PM Eastern Daylight Time		07/06/2019 09:21:13 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	178	0	2020	South Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	179	0		29	10	S4802_179_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:43 PM Eastern Daylight Time		07/06/2019 09:21:48 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	179	0	2020	Georgia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	180	0		29	10	S4802_180_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:40 PM Eastern Daylight Time		07/06/2019 09:22:23 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	180	0	2020	Florida		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	181	0		29	10	S4802_181_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:36 PM Eastern Daylight Time		07/06/2019 09:22:58 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	181	0	2020	"Alabama, Tennessee"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	182	0		29	10	S4802_182_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:32 PM Eastern Daylight Time		07/06/2019 09:23:32 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	182	0	2020	Michigan		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	183	0		29	10	S4802_183_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:29 PM Eastern Daylight Time		07/06/2019 09:24:07 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	183	0	2020	Ohio		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	184	0		29	10	S4802_184_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:25 PM Eastern Daylight Time		07/06/2019 09:24:41 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	184	0	2020	"Indiana, Kentucky"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	185	0		29	10	S4802_185_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:21 PM Eastern Daylight Time		07/06/2019 09:25:17 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	185	0	2020	Wisconsin		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	186	0		29	10	S4802_186_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:18 PM Eastern Daylight Time		07/06/2019 09:25:52 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	186	0	2020	Illinois		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	187	0		29	10	S4802_187_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:14 PM Eastern Daylight Time		07/06/2019 09:26:26 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	187	0	2020	Missouri		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	188	0		29	10	S4802_188_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:10 PM Eastern Daylight Time		07/06/2019 09:27:01 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	188	0	2020	Arkansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	189	0		29	10	S4802_189_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:06 PM Eastern Daylight Time		07/06/2019 09:27:36 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	189	0	2020	Mississippi		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	190	0		29	10	S4802_190_0	4	1			05/29/2019	2020.01	05/29/2019 12:34:03 PM Eastern Daylight Time		07/06/2019 09:28:10 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	190	0	2020	Louisiana		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	191	0		29	10	S4802_191_0	4	1			05/29/2019	2020.01	05/29/2019 12:33:59 PM Eastern Daylight Time		07/06/2019 09:28:45 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	191	0	2020	Texas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	192	0		29	10	S4802_192_0	4	1			05/29/2019	2020.01	05/29/2019 12:33:56 PM Eastern Daylight Time		07/06/2019 09:29:19 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	192	0	2020	Oklahoma		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	193	0		29	10	S4802_193_0	4	1			05/29/2019	2020.01	05/29/2019 12:33:53 PM Eastern Daylight Time		07/06/2019 09:29:54 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	193	0	2020	Kansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	194	0		29	10	S4802_194_0	4	1			05/29/2019	2020.01	05/29/2019 12:33:49 PM Eastern Daylight Time		07/06/2019 09:30:29 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	194	0	2020	"IA, MN, MT, ND, NE, SD, WY"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	195	0		29	10	S4802_195_0	4	1			05/29/2019	2020.01	05/29/2019 12:33:45 PM Eastern Daylight Time		07/06/2019 09:31:04 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	195	0	2020	New Mexico		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	196	0		29	10	S4802_196_0	4	1			05/29/2019	2020.01	05/29/2019 12:33:39 PM Eastern Daylight Time		07/06/2019 09:31:39 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	196	0	2020	Colorado		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	197	0		29	10	S4802_197_0	4	1			05/29/2019	2020.01	05/29/2019 12:33:36 PM Eastern Daylight Time		07/06/2019 09:32:14 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	197	0	2020	Arizona		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	198	0		29	10	S4802_198_0	4	1			05/29/2019	2020.01	05/29/2019 12:33:31 PM Eastern Daylight Time		07/06/2019 09:32:49 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	198	0	2020	Nevada		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	199	0		29	10	S4802_199_0	4	1			05/29/2019	2020.01	05/29/2019 12:33:27 PM Eastern Daylight Time		07/06/2019 09:33:25 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	199	0	2020	"Oregon, Washington"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	200	0		29	10	S4802_200_0	4	1			05/29/2019	2020.01	05/29/2019 12:33:21 PM Eastern Daylight Time		07/06/2019 09:34:00 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	200	0	2020	"Idaho, Utah"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	201	0		29	10	S4802_201_0	4	1			05/29/2019	2020.01	05/29/2019 12:33:16 PM Eastern Daylight Time		07/06/2019 09:34:35 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	201	0	2020	California		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	202	0		29	10	S4802_202_0	4	1			05/29/2019	2020.01	05/29/2019 12:33:11 PM Eastern Daylight Time		07/06/2019 09:35:09 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	202	0	2020	Hawaii		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S4802	203	0		29	10	S4802_203_0	4	1			05/29/2019	2020.01	05/29/2019 12:33:05 PM Eastern Daylight Time		07/06/2019 09:35:45 AM Central Daylight Time			07/12/2019 03:40:55 PM Central Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Wellness Rx (PDP)	10	29					S4802	203	0	2020	Alaska		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5450	801	0		29	10	S5450_801_0	1	1			04/15/2019	2020.01	04/15/2019 10:27:17 AM Eastern Daylight Time					05/31/2019 05:52:45 PM Eastern Daylight Time	"SECURITYCARE OF TENNESSEE, INC."	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	801	0	2020	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	802	0		29	10	S5450_802_0	1	1			04/15/2019	2020.01	04/15/2019 10:27:44 AM Eastern Daylight Time					05/31/2019 05:52:45 PM Eastern Daylight Time	"SECURITYCARE OF TENNESSEE, INC."	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	802	0	2020	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	803	0		29	10	S5450_803_0	1	1			04/15/2019	2020.01	04/15/2019 10:27:54 AM Eastern Daylight Time					05/31/2019 05:52:45 PM Eastern Daylight Time	"SECURITYCARE OF TENNESSEE, INC."	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	803	0	2020	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	804	0		29	10	S5450_804_0	1	1			04/15/2019	2020.01	04/15/2019 10:28:01 AM Eastern Daylight Time					05/31/2019 05:52:45 PM Eastern Daylight Time	"SECURITYCARE OF TENNESSEE, INC."	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	804	0	2020	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	805	0		29	10	S5450_805_0	1	1			04/15/2019	2020.01	04/15/2019 10:28:14 AM Eastern Daylight Time					05/31/2019 05:52:45 PM Eastern Daylight Time	"SECURITYCARE OF TENNESSEE, INC."	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	805	0	2020	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	806	0		29	10	S5450_806_0	1	1			04/15/2019	2020.01	04/15/2019 10:28:23 AM Eastern Daylight Time					05/31/2019 05:52:45 PM Eastern Daylight Time	"SECURITYCARE OF TENNESSEE, INC."	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	806	0	2020	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5450	807	0		29	10	S5450_807_0	1	1			04/15/2019	2020.01	04/15/2019 10:28:32 AM Eastern Daylight Time					05/31/2019 05:52:45 PM Eastern Daylight Time	"SECURITYCARE OF TENNESSEE, INC."	BlueScripts	bcbstmedicare.com	BlueScripts (PDP)	10	29					S5450	807	0	2020	38 PDP Regions		1					2						bcbstmedicare.com	bcbstmedicare.com										(800)818-0962		(800)818-0962		(888)476-5072		(888)476-5072										(711)-		(711)-		(711)-		(711)-																
S5540	2	0		29	10	S5540_002_0	4	1			05/31/2019	2020.01	05/31/2019 12:24:20 PM Eastern Daylight Time		06/01/2019 02:25:07 PM Eastern Daylight Time			06/01/2019 02:44:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Rx Standard (PDP)	10	29					S5540	2	0	2020	North Carolina		2					2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy										(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(711)-		(711)-		(711)-		(711)-																
S5540	4	0		29	10	S5540_004_0	4	1			05/31/2019	2020.01	05/31/2019 12:24:46 PM Eastern Daylight Time		06/01/2019 02:25:13 PM Eastern Daylight Time			06/01/2019 02:44:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Rx Enhanced (PDP)	10	29					S5540	4	0	2020	North Carolina		2					2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy										(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(711)-		(711)-		(711)-		(711)-																
S5540	801	0		29	10	S5540_801_0	4	1			05/15/2019	2020.01	05/15/2019 11:08:42 AM Eastern Daylight Time					06/01/2019 02:44:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Rx EGWP (PDP)	10	29					S5540	801	0	2020	National Employer Group Retirees		1					2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy										(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(711)-		(711)-		(711)-		(711)-																
S5540	802	0		29	10	S5540_802_0	4	1			05/01/2019	2020.01	05/01/2019 11:05:47 AM Eastern Daylight Time					06/01/2019 02:44:57 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	https://www.bluecrossnc.com/medicare	Blue Medicare Rx EGWP Value (PDP)	10	29					S5540	802	0	2020	NC Employer Groups		1					2						https://www.myprime.com/en/find-pharmacy.html	https://www.bluecrossnc.com/find-a-drug-or-pharmacy										(888)247-4142		(888)247-4142		(800)661-5518		(800)661-5518										(711)-		(711)-		(711)-		(711)-																
S5552	4	0		29	10	S5552_004_0	1	1			05/28/2019	2020.01	05/28/2019 12:11:14 PM Eastern Daylight Time		05/31/2019 08:09:04 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5552	4	0	2020	State of New York		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5552	5	0		29	10	S5552_005_0	1	1			05/31/2019	2020.01	05/31/2019 12:37:41 PM Eastern Daylight Time		06/01/2019 06:36:01 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5552	5	0	2020	State of New York		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5552	6	0		29	10	S5552_006_0	1	1			05/31/2019	2020.01	05/31/2019 10:30:34 AM Eastern Daylight Time		05/31/2019 08:09:06 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5552	6	0	2020	State of New York		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/21/2019	2020.01	05/21/2019 10:19:46 AM Eastern Daylight Time					05/28/2019 08:08:43 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana	www.humana.com/medicare	Humana Medicare Employer (PDP)	10	29					S5552	801	0	2020	State of New York		1					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-																
S5584	1	0		29	10	S5584_001_0	5	1			06/02/2019	2020.01	06/02/2019 05:14:33 PM Eastern Daylight Time		06/01/2019 09:22:51 PM Eastern Daylight Time			06/04/2019 12:09:30 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Select (PDP)	10	29					S5584	1	0	2020	State of Michigan		2					2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare										(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-																
S5584	2	0		29	10	S5584_002_0	5	1			06/01/2019	2020.01	06/01/2019 10:43:25 AM Eastern Daylight Time		06/01/2019 09:25:16 PM Eastern Daylight Time			06/04/2019 12:09:30 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Premium (PDP)	10	29					S5584	2	0	2020	State of Michigan		2					2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare										(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-																
S5584	5	0		29	10	S5584_005_0	6	1			06/01/2019	2020.01	06/01/2019 10:42:39 AM Eastern Daylight Time		06/26/2019 11:19:11 AM Eastern Daylight Time			07/11/2019 01:09:16 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Preferred (PDP)	10	29					S5584	5	0	2020	State of Michigan		2					2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare										(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-																
S5584	801	0		29	10	S5584_801_0	5	1			05/09/2019	2020.01	05/09/2019 09:39:58 PM Eastern Daylight Time					06/04/2019 12:09:30 AM 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	2020	State of Michigan		1					2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare										(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216										(711)-		(711)-		(711)-		(711)-																
S5584	802	0		29	10	S5584_802_0	5	1			05/06/2019	2020.01	05/06/2019 09:08:48 AM Eastern Daylight Time					06/04/2019 12:09:30 AM 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	2020	State of Michigan		1					2						www.bcbsm.com/pharmaciesmedicare	www.bcbsm.com/formularymedicare										(866)684-8216		(866)684-8216		(866)684-8216		(866)684-8216										(711)-		(711)-		(711)-		(711)-																
S5588	802	0		29	10	S5588_802_0	1	1			05/27/2019	2020.01	05/27/2019 12:47:24 PM Eastern Daylight Time					05/30/2019 10:23:53 AM 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	2020	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		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670																
S5588	803	0		29	10	S5588_803_0	1	1			05/27/2019	2020.01	05/27/2019 12:48:13 PM Eastern Daylight Time					05/30/2019 10:23:53 AM 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	2020	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		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670																
S5593	2	0		29	10	S5593_002_0	2	1			05/31/2019	2020.01	05/31/2019 09:48:00 AM Eastern Daylight Time		05/30/2019 07:04:13 PM Eastern Daylight Time			05/31/2019 01:29:06 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Inc.	medicare.highmark.com	Blue Rx PDP Plus (PDP)	10	29					S5593	2	0	2020	Pennsylvania  and West Virginia		2					2						medicare.highmark.com	medicare.highmark.com										(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(711)-		(711)-																
S5593	3	0		29	10	S5593_003_0	2	1			05/31/2019	2020.01	05/31/2019 09:49:31 AM Eastern Daylight Time		05/30/2019 07:05:18 PM Eastern Daylight Time			05/31/2019 01:29:06 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Inc.	medicare.highmark.com	Blue Rx PDP Complete (PDP)	10	29					S5593	3	0	2020	Pennsylvania  and West Virginia		2					2						medicare.highmark.com	medicare.highmark.com										(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(711)-		(711)-																
S5593	801	0		29	10	S5593_801_0	2	1			05/06/2019	2020.01	05/06/2019 10:54:55 AM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Inc.	medicare.highmark.com	Blue Rx PDP Employer Group Calendar (PDP)	10	29					S5593	801	0	2020	National		1					2						medicare.highmark.com	medicare.highmark.com										(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(711)-		(711)-																
S5593	802	0		29	10	S5593_802_0	2	1			04/11/2019	2020.01	04/11/2019 01:38:16 PM Eastern Daylight Time					05/31/2019 01:29:06 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Inc.	medicare.highmark.com	Blue Rx PDP Employer Group Non-Calendar (PDP)	10	29					S5593	802	0	2020	National		1					2						medicare.highmark.com	medicare.highmark.com										(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(711)-		(711)-																
S5596	1	0		29	10	S5596_001_0	3	1			05/29/2019	2020.01	05/29/2019 12:16:48 PM Eastern Daylight Time		05/30/2019 12:10:43 PM Eastern Daylight Time			06/01/2019 12:01:32 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	1	0	2020	Maine and New Hampshire		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	5	0		29	10	S5596_005_0	4	1			06/14/2019	2020.01	06/14/2019 11:13:41 AM Eastern Daylight Time		06/18/2019 12:52:37 PM Eastern Daylight Time			07/17/2019 05:21:24 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	5	0	2020	Virginia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	6	0		29	10	S5596_006_0	3	1			05/29/2019	2020.01	05/29/2019 12:17:16 PM Eastern Daylight Time		05/30/2019 12:12:21 PM Eastern Daylight Time			06/01/2019 12:01:32 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	6	0	2020	Virginia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	9	0		29	10	S5596_009_0	5	1			05/26/2019	2020.01	05/26/2019 09:03:48 PM Eastern Daylight Time		06/18/2019 12:53:38 PM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	9	0	2020	Georgia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	10	0		29	10	S5596_010_0	3	1			05/29/2019	2020.01	05/29/2019 12:17:52 PM Eastern Daylight Time		05/30/2019 12:13:59 PM Eastern Daylight Time			06/01/2019 12:01:32 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	10	0	2020	Georgia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	13	0		29	10	S5596_013_0	5	1			05/26/2019	2020.01	05/26/2019 09:03:23 PM Eastern Daylight Time		06/18/2019 12:54:39 PM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	13	0	2020	Ohio		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	14	0		29	10	S5596_014_0	3	1			05/29/2019	2020.01	05/29/2019 12:18:14 PM Eastern Daylight Time		05/30/2019 12:15:38 PM Eastern Daylight Time			06/01/2019 12:01:32 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	14	0	2020	Ohio		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	17	0		29	10	S5596_017_0	5	1			05/26/2019	2020.01	05/26/2019 09:03:00 PM Eastern Daylight Time		06/18/2019 12:55:41 PM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	17	0	2020	Indiana and Kentucky		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	18	0		29	10	S5596_018_0	3	1			05/29/2019	2020.01	05/29/2019 12:18:59 PM Eastern Daylight Time		05/30/2019 12:17:16 PM Eastern Daylight Time			06/01/2019 12:01:32 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	18	0	2020	Indiana and Kentucky		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	33	0		29	10	S5596_033_0	5	1			05/29/2019	2020.01	05/29/2019 10:10:36 AM Eastern Daylight Time		06/18/2019 12:56:43 PM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem Blue Cross MediBlue Rx Standard (PDP)	10	29					S5596	33	0	2020	California		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	34	0		29	10	S5596_034_0	3	1			05/29/2019	2020.01	05/29/2019 12:21:57 PM Eastern Daylight Time		05/30/2019 12:18:54 PM Eastern Daylight Time			06/01/2019 12:01:32 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem Blue Cross MediBlue Rx Plus (PDP)	10	29					S5596	34	0	2020	California		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	43	0		29	10	S5596_043_0	5	1			05/26/2019	2020.01	05/26/2019 09:02:14 PM Eastern Daylight Time		06/18/2019 12:57:44 PM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Blue MedicareRx Value (PDP)	10	29					S5596	43	0	2020	Missouri		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	44	0		29	10	S5596_044_0	3	1			05/29/2019	2020.01	05/29/2019 12:24:10 PM Eastern Daylight Time		05/31/2019 10:37:03 PM Eastern Daylight Time			06/01/2019 12:01:32 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Blue MedicareRx Plus (PDP)	10	29					S5596	44	0	2020	Missouri		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	46	0		29	10	S5596_046_0	5	1			05/26/2019	2020.01	05/26/2019 09:01:52 PM Eastern Daylight Time		06/18/2019 12:58:45 PM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	46	0	2020	Maine and New Hampshire		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	56	0		29	10	S5596_056_0	5	1			05/31/2019	2020.01	05/31/2019 12:59:01 PM Eastern Daylight Time		07/10/2019 09:26:22 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	56	0	2020	Wisconsin		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	57	0		29	10	S5596_057_0	5	1			06/03/2019	2020.01	06/03/2019 09:53:27 AM Eastern Daylight Time		07/10/2019 09:28:01 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	57	0	2020	Wisconsin		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	59	0		29	10	S5596_059_0	5	1			05/31/2019	2020.01	05/31/2019 12:46:43 PM Eastern Daylight Time		06/18/2019 01:00:49 PM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	59	0	2020	Colorado		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	60	0		29	10	S5596_060_0	5	1			06/03/2019	2020.01	06/03/2019 09:52:54 AM Eastern Daylight Time		07/10/2019 09:31:24 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	60	0	2020	Colorado		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	62	0		29	10	S5596_062_0	5	1			05/31/2019	2020.01	05/31/2019 12:59:46 PM Eastern Daylight Time		07/10/2019 09:33:06 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Standard (PDP)	10	29					S5596	62	0	2020	Nevada		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	63	0		29	10	S5596_063_0	5	1			06/03/2019	2020.01	06/03/2019 09:52:12 AM Eastern Daylight Time		07/10/2019 09:34:46 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Plus (PDP)	10	29					S5596	63	0	2020	Nevada		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	66	0		29	10	S5596_066_0	6	1			06/10/2019	2020.01	06/10/2019 04:08:49 PM Eastern Daylight Time		07/10/2019 09:36:33 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Enhanced (PDP)	10	29					S5596	66	0	2020	Maine and New Hampshire		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	68	0		29	10	S5596_068_0	6	1			05/26/2019	2020.01	05/26/2019 07:31:46 PM Eastern Daylight Time		07/10/2019 09:38:18 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Enhanced (PDP)	10	29					S5596	68	0	2020	Virginia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	70	0		29	10	S5596_070_0	6	1			05/26/2019	2020.01	05/26/2019 07:31:20 PM Eastern Daylight Time		07/10/2019 09:39:59 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Enhanced (PDP)	10	29					S5596	70	0	2020	Georgia		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	72	0		29	10	S5596_072_0	6	1			05/26/2019	2020.01	05/26/2019 07:30:30 PM Eastern Daylight Time		07/10/2019 09:41:30 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Enhanced (PDP)	10	29					S5596	72	0	2020	Ohio		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	74	0		29	10	S5596_074_0	6	1			05/26/2019	2020.01	05/26/2019 07:56:57 PM Eastern Daylight Time		07/10/2019 09:43:07 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Enhanced (PDP)	10	29					S5596	74	0	2020	Indiana and Kentucky		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	76	0		29	10	S5596_076_0	6	1			05/26/2019	2020.01	05/26/2019 08:02:02 PM Eastern Daylight Time		07/10/2019 09:44:39 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem Blue Cross MediBlue Rx Enhanced (PDP)	10	29					S5596	76	0	2020	California		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	78	0		29	10	S5596_078_0	5	1			05/26/2019	2020.01	05/26/2019 08:04:26 PM Eastern Daylight Time		07/10/2019 09:46:11 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Blue MedicareRx Enhanced (PDP)	10	29					S5596	78	0	2020	Missouri		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	80	0		29	10	S5596_080_0	6	1			05/26/2019	2020.01	05/26/2019 08:08:11 PM Eastern Daylight Time		07/10/2019 09:47:43 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Enhanced (PDP)	10	29					S5596	80	0	2020	Wisconsin		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	82	0		29	10	S5596_082_0	6	1			05/26/2019	2020.01	05/26/2019 08:17:14 PM Eastern Daylight Time		07/10/2019 09:49:14 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Enhanced (PDP)	10	29					S5596	82	0	2020	Colorado		2					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5596	84	0		29	10	S5596_084_0	6	1			05/26/2019	2020.01	05/26/2019 08:18:48 PM Eastern Daylight Time		07/10/2019 09:50:50 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Anthem MediBlue Rx Enhanced (PDP)	10	29					S5596	84	0	2020	Nevada		2					2						https://shop.anthem.com/medicare	https://shop.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			06/01/2019	2020.01	06/01/2019 12:00:47 PM Eastern Daylight Time					06/01/2019 12:01:32 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Blue MedicareRx (PDP)	10	29					S5596	803	0	2020	VA GA OH IN KY WI CO NV CA MO ME NH (Nationwide)		1					2						https://shop.anthem.com/medicare	https://shop.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			06/01/2019	2020.01	06/01/2019 12:00:54 PM Eastern Daylight Time					06/01/2019 12:01:32 PM Eastern Daylight Time	"ANTHEM INSURANCE COMPANIES, INC."	MediBlue Rx (PDP)	https://shop.anthem.com/medicare	Blue MedicareRx (PDP)	10	29					S5596	804	0	2020	VA GA OH IN KY WI CO NV CA MO ME NH (Nationwide)		1					2						https://shop.anthem.com/medicare	https://shop.anthem.com/medicare										(866)470-6265		(866)470-6265		(866)646-2436		(866)646-2436										(711)-		(711)-		(711)-		(711)-																
S5601	2	0		29	10	S5601_002_0	2	1			05/23/2019	2020.01	05/23/2019 06:47:03 PM Central Daylight Time		05/29/2019 08:48:32 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	2	0	2020	"Northern New England (NH, ME)"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	3	0		29	10	S5601_003_0	3	1			05/24/2019	2020.01	05/24/2019 02:12:36 PM Central Daylight Time		05/30/2019 11:57:24 AM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	3	0	2020	"Northern New England (NH, ME)"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	4	0		29	10	S5601_004_0	2	1			05/23/2019	2020.01	05/23/2019 04:18:16 PM Central Daylight Time		05/29/2019 08:50:30 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	4	0	2020	"Central New England (CT, MA, RI, VT)"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	5	0		29	10	S5601_005_0	3	1			05/24/2019	2020.01	05/24/2019 02:13:43 PM Central Daylight Time		05/30/2019 11:58:25 AM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	5	0	2020	"Central New England (CT, MA, RI, VT)"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	6	0		29	10	S5601_006_0	2	1			05/23/2019	2020.01	05/23/2019 04:26:09 PM Central Daylight Time		05/29/2019 08:52:28 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	6	0	2020	New York		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	7	0		29	10	S5601_007_0	3	1			05/23/2019	2020.01	05/23/2019 04:31:38 PM Central Daylight Time		05/30/2019 11:59:26 AM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	7	0	2020	New York		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	8	0		29	10	S5601_008_0	2	1			05/23/2019	2020.01	05/23/2019 04:34:51 PM Central Daylight Time		05/29/2019 08:54:27 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	8	0	2020	New Jersey		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	9	0		29	10	S5601_009_0	3	1			05/23/2019	2020.01	05/23/2019 04:40:08 PM Central Daylight Time		05/30/2019 12:00:25 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	9	0	2020	New Jersey		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	10	0		29	10	S5601_010_0	2	1			05/23/2019	2020.01	05/23/2019 04:42:35 PM Central Daylight Time		05/29/2019 08:56:26 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	10	0	2020	"Mid-Atlantic (DE, DC, MD)"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	11	0		29	10	S5601_011_0	3	1			05/24/2019	2020.01	05/24/2019 02:16:08 PM Central Daylight Time		05/30/2019 12:01:31 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	11	0	2020	"Mid-Atlantic (DE, DC, MD)"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	12	0		29	10	S5601_012_0	2	1			05/23/2019	2020.01	05/23/2019 04:48:49 PM Central Daylight Time		05/29/2019 08:58:23 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	12	0	2020	"Pennsylvania, West Virginia"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	13	0		29	10	S5601_013_0	4	1			05/24/2019	2020.01	05/24/2019 02:17:12 PM Central Daylight Time		05/30/2019 12:02:31 PM Central Daylight Time			05/31/2019 07:09:29 AM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	13	0	2020	"Pennsylvania, West Virginia"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	14	0		29	10	S5601_014_0	2	1			05/23/2019	2020.01	05/23/2019 04:56:08 PM Central Daylight Time		05/29/2019 09:00:20 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	14	0	2020	Virginia		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	15	0		29	10	S5601_015_0	4	1			05/23/2019	2020.01	05/23/2019 04:59:55 PM Central Daylight Time		07/16/2019 09:25:01 AM Central Daylight Time			07/18/2019 04:14:34 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	15	0	2020	Virginia		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	16	0		29	10	S5601_016_0	2	1			05/23/2019	2020.01	05/23/2019 05:02:31 PM Central Daylight Time		05/29/2019 09:02:17 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	16	0	2020	North Carolina		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	17	0		29	10	S5601_017_0	3	1			05/24/2019	2020.01	05/24/2019 02:19:48 PM Central Daylight Time		05/30/2019 12:04:47 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	17	0	2020	North Carolina		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	18	0		29	10	S5601_018_0	2	1			05/23/2019	2020.01	05/23/2019 05:09:19 PM Central Daylight Time		05/29/2019 09:04:29 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	18	0	2020	South Carolina		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	19	0		29	10	S5601_019_0	3	1			05/24/2019	2020.01	05/24/2019 02:20:52 PM Central Daylight Time		05/30/2019 12:05:51 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	19	0	2020	South Carolina		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	20	0		29	10	S5601_020_0	2	1			05/23/2019	2020.01	05/23/2019 05:15:47 PM Central Daylight Time		05/29/2019 09:06:30 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	20	0	2020	Georgia		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	21	0		29	10	S5601_021_0	4	1			05/24/2019	2020.01	05/24/2019 02:22:02 PM Central Daylight Time		07/16/2019 09:25:41 AM Central Daylight Time			07/18/2019 04:14:34 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	21	0	2020	Georgia		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	22	0		29	10	S5601_022_0	3	1			05/23/2019	2020.01	05/23/2019 05:30:20 PM Central Daylight Time		07/25/2019 01:05:01 PM Central Daylight Time			07/26/2019 09:19:12 AM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	22	0	2020	Florida		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	23	0		29	10	S5601_023_0	3	1			05/24/2019	2020.01	05/24/2019 02:23:19 PM Central Daylight Time		05/30/2019 12:07:56 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	23	0	2020	Florida		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	24	0		29	10	S5601_024_0	2	1			05/23/2019	2020.01	05/23/2019 05:36:06 PM Central Daylight Time		05/29/2019 09:10:36 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	24	0	2020	"Alabama, Tennessee"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	25	0		29	10	S5601_025_0	3	1			05/24/2019	2020.01	05/24/2019 04:17:53 PM Central Daylight Time		05/30/2019 12:08:59 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	25	0	2020	"Alabama, Tennessee"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	26	0		29	10	S5601_026_0	2	1			05/23/2019	2020.01	05/23/2019 05:43:42 PM Central Daylight Time		05/29/2019 09:12:35 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	26	0	2020	Michigan		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	27	0		29	10	S5601_027_0	4	1			05/24/2019	2020.01	05/24/2019 04:19:07 PM Central Daylight Time		07/16/2019 09:26:21 AM Central Daylight Time			07/18/2019 04:14:34 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	27	0	2020	Michigan		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	28	0		29	10	S5601_028_0	2	1			05/23/2019	2020.01	05/23/2019 05:49:44 PM Central Daylight Time		05/29/2019 09:14:34 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	28	0	2020	Ohio		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	29	0		29	10	S5601_029_0	3	1			05/24/2019	2020.01	05/24/2019 03:40:57 PM Central Daylight Time		05/30/2019 12:11:06 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	29	0	2020	Ohio		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	30	0		29	10	S5601_030_0	2	1			05/23/2019	2020.01	05/23/2019 05:56:32 PM Central Daylight Time		05/29/2019 09:16:33 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	30	0	2020	"Indiana, Kentucky"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	31	0		29	10	S5601_031_0	4	1			05/24/2019	2020.01	05/24/2019 01:37:04 PM Central Daylight Time		07/16/2019 09:27:01 AM Central Daylight Time			07/18/2019 04:14:34 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	31	0	2020	"Indiana, Kentucky"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	32	0		29	10	S5601_032_0	2	1			05/23/2019	2020.01	05/23/2019 06:03:21 PM Central Daylight Time		05/29/2019 09:18:33 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	32	0	2020	Wisconsin		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	33	0		29	10	S5601_033_0	4	1			05/24/2019	2020.01	05/24/2019 03:42:15 PM Central Daylight Time		07/16/2019 09:27:41 AM Central Daylight Time			07/18/2019 04:14:34 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	33	0	2020	Wisconsin		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	34	0		29	10	S5601_034_0	2	1			05/23/2019	2020.01	05/23/2019 06:10:43 PM Central Daylight Time		05/29/2019 09:20:31 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	34	0	2020	Illinois		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	35	0		29	10	S5601_035_0	3	1			05/24/2019	2020.01	05/24/2019 01:39:39 PM Central Daylight Time		05/30/2019 12:14:03 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	35	0	2020	Illinois		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	36	0		29	10	S5601_036_0	2	1			05/23/2019	2020.01	05/23/2019 06:20:12 PM Central Daylight Time		05/29/2019 09:22:30 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	36	0	2020	Missouri		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	37	0		29	10	S5601_037_0	4	1			05/28/2019	2020.01	05/28/2019 10:41:46 AM Central Daylight Time		07/16/2019 09:28:23 AM Central Daylight Time			07/18/2019 04:14:34 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	37	0	2020	Missouri		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	38	0		29	10	S5601_038_0	2	1			05/23/2019	2020.01	05/23/2019 06:49:03 PM Central Daylight Time		05/29/2019 09:24:29 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	38	0	2020	Arkansas		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	40	0		29	10	S5601_040_0	2	1			05/23/2019	2020.01	05/23/2019 06:51:51 PM Central Daylight Time		05/29/2019 09:25:29 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	40	0	2020	Mississippi		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	41	0		29	10	S5601_041_0	4	1			05/24/2019	2020.01	05/24/2019 02:43:08 PM Central Daylight Time		07/16/2019 09:29:02 AM Central Daylight Time			07/18/2019 04:14:34 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	41	0	2020	Mississippi		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	42	0		29	10	S5601_042_0	3	1			05/23/2019	2020.01	05/23/2019 07:00:32 PM Central Daylight Time		07/25/2019 01:14:58 PM Central Daylight Time			07/26/2019 09:19:12 AM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	42	0	2020	Louisiana		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	44	0		29	10	S5601_044_0	2	1			05/23/2019	2020.01	05/23/2019 07:06:30 PM Central Daylight Time		05/29/2019 09:28:28 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	44	0	2020	Texas		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	45	0		29	10	S5601_045_0	3	1			05/24/2019	2020.01	05/24/2019 01:41:35 PM Central Daylight Time		05/30/2019 12:17:03 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	45	0	2020	Texas		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	46	0		29	10	S5601_046_0	2	1			05/23/2019	2020.01	05/23/2019 07:13:06 PM Central Daylight Time		05/29/2019 09:30:28 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	46	0	2020	Oklahoma		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	48	0		29	10	S5601_048_0	2	1			05/23/2019	2020.01	05/23/2019 07:17:06 PM Central Daylight Time		05/29/2019 09:31:29 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	48	0	2020	Kansas		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	49	0		29	10	S5601_049_0	3	1			05/24/2019	2020.01	05/24/2019 01:42:34 PM Central Daylight Time		05/30/2019 12:18:03 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	49	0	2020	Kansas		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	50	0		29	10	S5601_050_0	2	1			05/24/2019	2020.01	05/24/2019 02:04:14 PM Central Daylight Time		05/29/2019 09:33:30 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	50	0	2020	"Upper MW and N.Plains (IA, MN, MT, ND, NE, SD, WY)"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	51	0		29	10	S5601_051_0	3	1			05/24/2019	2020.01	05/24/2019 02:44:38 PM Central Daylight Time		05/30/2019 12:19:04 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	51	0	2020	"Upper MW and N.Plains (IA, MN, MT, ND, NE, SD, WY)"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	52	0		29	10	S5601_052_0	2	1			05/23/2019	2020.01	05/23/2019 07:34:05 PM Central Daylight Time		05/29/2019 09:35:30 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	52	0	2020	New Mexico		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	53	0		29	10	S5601_053_0	3	1			05/23/2019	2020.01	05/23/2019 07:36:51 PM Central Daylight Time		05/30/2019 12:20:04 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	53	0	2020	New Mexico		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	54	0		29	10	S5601_054_0	2	1			05/23/2019	2020.01	05/23/2019 07:38:52 PM Central Daylight Time		05/29/2019 09:37:31 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	54	0	2020	Colorado		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	55	0		29	10	S5601_055_0	3	1			05/24/2019	2020.01	05/24/2019 01:44:37 PM Central Daylight Time		05/30/2019 12:21:04 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	55	0	2020	Colorado		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	56	0		29	10	S5601_056_0	2	1			05/23/2019	2020.01	05/23/2019 07:45:07 PM Central Daylight Time		05/29/2019 09:39:37 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	56	0	2020	Arizona		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	57	0		29	10	S5601_057_0	3	1			05/24/2019	2020.01	05/24/2019 01:45:47 PM Central Daylight Time		05/30/2019 12:22:04 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	57	0	2020	Arizona		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	58	0		29	10	S5601_058_0	2	1			05/23/2019	2020.01	05/23/2019 07:50:13 PM Central Daylight Time		05/29/2019 09:41:36 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	58	0	2020	Nevada		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	59	0		29	10	S5601_059_0	3	1			05/24/2019	2020.01	05/24/2019 01:46:41 PM Central Daylight Time		05/30/2019 12:23:03 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	59	0	2020	Nevada		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	60	0		29	10	S5601_060_0	2	1			05/23/2019	2020.01	05/23/2019 07:55:52 PM Central Daylight Time		05/29/2019 09:43:34 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	60	0	2020	"Oregon, Washington"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	61	0		29	10	S5601_061_0	3	1			05/23/2019	2020.01	05/23/2019 07:59:33 PM Central Daylight Time		05/30/2019 12:24:02 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	61	0	2020	"Oregon, Washington"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	62	0		29	10	S5601_062_0	2	1			05/23/2019	2020.01	05/23/2019 08:01:51 PM Central Daylight Time		05/29/2019 09:45:34 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	62	0	2020	"Idaho, Utah"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	63	0		29	10	S5601_063_0	3	1			05/24/2019	2020.01	05/24/2019 01:47:43 PM Central Daylight Time		05/30/2019 12:25:02 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	63	0	2020	"Idaho, Utah"		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	64	0		29	10	S5601_064_0	2	1			05/23/2019	2020.01	05/23/2019 10:10:51 PM Central Daylight Time		05/29/2019 09:47:37 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	64	0	2020	California		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	65	0		29	10	S5601_065_0	3	1			05/24/2019	2020.01	05/24/2019 01:48:40 PM Central Daylight Time		05/30/2019 12:26:02 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	65	0	2020	California		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	66	0		29	10	S5601_066_0	2	1			05/28/2019	2020.01	05/28/2019 02:23:37 PM Central Daylight Time		05/29/2019 09:49:37 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	66	0	2020	Hawaii		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	67	0		29	10	S5601_067_0	3	1			05/24/2019	2020.01	05/24/2019 01:49:47 PM Central Daylight Time		05/30/2019 12:27:01 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	67	0	2020	Hawaii		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	68	0		29	10	S5601_068_0	2	1			05/23/2019	2020.01	05/23/2019 08:20:52 PM Central Daylight Time		05/29/2019 09:51:37 PM Central Daylight Time			05/30/2019 04:49:32 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	68	0	2020	Alaska		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	107	0		29	10	S5601_107_0	4	1			05/24/2019	2020.01	05/24/2019 03:06:02 PM Central Daylight Time		07/16/2019 09:29:42 AM Central Daylight Time			07/18/2019 04:14:34 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	107	0	2020	Arkansas		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	108	0		29	10	S5601_108_0	3	1			05/24/2019	2020.01	05/24/2019 01:52:02 PM Central Daylight Time		05/30/2019 12:29:10 PM Central Daylight Time			05/30/2019 06:46:36 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	108	0	2020	Louisiana		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	109	0		29	10	S5601_109_0	4	1			05/24/2019	2020.01	05/24/2019 02:01:19 PM Central Daylight Time		07/16/2019 09:30:23 AM Central Daylight Time			07/18/2019 04:14:34 PM Central Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	109	0	2020	Oklahoma		2					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	801	0		29	10	S5601_801_0	1	1			05/30/2019	2020.01	05/30/2019 12:35:59 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - 5 Tier - Calendar (PDP)	10	29					S5601	801	0	2020	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	802	0		29	10	S5601_802_0	1	1			05/30/2019	2020.01	05/30/2019 12:36:10 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - 5 Tier - Non Calendar (PDP)	10	29					S5601	802	0	2020	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										(711)-		(711)-		(711)-		(711)-																
S5601	803	0		29	10	S5601_803_0	1	1			05/30/2019	2020.01	05/30/2019 12:36:19 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript FI Group - 5 Tier - Calendar (PDP)	10	29					S5601	803	0	2020	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	804	0		29	10	S5601_804_0	1	1			05/30/2019	2020.01	05/30/2019 12:36:27 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript FI Group - 5 Tier Calendar (PDP)	10	29					S5601	804	0	2020	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	805	0		29	10	S5601_805_0	1	1			05/30/2019	2020.01	05/30/2019 12:36:35 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript SF Group - 5 Tier - Calendar (PDP)	10	29					S5601	805	0	2020	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	806	0		29	10	S5601_806_0	1	1			05/30/2019	2020.01	05/30/2019 12:36:44 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript SF Group - 5 Tier - Calendar (PDP)	10	29					S5601	806	0	2020	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	807	0		29	10	S5601_807_0	1	1			05/30/2019	2020.01	05/30/2019 12:36:54 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - 5 Tier - Calendar (PDP)	10	29					S5601	807	0	2020	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	808	0		29	10	S5601_808_0	1	1			05/30/2019	2020.01	05/30/2019 12:37:06 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - 5 Tier - Non Calendar (PDP)	10	29					S5601	808	0	2020	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	809	0		29	10	S5601_809_0	1	1			05/30/2019	2020.01	05/30/2019 12:37:15 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - 5 Tier - Calendar (PDP)	10	29					S5601	809	0	2020	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	810	0		29	10	S5601_810_0	1	1			05/30/2019	2020.01	05/30/2019 12:37:25 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - 5 Tier - Non Calendar (PDP)	10	29					S5601	810	0	2020	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	811	0		29	10	S5601_811_0	1	1			05/30/2019	2020.01	05/30/2019 12:37:33 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript Group - State of NY (PDP)	10	29					S5601	811	0	2020	National		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	812	0		29	10	S5601_812_0	1	1			05/30/2019	2020.01	05/30/2019 12:37:42 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript SF Group - 5 Tier - Calendar (PDP)	10	29					S5601	812	0	2020	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	813	0		29	10	S5601_813_0	1	1			05/30/2019	2020.01	05/30/2019 12:37:50 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript SF Group - 5 Tier - Calendar (PDP)	10	29					S5601	813	0	2020	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	814	0		29	10	S5601_814_0	1	1			05/30/2019	2020.01	05/30/2019 12:37:58 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript SF Group - 5 Tier - Calendar (PDP)	10	29					S5601	814	0	2020	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	815	0		29	10	S5601_815_0	1	1			05/30/2019	2020.01	05/30/2019 12:38:06 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	SilverScript SF Group - 5 Tier - Calendar (PDP)	10	29					S5601	815	0	2020	National SilverScript Group		1					2						www.SilverScript.com	www.SilverScript.com										(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	816	0		29	10	S5601_816_0	1	1			05/30/2019	2020.01	05/30/2019 12:38:25 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	Aetna Medicare Rx offered by SilverScript - FI (PDP)	10	29					S5601	816	0	2020	Employer National		1					2						www.SilverScript.com	www.SilverScript.com										(855)212-0883		(855)212-0883		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	817	0		29	10	S5601_817_0	1	1			05/30/2019	2020.01	05/30/2019 12:38:44 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	Aetna Medicare Rx offered by SilverScript - FI SH (PDP)	10	29					S5601	817	0	2020	Employer National		1					2						www.SilverScript.com	www.SilverScript.com										(855)212-0883		(855)212-0883		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	818	0		29	10	S5601_818_0	1	1			05/30/2019	2020.01	05/30/2019 12:38:52 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	Aetna Medicare Rx offered by SilverScript - SF (PDP)	10	29					S5601	818	0	2020	'Employer National		1					2						www.SilverScript.com	www.SilverScript.com										(855)212-0883		(855)212-0883		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	819	0		29	10	S5601_819_0	1	1			05/30/2019	2020.01	05/30/2019 12:39:02 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	Aetna Medicare Rx offered by SilverScript - SF SH (PDP)	10	29					S5601	819	0	2020	Employer National		1					2						www.SilverScript.com	www.SilverScript.com										(855)212-0883		(855)212-0883		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	820	0		29	10	S5601_820_0	1	1			05/30/2019	2020.01	05/30/2019 12:39:11 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	Aetna Medicare Rx offered by SilverScript - DC (PDP)	10	29					S5601	820	0	2020	Employer National		1					2						www.SilverScript.com	www.SilverScript.com										(855)212-0883		(855)212-0883		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5601	821	0		29	10	S5601_821_0	1	1			05/30/2019	2020.01	05/30/2019 12:39:21 PM Eastern Daylight Time					05/31/2019 09:39:51 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.silverscript.com	Aetna Medicare Rx offered by SilverScript - DC SH (PDP)	10	29					S5601	821	0	2020	Employer National		1					2						www.SilverScript.com	www.SilverScript.com										(855)212-0883		(855)212-0883		(866)552-6106		(866)552-6106										(711)-		(711)-		(711)-		(711)-																
S5609	1	0		29	10	S5609_001_0	5	1			06/03/2019	2020.01	06/03/2019 09:46:11 AM Mountain Daylight Time		07/10/2019 11:54:24 AM Mountain Daylight Time			07/17/2019 11:23:17 AM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script Basic (PDP)	10	29					S5609	1	0	2020	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	2	0		29	10	S5609_002_0	8	1			05/29/2019	2020.01	05/29/2019 04:47:27 PM Mountain Daylight Time		07/10/2019 11:56:48 AM Mountain Daylight Time			07/17/2019 11:23:17 AM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script Enhanced (PDP)	10	29					S5609	2	0	2020	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	3	0		29	10	S5609_003_0	8	1			05/31/2019	2020.01	05/31/2019 09:43:46 AM Mountain Daylight Time		07/10/2019 12:00:05 PM Mountain Daylight Time			07/17/2019 11:23:17 AM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script Saver (PDP)	10	29					S5609	3	0	2020	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	3	1			05/17/2019	2020.01	05/17/2019 11:46:59 AM Mountain Daylight Time					06/03/2019 10:36:44 AM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script (PDP)	10	29					S5609	802	0	2020	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)-																
S5609	804	0		29	10	S5609_804_0	3	1			05/17/2019	2020.01	05/17/2019 11:47:18 AM Mountain Daylight Time					06/03/2019 10:36:44 AM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script 02 (PDP)	10	29					S5609	804	0	2020	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)-																
S5609	805	0		29	10	S5609_805_0	3	1			05/17/2019	2020.01	05/17/2019 11:55:21 AM Mountain Daylight Time					06/03/2019 10:36:44 AM Mountain Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script 03 (PDP)	10	29					S5609	805	0	2020	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	3	0		29	10	S5617_003_0	2	1			05/31/2019	2020.01	05/31/2019 04:40:49 PM Central Daylight Time		05/31/2019 04:24:32 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	3	0	2020	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	8	0		29	10	S5617_008_0	1	1			05/31/2019	2020.01	05/31/2019 04:40:33 PM Central Daylight Time		05/31/2019 04:25:38 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	8	0	2020	"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	13	0		29	10	S5617_013_0	1	1			05/31/2019	2020.01	05/31/2019 04:40:23 PM Central Daylight Time		05/31/2019 04:26:36 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	13	0	2020	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	18	0		29	10	S5617_018_0	1	1			05/31/2019	2020.01	05/31/2019 04:40:14 PM Central Daylight Time		05/31/2019 04:27:32 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	18	0	2020	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	53	0		29	10	S5617_053_0	1	1			05/31/2019	2020.01	05/31/2019 04:40:06 PM Central Daylight Time		05/31/2019 04:28:24 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	53	0	2020	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	68	0		29	10	S5617_068_0	1	1			05/31/2019	2020.01	05/31/2019 04:39:55 PM Central Daylight Time		05/31/2019 04:29:18 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	68	0	2020	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	88	0		29	10	S5617_088_0	1	1			05/31/2019	2020.01	05/31/2019 04:39:45 PM Central Daylight Time		05/31/2019 04:30:14 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	88	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:39:35 PM Central Daylight Time		05/31/2019 04:31:12 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:39:22 PM Central Daylight Time		05/31/2019 04:32:06 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:39:12 PM Central Daylight Time		05/31/2019 04:33:02 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:39:01 PM Central Daylight Time		05/31/2019 04:33:58 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:38:53 PM Central Daylight Time		05/31/2019 04:34:52 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	"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	1	1			05/31/2019	2020.01	05/31/2019 04:38:40 PM Central Daylight Time		05/31/2019 04:35:46 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:38:31 PM Central Daylight Time		05/31/2019 04:36:42 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:38:23 PM Central Daylight Time		05/31/2019 04:37:34 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:38:13 PM Central Daylight Time		05/31/2019 04:38:30 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:38:03 PM Central Daylight Time		05/31/2019 04:39:26 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:37:52 PM Central Daylight Time		05/31/2019 04:40:26 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:37:42 PM Central Daylight Time		05/31/2019 04:41:24 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:37:30 PM Central Daylight Time		05/31/2019 04:42:24 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	214	0		29	10	S5617_214_0	1	1			05/31/2019	2020.01	05/31/2019 04:37:21 PM Central Daylight Time		05/31/2019 04:43:22 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	"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	1	1			05/31/2019	2020.01	05/31/2019 04:37:08 PM Central Daylight Time		05/31/2019 04:44:28 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:37:00 PM Central Daylight Time		05/31/2019 04:45:26 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:36:50 PM Central Daylight Time		05/31/2019 04:46:24 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:36:40 PM Central Daylight Time		05/31/2019 04:47:22 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:36:29 PM Central Daylight Time		05/31/2019 04:48:20 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:36:19 PM Central Daylight Time		05/31/2019 04:49:18 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:36:08 PM Central Daylight Time		05/31/2019 04:50:16 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:35:59 PM Central Daylight Time		05/31/2019 04:51:16 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:35:48 PM Central Daylight Time		05/31/2019 04:52:14 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:35:37 PM Central Daylight Time		05/31/2019 04:53:16 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:35:27 PM Central Daylight Time		05/31/2019 04:54:14 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:34:31 PM Central Daylight Time		05/31/2019 04:55:12 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:34:13 PM Central Daylight Time		05/31/2019 04:56:16 PM Central Daylight Time			05/31/2019 09:29:23 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	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:05:02 PM Central Daylight Time		05/31/2019 04:08:36 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	246	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:03:30 PM Central Daylight Time		05/31/2019 04:09:40 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	247	0	2020	"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	1	1			05/31/2019	2020.01	05/31/2019 04:03:17 PM Central Daylight Time		05/31/2019 04:10:44 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	248	0	2020	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	2	1			05/31/2019	2020.01	05/31/2019 04:03:02 PM Central Daylight Time		05/31/2019 04:11:46 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	249	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:02:45 PM Central Daylight Time		05/31/2019 04:12:48 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	250	0	2020	"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	1	1			05/31/2019	2020.01	05/31/2019 04:02:33 PM Central Daylight Time		05/31/2019 04:13:52 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	251	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:02:20 PM Central Daylight Time		05/31/2019 04:14:54 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	252	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:01:19 PM Central Daylight Time		05/31/2019 04:16:00 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	253	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:00:58 PM Central Daylight Time		05/31/2019 04:17:04 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	254	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 04:00:24 PM Central Daylight Time		05/31/2019 04:18:12 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	255	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 03:59:46 PM Central Daylight Time		05/31/2019 04:19:16 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	256	0	2020	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	2	1			05/31/2019	2020.01	05/31/2019 03:59:31 PM Central Daylight Time		07/02/2019 01:53:12 PM Central Daylight Time			07/17/2019 11:51:50 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	257	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 03:59:14 PM Central Daylight Time		05/31/2019 04:21:20 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	258	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 03:59:03 PM Central Daylight Time		05/31/2019 04:22:24 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	259	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 03:58:46 PM Central Daylight Time		05/31/2019 04:23:28 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	260	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 03:58:36 PM Central Daylight Time		05/31/2019 04:26:52 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	261	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 03:58:22 PM Central Daylight Time		05/31/2019 04:27:56 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	262	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 03:58:07 PM Central Daylight Time		05/31/2019 04:28:54 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	263	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 03:57:52 PM Central Daylight Time		05/31/2019 04:30:00 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	264	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 03:57:38 PM Central Daylight Time		05/31/2019 04:31:10 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	265	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 03:57:25 PM Central Daylight Time		05/31/2019 04:32:12 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	266	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 03:57:03 PM Central Daylight Time		05/31/2019 04:33:16 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	267	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 03:56:48 PM Central Daylight Time		05/31/2019 04:34:16 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	268	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 03:56:35 PM Central Daylight Time		05/31/2019 04:35:18 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	269	0	2020	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	2	1			05/31/2019	2020.01	05/31/2019 03:56:23 PM Central Daylight Time		07/02/2019 01:54:10 PM Central Daylight Time			07/17/2019 11:51:50 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	270	0	2020	"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	271	0		29	10	S5617_271_0	1	1			05/31/2019	2020.01	05/31/2019 03:56:01 PM Central Daylight Time		05/31/2019 04:37:28 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	271	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 02:47:42 PM Central Daylight Time		05/31/2019 04:38:34 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	272	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 02:46:07 PM Central Daylight Time		05/31/2019 04:39:42 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	273	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 02:45:50 PM Central Daylight Time		05/31/2019 04:40:46 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	274	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 02:45:37 PM Central Daylight Time		05/31/2019 04:41:56 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	275	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 02:45:25 PM Central Daylight Time		05/31/2019 04:43:04 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	276	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 02:44:23 PM Central Daylight Time		05/31/2019 04:44:10 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	277	0	2020	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	2	1			05/31/2019	2020.01	05/31/2019 02:44:00 PM Central Daylight Time		07/02/2019 01:55:12 PM Central Daylight Time			07/17/2019 11:51:50 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	278	0	2020	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	1	1			05/31/2019	2020.01	05/31/2019 02:43:45 PM Central Daylight Time		05/31/2019 04:46:28 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Extra (PDP)	10	29					S5617	279	0	2020	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	280	0		29	10	S5617_280_0	1	1			05/31/2019	2020.01	05/31/2019 04:16:04 PM Central Daylight Time		05/31/2019 04:16:00 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	280	0	2020	New Hampshire and Maine		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	281	0		29	10	S5617_281_0	2	1			05/31/2019	2020.01	05/31/2019 04:15:54 PM Central Daylight Time		05/31/2019 04:16:52 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	281	0	2020	"Connecticut, Massachusetts, Rhode Island, Vermont"		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	282	0		29	10	S5617_282_0	1	1			05/31/2019	2020.01	05/31/2019 04:15:43 PM Central Daylight Time		05/31/2019 04:17:42 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	282	0	2020	New York		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	283	0		29	10	S5617_283_0	1	1			05/31/2019	2020.01	05/31/2019 04:15:32 PM Central Daylight Time		05/31/2019 04:18:34 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	283	0	2020	New Jersey		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	284	0		29	10	S5617_284_0	1	1			05/31/2019	2020.01	05/31/2019 04:15:23 PM Central Daylight Time		05/31/2019 04:19:26 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	284	0	2020	"Delaware, Maryland and District of Columbia"		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	285	0		29	10	S5617_285_0	1	1			05/31/2019	2020.01	05/31/2019 04:15:12 PM Central Daylight Time		05/31/2019 04:20:18 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	285	0	2020	Pennsylvania and West Virginia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	286	0		29	10	S5617_286_0	1	1			05/31/2019	2020.01	05/31/2019 04:15:02 PM Central Daylight Time		05/31/2019 04:21:10 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	286	0	2020	Virginia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	287	0		29	10	S5617_287_0	1	1			05/31/2019	2020.01	05/31/2019 04:14:52 PM Central Daylight Time		05/31/2019 04:22:02 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	287	0	2020	North Carolina		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	288	0		29	10	S5617_288_0	1	1			05/31/2019	2020.01	05/31/2019 04:14:41 PM Central Daylight Time		05/31/2019 04:22:52 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	288	0	2020	South Carolina		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	289	0		29	10	S5617_289_0	1	1			05/31/2019	2020.01	05/31/2019 04:14:31 PM Central Daylight Time		05/31/2019 04:23:46 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	289	0	2020	Georgia		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	290	0		29	10	S5617_290_0	1	1			05/31/2019	2020.01	05/31/2019 04:14:21 PM Central Daylight Time		05/31/2019 04:24:38 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	290	0	2020	Florida		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	291	0		29	10	S5617_291_0	1	1			05/31/2019	2020.01	05/31/2019 04:14:12 PM Central Daylight Time		05/31/2019 04:25:40 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	291	0	2020	Alabama and Tennessee		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	292	0		29	10	S5617_292_0	1	1			05/31/2019	2020.01	05/31/2019 04:14:01 PM Central Daylight Time		05/31/2019 04:26:32 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	292	0	2020	Michigan		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	293	0		29	10	S5617_293_0	1	1			05/31/2019	2020.01	05/31/2019 04:13:50 PM Central Daylight Time		05/31/2019 04:27:24 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	293	0	2020	Ohio		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	294	0		29	10	S5617_294_0	1	1			05/31/2019	2020.01	05/31/2019 04:13:39 PM Central Daylight Time		05/31/2019 04:28:16 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	294	0	2020	Indiana and Kentucky		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	295	0		29	10	S5617_295_0	1	1			05/31/2019	2020.01	05/31/2019 04:13:29 PM Central Daylight Time		05/31/2019 04:29:08 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	295	0	2020	Wisconsin		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	296	0		29	10	S5617_296_0	1	1			05/31/2019	2020.01	05/31/2019 04:13:19 PM Central Daylight Time		05/31/2019 04:30:00 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	296	0	2020	Illinois		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	297	0		29	10	S5617_297_0	1	1			05/31/2019	2020.01	05/31/2019 04:13:05 PM Central Daylight Time		05/31/2019 04:30:54 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	297	0	2020	Missouri		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	298	0		29	10	S5617_298_0	1	1			05/31/2019	2020.01	05/31/2019 04:12:53 PM Central Daylight Time		05/31/2019 04:31:46 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	298	0	2020	Arkansas		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	299	0		29	10	S5617_299_0	1	1			05/31/2019	2020.01	05/31/2019 04:12:42 PM Central Daylight Time		05/31/2019 04:32:38 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	299	0	2020	Mississippi		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	300	0		29	10	S5617_300_0	1	1			05/31/2019	2020.01	05/31/2019 04:12:32 PM Central Daylight Time		05/31/2019 04:33:30 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	300	0	2020	Louisiana		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	301	0		29	10	S5617_301_0	1	1			05/31/2019	2020.01	05/31/2019 04:12:21 PM Central Daylight Time		05/31/2019 04:34:22 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	301	0	2020	Texas		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	302	0		29	10	S5617_302_0	1	1			05/31/2019	2020.01	05/31/2019 04:12:11 PM Central Daylight Time		05/31/2019 04:35:14 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	302	0	2020	Oklahoma		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	303	0		29	10	S5617_303_0	1	1			05/31/2019	2020.01	05/31/2019 04:11:59 PM Central Daylight Time		05/31/2019 04:36:06 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	303	0	2020	Kansas		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	304	0		29	10	S5617_304_0	1	1			05/31/2019	2020.01	05/31/2019 04:11:49 PM Central Daylight Time		05/31/2019 04:36:58 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	304	0	2020	"IA, MN, MT, ND, SD, NE, WY"		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	305	0		29	10	S5617_305_0	1	1			05/31/2019	2020.01	05/31/2019 04:11:27 PM Central Daylight Time		05/31/2019 04:37:50 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	305	0	2020	New Mexico		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	306	0		29	10	S5617_306_0	1	1			05/31/2019	2020.01	05/31/2019 04:11:39 PM Central Daylight Time		05/31/2019 04:38:42 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	306	0	2020	Colorado		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	307	0		29	10	S5617_307_0	1	1			05/31/2019	2020.01	05/31/2019 04:10:52 PM Central Daylight Time		05/31/2019 04:39:34 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	307	0	2020	Arizona		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	308	0		29	10	S5617_308_0	1	1			05/31/2019	2020.01	05/31/2019 04:10:39 PM Central Daylight Time		05/31/2019 04:40:30 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	308	0	2020	Nevada		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	309	0		29	10	S5617_309_0	1	1			05/31/2019	2020.01	05/31/2019 04:07:20 PM Central Daylight Time		05/31/2019 04:41:28 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	309	0	2020	Oregon and Washington		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	310	0		29	10	S5617_310_0	1	1			05/31/2019	2020.01	05/31/2019 04:07:02 PM Central Daylight Time		05/31/2019 04:42:28 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	310	0	2020	Idaho and Utah		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	311	0		29	10	S5617_311_0	1	1			05/31/2019	2020.01	05/31/2019 04:06:51 PM Central Daylight Time		05/31/2019 04:43:34 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	311	0	2020	California		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	312	0		29	10	S5617_312_0	1	1			05/31/2019	2020.01	05/31/2019 04:06:41 PM Central Daylight Time		05/31/2019 04:44:40 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	312	0	2020	Hawaii		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-																
S5617	313	0		29	10	S5617_313_0	1	1			05/31/2019	2020.01	05/31/2019 04:06:29 PM Central Daylight Time		05/31/2019 04:45:46 PM Central Daylight Time			05/31/2019 09:29:23 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Essential (PDP)	10	29					S5617	313	0	2020	Alaska		2					2						www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPformulary									(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			04/09/2019	2020.01	04/09/2019 04:19:54 PM Central Daylight Time					05/31/2019 09:29:23 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	2020	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			04/09/2019	2020.01	04/09/2019 04:19:31 PM Central Daylight Time					05/31/2019 09:29:23 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	2020	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			04/09/2019	2020.01	04/09/2019 04:19:36 PM Central Daylight Time					05/31/2019 09:29:23 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	2020	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			04/09/2019	2020.01	04/09/2019 04:19:40 PM Central Daylight Time					05/31/2019 09:29:23 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	2020	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	1	1			05/29/2019	2020.01	05/29/2019 09:59:03 AM Eastern Daylight Time		05/29/2019 10:18:42 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	104	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:35:14 PM Eastern Daylight Time		05/27/2019 11:43:08 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	105	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:22:15 PM Eastern Daylight Time		05/27/2019 11:43:32 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	106	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:27:43 PM Eastern Daylight Time		05/29/2019 10:20:50 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	107	0	2020	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			05/27/2019	2020.01	05/27/2019 12:22:52 PM Eastern Daylight Time		07/08/2019 10:22:50 AM Eastern Daylight Time			07/17/2019 11:24:47 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	108	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:42:33 PM Eastern Daylight Time		05/27/2019 11:44:48 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	109	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:14:50 PM Eastern Daylight Time		05/27/2019 11:45:14 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	110	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:43:23 PM Eastern Daylight Time		05/27/2019 11:45:38 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	111	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:40:21 PM Eastern Daylight Time		05/27/2019 11:46:04 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	112	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:09:28 PM Eastern Daylight Time		05/27/2019 11:46:30 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	113	0	2020	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			05/27/2019	2020.01	05/27/2019 12:24:46 PM Eastern Daylight Time		07/08/2019 10:23:18 AM Eastern Daylight Time			07/17/2019 11:24:47 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	114	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:35:48 PM Eastern Daylight Time		05/27/2019 11:47:20 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	115	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:15:25 PM Eastern Daylight Time		05/27/2019 11:47:44 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	116	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:25:21 PM Eastern Daylight Time		05/27/2019 11:48:08 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	117	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:38:33 PM Eastern Daylight Time		05/27/2019 11:48:32 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	118	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:15:57 PM Eastern Daylight Time		05/27/2019 11:48:56 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	119	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:43:50 PM Eastern Daylight Time		05/27/2019 11:49:22 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	120	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:11:55 PM Eastern Daylight Time		05/27/2019 11:49:46 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	121	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:12:39 PM Eastern Daylight Time		05/27/2019 11:50:12 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	122	0	2020	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			05/27/2019	2020.01	05/27/2019 12:20:12 PM Eastern Daylight Time		07/08/2019 10:23:46 AM Eastern Daylight Time			07/17/2019 11:24:47 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	123	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:10:11 PM Eastern Daylight Time		05/27/2019 11:51:00 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	124	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:31:56 PM Eastern Daylight Time		05/27/2019 12:09:38 PM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	125	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:13:04 PM Eastern Daylight Time		05/27/2019 11:51:28 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	126	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:21:17 PM Eastern Daylight Time		05/27/2019 11:51:52 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	127	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:23:26 PM Eastern Daylight Time		05/27/2019 11:52:16 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	128	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:19:05 PM Eastern Daylight Time		05/27/2019 11:52:42 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	129	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:17:40 PM Eastern Daylight Time		05/27/2019 11:53:06 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	130	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:21:55 PM Eastern Daylight Time		05/27/2019 11:53:32 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	131	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:44:14 PM Eastern Daylight Time		05/27/2019 11:53:56 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	132	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:29:33 PM Eastern Daylight Time		05/27/2019 11:54:20 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	133	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:41:01 PM Eastern Daylight Time		05/27/2019 11:54:46 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	134	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:44:35 PM Eastern Daylight Time		05/27/2019 11:55:10 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	135	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 12:33:09 PM Eastern Daylight Time		05/29/2019 10:22:32 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	136	0	2020	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	1	1			05/27/2019	2020.01	05/27/2019 01:19:43 PM Eastern Daylight Time		05/27/2019 11:55:58 AM Eastern Daylight Time			06/02/2019 02:12:21 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	137	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:37:52 PM Eastern Daylight Time		05/27/2019 11:24:34 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	172	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:43:57 PM Eastern Daylight Time		05/27/2019 11:25:00 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	176	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:45:59 PM Eastern Daylight Time		05/27/2019 11:25:24 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	180	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:28:51 PM Eastern Daylight Time		05/27/2019 11:25:48 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	181	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:46:25 PM Eastern Daylight Time		05/27/2019 11:26:12 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	182	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:32:23 PM Eastern Daylight Time		05/27/2019 11:26:38 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	183	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:46:49 PM Eastern Daylight Time		05/27/2019 11:27:02 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	184	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:47:13 PM Eastern Daylight Time		05/27/2019 11:27:26 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	185	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:47:39 PM Eastern Daylight Time		05/27/2019 11:27:52 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	186	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:48:05 PM Eastern Daylight Time		05/27/2019 11:28:16 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	187	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:49:32 PM Eastern Daylight Time		05/27/2019 11:28:42 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	190	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:50:25 PM Eastern Daylight Time		05/27/2019 11:29:06 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	192	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:51:22 PM Eastern Daylight Time		05/27/2019 11:29:30 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	194	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:51:43 PM Eastern Daylight Time		05/27/2019 11:29:56 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	195	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:52:13 PM Eastern Daylight Time		05/27/2019 11:30:20 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	196	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:52:37 PM Eastern Daylight Time		05/27/2019 11:30:44 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	197	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:52:59 PM Eastern Daylight Time		05/27/2019 11:31:08 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	198	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:53:23 PM Eastern Daylight Time		05/27/2019 11:31:34 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	199	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:33:38 PM Eastern Daylight Time		05/27/2019 11:31:58 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	202	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:55:11 PM Eastern Daylight Time		05/27/2019 11:32:22 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	203	0	2020	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	1	1			05/26/2019	2020.01	05/26/2019 08:55:40 PM Eastern Daylight Time		05/27/2019 11:32:48 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	204	0	2020	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	206	0		29	10	S5660_206_0	1	1			05/26/2019	2020.01	05/26/2019 08:42:08 PM Eastern Daylight Time		05/27/2019 11:33:12 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	206	0	2020	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			05/26/2019	2020.01	05/26/2019 08:43:01 PM Eastern Daylight Time		05/27/2019 11:33:36 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	207	0	2020	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			05/26/2019	2020.01	05/26/2019 08:43:30 PM Eastern Daylight Time		05/27/2019 11:34:00 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	208	0	2020	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			05/26/2019	2020.01	05/26/2019 08:44:53 PM Eastern Daylight Time		05/27/2019 11:34:24 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	209	0	2020	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			05/26/2019	2020.01	05/26/2019 08:45:20 PM Eastern Daylight Time		05/27/2019 12:08:00 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	210	0	2020	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			05/26/2019	2020.01	05/26/2019 08:48:30 PM Eastern Daylight Time		05/27/2019 11:34:52 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	211	0	2020	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			05/26/2019	2020.01	05/26/2019 08:48:54 PM Eastern Daylight Time		05/27/2019 11:35:18 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	212	0	2020	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			05/26/2019	2020.01	05/26/2019 08:49:59 PM Eastern Daylight Time		05/27/2019 11:35:42 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	213	0	2020	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			05/26/2019	2020.01	05/26/2019 08:51:00 PM Eastern Daylight Time		05/27/2019 11:36:06 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	214	0	2020	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			05/26/2019	2020.01	05/26/2019 08:54:10 PM Eastern Daylight Time		05/27/2019 11:36:30 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	215	0	2020	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			05/26/2019	2020.01	05/26/2019 08:54:33 PM Eastern Daylight Time		05/27/2019 11:36:54 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	216	0	2020	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			05/26/2019	2020.01	05/26/2019 08:44:27 PM Eastern Daylight Time		05/27/2019 11:37:20 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	217	0	2020	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	218	0		29	10	S5660_218_0	1	1			05/27/2019	2020.01	05/27/2019 03:48:33 PM Eastern Daylight Time		05/27/2019 11:40:12 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	218	0	2020	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	219	0		29	10	S5660_219_0	1	1			05/27/2019	2020.01	05/27/2019 03:49:48 PM Eastern Daylight Time		05/27/2019 11:40:40 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	219	0	2020	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	220	0		29	10	S5660_220_0	1	1			05/27/2019	2020.01	05/27/2019 03:31:37 PM Eastern Daylight Time		05/27/2019 11:41:06 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	220	0	2020	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	221	0		29	10	S5660_221_0	1	1			05/28/2019	2020.01	05/28/2019 01:24:46 PM Eastern Daylight Time		05/27/2019 12:08:44 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	221	0	2020	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	222	0		29	10	S5660_222_0	1	1			05/27/2019	2020.01	05/27/2019 03:45:12 PM Eastern Daylight Time		05/27/2019 11:41:38 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	222	0	2020	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	223	0		29	10	S5660_223_0	1	1			05/27/2019	2020.01	05/27/2019 03:40:05 PM Eastern Daylight Time		05/27/2019 11:42:06 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	223	0	2020	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	224	0		29	10	S5660_224_0	1	1			05/27/2019	2020.01	05/27/2019 03:42:15 PM Eastern Daylight Time		05/27/2019 11:42:32 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	224	0	2020	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	225	0		29	10	S5660_225_0	1	1			05/27/2019	2020.01	05/27/2019 03:32:32 PM Eastern Daylight Time		05/27/2019 11:43:00 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	225	0	2020	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	226	0		29	10	S5660_226_0	1	1			05/27/2019	2020.01	05/27/2019 03:24:44 PM Eastern Daylight Time		05/27/2019 11:43:28 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	226	0	2020	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	227	0		29	10	S5660_227_0	1	1			05/28/2019	2020.01	05/28/2019 01:24:32 PM Eastern Daylight Time		05/27/2019 11:43:56 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	227	0	2020	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	228	0		29	10	S5660_228_0	1	1			05/27/2019	2020.01	05/27/2019 03:28:22 PM Eastern Daylight Time		05/27/2019 11:44:22 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	228	0	2020	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	229	0		29	10	S5660_229_0	1	1			05/27/2019	2020.01	05/27/2019 03:20:48 PM Eastern Daylight Time		05/27/2019 11:44:50 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	229	0	2020	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	230	0		29	10	S5660_230_0	1	1			05/27/2019	2020.01	05/27/2019 03:50:19 PM Eastern Daylight Time		05/27/2019 11:52:50 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	230	0	2020	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	231	0		29	10	S5660_231_0	1	1			05/27/2019	2020.01	05/27/2019 03:43:06 PM Eastern Daylight Time		05/27/2019 11:53:18 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	231	0	2020	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	232	0		29	10	S5660_232_0	1	1			05/27/2019	2020.01	05/27/2019 03:50:44 PM Eastern Daylight Time		05/27/2019 11:53:46 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	232	0	2020	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	233	0		29	10	S5660_233_0	1	1			05/28/2019	2020.01	05/28/2019 03:28:02 PM Eastern Daylight Time		05/27/2019 11:54:14 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	233	0	2020	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	234	0		29	10	S5660_234_0	1	1			05/27/2019	2020.01	05/27/2019 03:51:32 PM Eastern Daylight Time		05/27/2019 11:54:42 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	234	0	2020	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	235	0		29	10	S5660_235_0	1	1			05/27/2019	2020.01	05/27/2019 03:35:09 PM Eastern Daylight Time		05/27/2019 11:58:46 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	235	0	2020	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	236	0		29	10	S5660_236_0	1	1			05/27/2019	2020.01	05/27/2019 03:33:05 PM Eastern Daylight Time		05/27/2019 11:59:14 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	236	0	2020	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	237	0		29	10	S5660_237_0	1	1			05/27/2019	2020.01	05/27/2019 03:22:42 PM Eastern Daylight Time		05/27/2019 11:59:44 AM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	237	0	2020	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	238	0		29	10	S5660_238_0	1	1			05/27/2019	2020.01	05/27/2019 03:46:02 PM Eastern Daylight Time		05/27/2019 12:00:12 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	238	0	2020	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	239	0		29	10	S5660_239_0	1	1			05/27/2019	2020.01	05/27/2019 03:25:55 PM Eastern Daylight Time		05/27/2019 12:00:40 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	239	0	2020	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	240	0		29	10	S5660_240_0	1	1			05/27/2019	2020.01	05/27/2019 03:51:59 PM Eastern Daylight Time		05/27/2019 12:01:10 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	240	0	2020	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	241	0		29	10	S5660_241_0	1	1			05/27/2019	2020.01	05/27/2019 03:52:28 PM Eastern Daylight Time		05/27/2019 12:01:38 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	241	0	2020	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	242	0		29	10	S5660_242_0	1	1			05/27/2019	2020.01	05/27/2019 03:38:45 PM Eastern Daylight Time		05/27/2019 12:02:04 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	242	0	2020	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	243	0		29	10	S5660_243_0	1	1			05/27/2019	2020.01	05/27/2019 03:43:32 PM Eastern Daylight Time		05/27/2019 12:02:32 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	243	0	2020	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	244	0		29	10	S5660_244_0	1	1			05/27/2019	2020.01	05/27/2019 03:40:41 PM Eastern Daylight Time		05/27/2019 12:02:58 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	244	0	2020	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	245	0		29	10	S5660_245_0	1	1			05/27/2019	2020.01	05/27/2019 03:52:55 PM Eastern Daylight Time		05/27/2019 12:03:26 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	245	0	2020	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	246	0		29	10	S5660_246_0	1	1			05/27/2019	2020.01	05/27/2019 03:46:29 PM Eastern Daylight Time		05/27/2019 12:03:52 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	246	0	2020	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	247	0		29	10	S5660_247_0	1	1			05/27/2019	2020.01	05/27/2019 03:33:26 PM Eastern Daylight Time		05/27/2019 12:04:20 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	247	0	2020	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	248	0		29	10	S5660_248_0	1	1			05/28/2019	2020.01	05/28/2019 03:28:48 PM Eastern Daylight Time		05/27/2019 12:04:46 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	248	0	2020	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	249	0		29	10	S5660_249_0	2	1			05/27/2019	2020.01	05/27/2019 03:46:53 PM Eastern Daylight Time		07/08/2019 10:24:14 AM Eastern Daylight Time			07/17/2019 11:24:47 AM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	249	0	2020	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	250	0		29	10	S5660_250_0	1	1			05/28/2019	2020.01	05/28/2019 01:25:24 PM Eastern Daylight Time		05/27/2019 12:05:42 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	250	0	2020	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	251	0		29	10	S5660_251_0	1	1			05/27/2019	2020.01	05/27/2019 03:53:39 PM Eastern Daylight Time		05/27/2019 12:06:08 PM Eastern Daylight Time			06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5660	251	0	2020	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	801	0		29	10	S5660_801_0	1	1			05/31/2019	2020.01	05/31/2019 02:08:59 PM Eastern Daylight Time					06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	801	0	2020	Premier Access Open 5 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			05/31/2019	2020.01	05/31/2019 02:17:46 PM Eastern Daylight Time					06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	802	0	2020	Premier Performance Closed 5 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	803	0		29	10	S5660_803_0	1	1			05/31/2019	2020.01	05/31/2019 02:17:51 PM Eastern Daylight Time					06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	803	0	2020	High Performance Closed 5 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	804	0		29	10	S5660_804_0	1	1			05/31/2019	2020.01	05/31/2019 02:17:56 PM Eastern Daylight Time					06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	804	0	2020	Premier Performance Closed 5 - Non Calendar		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			05/31/2019	2020.01	05/31/2019 02:18:01 PM Eastern Daylight Time					06/02/2019 03:08:07 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	806	0	2020	National - URMBT 3 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																
S5715	1	0		29	10	S5715_001_0	3	1			05/30/2019	2020.01	05/30/2019 11:34:27 AM Central Daylight Time		07/18/2019 02:10:08 PM Central Daylight Time			07/24/2019 10:16:07 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.getblueil.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	1	0	2020	State of Illinois		2					2						www.getblueil.com/pdp/pharmacies	www.getblueil.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	2	0		29	10	S5715_002_0	3	1			05/29/2019	2020.01	05/29/2019 12:58:04 PM Central Daylight Time		07/18/2019 02:10:50 PM Central Daylight Time			07/24/2019 10:16:07 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.getblueil.com/pdp	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	2	0	2020	State of Illinois		2					2						www.getblueil.com/pdp/pharmacies	www.getblueil.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	3	0		29	10	S5715_003_0	3	1			05/29/2019	2020.01	05/29/2019 12:58:53 PM Central Daylight Time		07/18/2019 02:11:30 PM Central Daylight Time			07/24/2019 10:16:07 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.getbluenm.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	3	0	2020	State of New Mexico		2					2						www.getbluenm.com/pdp/pharmacies	www.getbluenm.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	4	0		29	10	S5715_004_0	3	1			05/29/2019	2020.01	05/29/2019 12:59:17 PM Central Daylight Time		07/18/2019 02:12:12 PM Central Daylight Time			07/24/2019 10:16:07 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.getbluenm.com/pdp	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	4	0	2020	State of New Mexico		2					2						www.getbluenm.com/pdp/pharmacies	www.getbluenm.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	5	0		29	10	S5715_005_0	3	1			05/29/2019	2020.01	05/29/2019 12:59:47 PM Central Daylight Time		07/18/2019 02:12:54 PM Central Daylight Time			07/24/2019 10:16:07 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.getbluetx.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	5	0	2020	State of Texas		2					2						www.getbluetx.com/pdp/pharmacies	www.getbluetx.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	6	0		29	10	S5715_006_0	3	1			05/29/2019	2020.01	05/29/2019 01:00:11 PM Central Daylight Time		07/18/2019 02:13:36 PM Central Daylight Time			07/24/2019 10:16:07 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.getbluetx.com/pdp	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	6	0	2020	State of Texas		2					2						www.getbluetx.com/pdp/pharmacies	www.getbluetx.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	10	0		29	10	S5715_010_0	3	1			05/29/2019	2020.01	05/29/2019 01:01:19 PM Central Daylight Time		07/18/2019 02:14:20 PM Central Daylight Time			07/24/2019 10:16:07 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.getblueok.com/pdp	Blue Cross MedicareRx Value (PDP)	10	29					S5715	10	0	2020	State of Oklahoma		2					2						www.getblueok.com/pdp/pharmacies	www.getblueok.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	11	0		29	10	S5715_011_0	3	1			05/29/2019	2020.01	05/29/2019 01:01:43 PM Central Daylight Time		07/18/2019 02:15:00 PM Central Daylight Time			07/24/2019 10:16:07 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.getblueok.com/pdp	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	11	0	2020	State of Oklahoma		2					2						www.getblueok.com/pdp/pharmacies	www.getblueok.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	12	0		29	10	S5715_012_0	2	1			05/31/2019	2020.01	05/31/2019 07:54:45 PM Central Daylight Time		06/01/2019 03:59:22 PM Central Daylight Time			06/03/2019 10:58:38 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.getblueil.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	12	0	2020	State of Illinois		2					2						www.getblueil.com/pdp/pharmacies	www.getblueil.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	13	0		29	10	S5715_013_0	2	1			05/31/2019	2020.01	05/31/2019 07:55:28 PM Central Daylight Time		06/01/2019 04:00:00 PM Central Daylight Time			06/03/2019 10:58:38 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.getbluenm.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	13	0	2020	State of New Mexico		2					2						www.getbluenm.com/pdp/pharmacies	www.getbluenm.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	14	0		29	10	S5715_014_0	2	1			05/31/2019	2020.01	05/31/2019 07:56:39 PM Central Daylight Time		06/01/2019 04:00:38 PM Central Daylight Time			06/03/2019 10:58:38 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.getbluetx.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	14	0	2020	State of Texas		2					2						www.getbluetx.com/pdp/pharmacies	www.getbluetx.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	15	0		29	10	S5715_015_0	2	1			05/31/2019	2020.01	05/31/2019 07:57:14 PM Central Daylight Time		06/01/2019 04:01:16 PM Central Daylight Time			06/03/2019 10:58:38 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.getblueok.com/pdp	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	15	0	2020	State of Oklahoma		2					2						www.getblueok.com/pdp/pharmacies	www.getblueok.com/pdp/druglist										(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	801	0		29	10	S5715_801_0	2	1			05/01/2019	2020.01	05/01/2019 03:29:21 PM Central Daylight Time					06/03/2019 11:23:53 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	801	0	2020	State of Illinois		1					2						www.myprime.com	www.myprime.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	2	1			05/14/2019	2020.01	05/14/2019 11:52:31 AM Central Daylight Time					06/03/2019 11:23:53 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	802	0	2020	State of New Mexico		1					2						www.myprime.com	www.myprime.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	2	1			05/14/2019	2020.01	05/14/2019 11:52:37 AM Central Daylight Time					06/03/2019 11:23:53 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	803	0	2020	State of Texas		1					2						www.myprime.com	www.myprime.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	2	1			05/14/2019	2020.01	05/14/2019 11:52:42 AM Central Daylight Time					06/03/2019 11:23:53 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	807	0	2020	State of Oklahoma		1					2						www.myprime.com	www.myprime.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	2	1			05/14/2019	2020.01	05/14/2019 11:52:47 AM Central Daylight Time					06/03/2019 11:23:53 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	809	0	2020	State of Oklahoma		1					2						www.myprime.com	www.myprime.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	2	1			05/14/2019	2020.01	05/14/2019 11:52:53 AM Central Daylight Time					06/03/2019 11:23:53 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	811	0	2020	State of Illinois		1					2						www.myprime.com	www.myprime.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	2	1			05/14/2019	2020.01	05/14/2019 11:52:58 AM Central Daylight Time					06/03/2019 11:23:53 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	813	0	2020	State of New Mexico		1					2						www.myprime.com	www.myprime.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	2	1			05/14/2019	2020.01	05/14/2019 11:53:02 AM Central Daylight Time					06/03/2019 11:23:53 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	815	0	2020	State of Texas		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	817	0		29	10	S5715_817_0	2	1			05/14/2019	2020.01	05/14/2019 11:53:07 AM Central Daylight Time					06/03/2019 11:23:53 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	817	0	2020	"Illinois, New Mexico, Oklahoma and Texas"		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	818	0		29	10	S5715_818_0	2	1			05/14/2019	2020.01	05/14/2019 11:53:12 AM Central Daylight Time					06/03/2019 11:23:53 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	818	0	2020	"Illinois, New Mexico, Oklahoma, Texas"		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5715	819	0		29	10	S5715_819_0	2	1			05/14/2019	2020.01	05/14/2019 11:53:16 AM Central Daylight Time					06/03/2019 11:23:53 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	"Blue Cross and Blue Shield of IL, NM, OK, TX"	www.hcsc.com	Blue Cross MedicareRx (PDP)	10	29					S5715	819	0	2020	"Illinois, New Mexico, Oklahoma, Texas"		1					2						www.myprime.com	www.myprime.com										(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-																
S5726	13	0		29	10	S5726_013_0	3	1			06/01/2019	2020.01	06/01/2019 11:16:03 AM Eastern Daylight Time		06/21/2019 04:22:53 PM Eastern Daylight Time			07/17/2019 03:30:28 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx (PDP)	https://shop.partdkansas.com/medicare	Blue MedicareRx Value (PDP)	10	29					S5726	13	0	2020	Kansas		2					2						https://shop.partdkansas.com/medicare	https://shop.partdkansas.com/medicare										(866)755-2776		(866)755-2776		(877)471-4121		(877)471-4121										(711)-		(711)-		(711)-		(711)-																
S5726	14	0		29	10	S5726_014_0	4	1			06/01/2019	2020.01	06/01/2019 11:16:08 AM Eastern Daylight Time		06/21/2019 04:24:25 PM Eastern Daylight Time			07/17/2019 03:30:28 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx (PDP)	https://shop.partdkansas.com/medicare	Blue MedicareRx Plus (PDP)	10	29					S5726	14	0	2020	Kansas		2					2						https://shop.partdkansas.com/medicare	https://shop.partdkansas.com/medicare										(866)755-2776		(866)755-2776		(877)471-4121		(877)471-4121										(711)-		(711)-		(711)-		(711)-																
S5726	19	0		29	10	S5726_019_0	3	1			06/01/2019	2020.01	06/01/2019 11:16:13 AM Eastern Daylight Time		07/10/2019 09:55:17 AM Eastern Daylight Time			07/17/2019 03:30:28 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx (PDP)	https://shop.partdkansas.com/medicare	Blue MedicareRx Enhanced (PDP)	10	29					S5726	19	0	2020	Kansas		2					2						https://shop.partdkansas.com/medicare	https://shop.partdkansas.com/medicare										(866)755-2776		(866)755-2776		(877)471-4121		(877)471-4121										(711)-		(711)-		(711)-		(711)-																
S5726	805	0		29	10	S5726_805_0	1	1			06/01/2019	2020.01	06/01/2019 11:16:17 AM Eastern Daylight Time					06/01/2019 11:17:56 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx (PDP)	https://shop.partdkansas.com/medicare	Blue MedicareRx (PDP)	10	29					S5726	805	0	2020	Kansas		1					2						https://shop.partdkansas.com/medicare	https://shop.partdkansas.com/medicare										(866)830-0174		(866)830-0174		(866)830-0296		(866)830-0296										(711)-		(711)-		(711)-		(711)-																
S5743	1	0		29	10	S5743_001_0	4	1			06/01/2019	2020.01	06/01/2019 12:20:13 PM Central Daylight Time		07/26/2019 01:45:58 PM Central Daylight Time			07/26/2019 02:23:38 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	1	0	2020	"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	4	0		29	10	S5743_004_0	3	1			06/01/2019	2020.01	06/01/2019 11:14:09 AM Central Daylight Time		06/01/2019 01:39:13 PM Central Daylight Time			06/01/2019 04:04:14 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	4	0	2020	"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			06/01/2019	2020.01	06/01/2019 04:03:21 PM Central Daylight Time					06/01/2019 04:04:14 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	2020	Nationwide		1					2						www.YourMedicareSolutions.com	www.YourMedicareSolutions.com										(877)838-3827		(877)838-3827		(866)434-2037		(866)434-2037										(711)-		(711)-		(711)-		(711)-																
S5743	805	0		29	10	S5743_805_0	1	1			06/01/2019	2020.01	06/01/2019 04:03:42 PM Central Daylight Time					06/01/2019 04:04:14 PM Central Daylight Time	"WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY"	MedicareBlue Rx	www.YourMedicareSolutions.com	Group MedicareBlue Rx Self-funded (PDP)	10	29					S5743	805	0	2020	Nationwide		1					2						www.YourMedicareSolutions.com	www.YourMedicareSolutions.com										(877)838-3827		(877)838-3827		(866)434-2037		(866)434-2037										(711)-		(711)-		(711)-		(711)-																
S5753	6	0		29	10	S5753_006_0	2	1			05/31/2019	2020.01	05/31/2019 10:55:35 AM Central Daylight Time		06/03/2019 09:34:03 AM Central Daylight Time			06/03/2019 09:38:52 AM Central Daylight Time	WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION	WPS Health Insurance	www.wpsmedicaredrugs.com	WPS MedicareRx Plan 1 (PDP)	10	29					S5753	6	0	2020	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	7	0		29	10	S5753_007_0	2	1			05/31/2019	2020.01	05/31/2019 10:55:47 AM Central Daylight Time		06/03/2019 09:34:03 AM Central Daylight Time			06/03/2019 09:38:52 AM Central Daylight Time	WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION	WPS Health Insurance	www.wpsmedicaredrugs.com	WPS MedicareRx Plan 2 (PDP)	10	29					S5753	7	0	2020	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)-																
S5768	125	0		29	10	S5768_125_0	4	1			05/29/2019	2020.01	05/29/2019 01:38:09 PM Eastern Daylight Time		07/06/2019 10:36:19 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	125	0	2020	"Northern New England (NH, ME)"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	126	0		29	10	S5768_126_0	4	1			05/29/2019	2020.01	05/29/2019 01:38:04 PM Eastern Daylight Time		07/06/2019 10:36:53 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	126	0	2020	"Central New England  (CT, RI, MA, VT)"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	127	0		29	10	S5768_127_0	3	1			05/29/2019	2020.01	05/29/2019 01:37:59 PM Eastern Daylight Time		07/06/2019 10:37:28 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	127	0	2020	New Jersey		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	128	0		29	10	S5768_128_0	3	1			05/29/2019	2020.01	05/29/2019 01:37:51 PM Eastern Daylight Time		07/06/2019 10:38:02 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	128	0	2020	"Mid-Atlantic (DE, DC, MD)"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	129	0		29	10	S5768_129_0	3	1			05/29/2019	2020.01	05/29/2019 01:37:48 PM Eastern Daylight Time		07/06/2019 10:38:37 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	129	0	2020	"Pennsylvania, West Virginia"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	130	0		29	10	S5768_130_0	3	1			05/29/2019	2020.01	05/29/2019 01:37:43 PM Eastern Daylight Time		07/06/2019 10:39:12 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	130	0	2020	Virginia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	131	0		29	10	S5768_131_0	3	1			05/29/2019	2020.01	05/29/2019 01:37:37 PM Eastern Daylight Time		07/06/2019 10:39:46 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	131	0	2020	North Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	132	0		29	10	S5768_132_0	3	1			05/29/2019	2020.01	05/29/2019 01:37:33 PM Eastern Daylight Time		07/06/2019 10:40:22 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	132	0	2020	South Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	133	0		29	10	S5768_133_0	3	1			05/29/2019	2020.01	05/29/2019 01:37:25 PM Eastern Daylight Time		07/06/2019 10:40:56 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	133	0	2020	Georgia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	134	0		29	10	S5768_134_0	3	1			05/29/2019	2020.01	05/29/2019 01:37:22 PM Eastern Daylight Time		07/06/2019 10:41:31 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	134	0	2020	Florida		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	135	0		29	10	S5768_135_0	3	1			05/29/2019	2020.01	05/29/2019 01:37:18 PM Eastern Daylight Time		07/06/2019 10:42:05 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	135	0	2020	"Alabama, Tennessee"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	136	0		29	10	S5768_136_0	3	1			05/29/2019	2020.01	05/29/2019 01:36:51 PM Eastern Daylight Time		07/06/2019 10:42:41 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	136	0	2020	Michigan		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	137	0		29	10	S5768_137_0	3	1			05/29/2019	2020.01	05/29/2019 01:36:46 PM Eastern Daylight Time		07/06/2019 10:43:16 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	137	0	2020	Ohio		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	138	0		29	10	S5768_138_0	3	1			05/29/2019	2020.01	05/29/2019 01:36:42 PM Eastern Daylight Time		07/06/2019 10:43:51 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	138	0	2020	"Indiana, Kentucky"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	139	0		29	10	S5768_139_0	3	1			05/29/2019	2020.01	05/29/2019 01:36:39 PM Eastern Daylight Time		07/06/2019 10:44:26 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	139	0	2020	Wisconsin		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	140	0		29	10	S5768_140_0	3	1			05/29/2019	2020.01	05/29/2019 01:36:35 PM Eastern Daylight Time		07/06/2019 10:45:01 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	140	0	2020	Illinois		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	141	0		29	10	S5768_141_0	3	1			05/29/2019	2020.01	05/29/2019 01:36:32 PM Eastern Daylight Time		07/06/2019 10:45:36 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	141	0	2020	Missouri		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	142	0		29	10	S5768_142_0	3	1			05/29/2019	2020.01	05/29/2019 01:36:28 PM Eastern Daylight Time		07/06/2019 10:46:11 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	142	0	2020	Arkansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	143	0		29	10	S5768_143_0	3	1			05/29/2019	2020.01	05/29/2019 01:36:23 PM Eastern Daylight Time		07/06/2019 10:46:45 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	143	0	2020	Mississippi		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	144	0		29	10	S5768_144_0	3	1			05/29/2019	2020.01	05/29/2019 01:36:18 PM Eastern Daylight Time		07/06/2019 10:47:21 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	144	0	2020	Louisiana		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	145	0		29	10	S5768_145_0	3	1			05/29/2019	2020.01	05/29/2019 01:36:05 PM Eastern Daylight Time		07/06/2019 10:47:55 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	145	0	2020	Texas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	146	0		29	10	S5768_146_0	3	1			05/29/2019	2020.01	05/29/2019 01:36:02 PM Eastern Daylight Time		07/06/2019 10:48:30 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	146	0	2020	Oklahoma		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	147	0		29	10	S5768_147_0	3	1			05/29/2019	2020.01	05/29/2019 01:35:58 PM Eastern Daylight Time		07/06/2019 10:49:05 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	147	0	2020	Kansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	148	0		29	10	S5768_148_0	3	1			05/29/2019	2020.01	05/29/2019 01:35:55 PM Eastern Daylight Time		07/06/2019 10:49:40 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	148	0	2020	"Upper MW and N Plains (IA, MN, NE, SD, ND, WY, MT)"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	149	0		29	10	S5768_149_0	3	1			05/29/2019	2020.01	05/29/2019 01:35:51 PM Eastern Daylight Time		07/06/2019 10:50:15 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	149	0	2020	New Mexico		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	150	0		29	10	S5768_150_0	3	1			05/29/2019	2020.01	05/29/2019 01:35:48 PM Eastern Daylight Time		07/06/2019 10:50:50 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	150	0	2020	Colorado		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	151	0		29	10	S5768_151_0	3	1			05/29/2019	2020.01	05/29/2019 01:35:44 PM Eastern Daylight Time		07/06/2019 10:51:25 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	151	0	2020	Arizona		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	152	0		29	10	S5768_152_0	3	1			05/29/2019	2020.01	05/29/2019 01:35:40 PM Eastern Daylight Time		07/06/2019 10:52:00 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	152	0	2020	Nevada		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	153	0		29	10	S5768_153_0	3	1			05/29/2019	2020.01	05/29/2019 01:35:35 PM Eastern Daylight Time		07/06/2019 10:52:34 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	153	0	2020	"Oregon, Washington"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	154	0		29	10	S5768_154_0	3	1			05/29/2019	2020.01	05/29/2019 01:35:30 PM Eastern Daylight Time		07/06/2019 10:53:09 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	154	0	2020	"Idaho, Utah"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	155	0		29	10	S5768_155_0	3	1			05/29/2019	2020.01	05/29/2019 01:35:26 PM Eastern Daylight Time		07/06/2019 10:53:43 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	155	0	2020	California		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	197	0		29	10	S5768_197_0	3	1			05/29/2019	2020.01	05/29/2019 01:35:18 PM Eastern Daylight Time		07/06/2019 10:54:20 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	197	0	2020	Alaska		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	198	0		29	10	S5768_198_0	3	1			05/29/2019	2020.01	05/29/2019 01:35:15 PM Eastern Daylight Time		07/06/2019 10:54:54 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	198	0	2020	Hawaii		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5768	200	0		29	10	S5768_200_0	3	1			05/29/2019	2020.01	05/29/2019 01:35:11 PM Eastern Daylight Time		07/06/2019 10:55:28 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Value Plus (PDP)	10	29					S5768	200	0	2020	New York		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5795	2	0		29	10	S5795_002_0	5	1			05/31/2019	2020.01	05/31/2019 08:16:25 AM Central Daylight Time		06/03/2019 02:44:24 PM Central Daylight Time			06/03/2019 02:45:02 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Rx Premier (PDP)	10	29					S5795	2	0	2020	State of Arkansas		2					2						http://www.arkansasbluecross.com	http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx										(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	3	0		29	10	S5795_003_0	5	1			05/31/2019	2020.01	05/31/2019 12:35:17 PM Central Daylight Time		06/03/2019 02:44:24 PM Central Daylight Time			06/03/2019 02:45:02 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com/medicare	AR Blue Cross - Medi-Pak Rx Basic (PDP)	10	29					S5795	3	0	2020	State of Arkansas		2					2						http://www.arkansasbluecross.com	http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx										(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	804	0		29	10	S5795_804_0	6	1			05/23/2019	2020.01	05/23/2019 08:24:34 AM Central Daylight Time					06/03/2019 02:45:02 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	2020	Employer Group Plan		1					2						http://www.arkansasbluecross.com	http://www.arkansasbluecross.com										(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	809	0		29	10	S5795_809_0	6	1			05/23/2019	2020.01	05/23/2019 08:24:38 AM Central Daylight Time					06/03/2019 02:45:02 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	2020	Employer Group Plan		1					2						http://www.arkansasbluecross.com	http://www.arkansasbluecross.com										(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	811	0		29	10	S5795_811_0	6	1			05/23/2019	2020.01	05/23/2019 08:24:44 AM Central Daylight Time					06/03/2019 02:45:02 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	2020	Employer Group Plan		1					2						http://www.arkansasbluecross.com	http://www.arkansasbluecross.com										(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5795	812	0		29	10	S5795_812_0	6	1			05/23/2019	2020.01	05/23/2019 08:24:50 AM Central Daylight Time					06/03/2019 02:45:02 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	2020	Employer Group Plan		1					2						http://www.arkansasbluecross.com	http://www.arkansasbluecross.com										(866)390-3369		(866)390-3369		(844)298-2444		(844)298-2444										(711)-		(711)-		(711)-		(711)-																
S5805	1	0		29	10	S5805_001_0	2	1			06/02/2019	2020.01	06/02/2019 09:02:02 AM Central Daylight Time		06/24/2019 11:42:08 AM Central Daylight Time			07/23/2019 08:29:58 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5805	1	0	2020	New York		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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			05/11/2019	2020.01	05/11/2019 09:46:05 AM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	803	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/06/2019	2020.01	05/06/2019 11:36:16 AM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	804	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/06/2019	2020.01	05/06/2019 11:40:13 AM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	807	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/06/2019	2020.01	05/06/2019 11:42:50 AM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	808	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/06/2019	2020.01	05/06/2019 11:49:57 AM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	809	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/06/2019	2020.01	05/06/2019 11:51:53 AM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	810	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/06/2019	2020.01	05/06/2019 02:43:10 PM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	811	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/06/2019	2020.01	05/06/2019 02:45:04 PM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	812	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/06/2019	2020.01	05/06/2019 02:46:58 PM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	813	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/06/2019	2020.01	05/06/2019 02:49:27 PM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	814	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/06/2019	2020.01	05/06/2019 02:50:12 PM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	815	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/06/2019	2020.01	05/06/2019 02:50:40 PM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	816	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/06/2019	2020.01	05/06/2019 03:09:38 PM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	818	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/06/2019	2020.01	05/06/2019 03:10:44 PM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	819	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/06/2019	2020.01	05/06/2019 04:18:07 PM Eastern Daylight Time					06/03/2019 07:42:28 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	820	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/06/2019	2020.01	05/06/2019 03:14:04 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	821	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/06/2019	2020.01	05/06/2019 03:23:28 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	822	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/06/2019	2020.01	05/06/2019 03:24:28 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	823	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/06/2019	2020.01	05/06/2019 03:25:42 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	824	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/06/2019	2020.01	05/06/2019 03:34:09 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	825	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/06/2019	2020.01	05/06/2019 03:35:27 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	826	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/06/2019	2020.01	05/06/2019 03:36:40 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	827	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/06/2019	2020.01	05/06/2019 03:43:31 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	828	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	829	0		29	10	S5805_829_0	1	1			05/06/2019	2020.01	05/06/2019 03:45:28 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	829	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	830	0		29	10	S5805_830_0	1	1			05/06/2019	2020.01	05/06/2019 03:48:43 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	830	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	831	0		29	10	S5805_831_0	1	1			05/06/2019	2020.01	05/06/2019 03:50:52 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	831	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	832	0		29	10	S5805_832_0	1	1			05/06/2019	2020.01	05/06/2019 03:56:01 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	832	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	833	0		29	10	S5805_833_0	1	1			05/06/2019	2020.01	05/06/2019 03:58:32 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	833	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	834	0		29	10	S5805_834_0	1	1			05/06/2019	2020.01	05/06/2019 04:03:51 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	834	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	835	0		29	10	S5805_835_0	1	1			05/06/2019	2020.01	05/06/2019 04:12:40 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	835	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	836	0		29	10	S5805_836_0	1	1			05/06/2019	2020.01	05/06/2019 04:13:48 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	836	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	837	0		29	10	S5805_837_0	1	1			05/06/2019	2020.01	05/06/2019 04:14:50 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	837	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5805	838	0		29	10	S5805_838_0	1	1			05/06/2019	2020.01	05/06/2019 04:16:01 PM Eastern Daylight Time					06/03/2019 07:44:33 AM Eastern Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	838	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5810	35	0		29	10	S5810_035_0	4	1			05/29/2019	2020.01	05/29/2019 01:27:51 PM Eastern Daylight Time		07/11/2019 09:48:26 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	35	0	2020	"Northern New England (NH, ME)"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	36	0		29	10	S5810_036_0	4	1			05/29/2019	2020.01	05/29/2019 01:34:54 PM Eastern Daylight Time		07/11/2019 02:29:24 PM Eastern Daylight Time			07/17/2019 09:09:43 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	36	0	2020	"Central New England  (CT, RI, MA, VT)"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	37	0		29	10	S5810_037_0	3	1			05/29/2019	2020.01	05/29/2019 01:34:48 PM Eastern Daylight Time		07/11/2019 09:49:05 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	37	0	2020	New  York		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	38	0		29	10	S5810_038_0	3	1			05/29/2019	2020.01	05/29/2019 01:34:44 PM Eastern Daylight Time		07/06/2019 10:57:49 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	38	0	2020	New Jersey		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	39	0		29	10	S5810_039_0	3	1			05/29/2019	2020.01	05/29/2019 01:34:40 PM Eastern Daylight Time		07/06/2019 10:58:24 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	39	0	2020	"Mid-Atlantic (DE, DC, MD)"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	40	0		29	10	S5810_040_0	3	1			05/29/2019	2020.01	05/29/2019 01:33:55 PM Eastern Daylight Time		07/06/2019 10:58:59 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	40	0	2020	"Pennsylvania, West Virginia"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	41	0		29	10	S5810_041_0	3	1			05/29/2019	2020.01	05/29/2019 01:33:50 PM Eastern Daylight Time		07/11/2019 09:49:52 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	41	0	2020	Virginia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	42	0		29	10	S5810_042_0	3	1			05/29/2019	2020.01	05/29/2019 01:33:35 PM Eastern Daylight Time		07/11/2019 09:50:35 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	42	0	2020	North Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	43	0		29	10	S5810_043_0	3	1			05/29/2019	2020.01	05/29/2019 01:33:26 PM Eastern Daylight Time		07/11/2019 09:51:15 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	43	0	2020	South Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	44	0		29	10	S5810_044_0	3	1			05/29/2019	2020.01	05/29/2019 01:33:22 PM Eastern Daylight Time		07/06/2019 11:01:16 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	44	0	2020	Georgia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	45	0		29	10	S5810_045_0	3	1			05/29/2019	2020.01	05/29/2019 01:33:14 PM Eastern Daylight Time		07/11/2019 09:51:54 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	45	0	2020	Florida		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	46	0		29	10	S5810_046_0	3	1			05/29/2019	2020.01	05/29/2019 01:33:07 PM Eastern Daylight Time		07/11/2019 09:52:32 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	46	0	2020	"Alabama, Tennessee"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	47	0		29	10	S5810_047_0	3	1			05/29/2019	2020.01	05/29/2019 01:33:01 PM Eastern Daylight Time		07/06/2019 11:03:00 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	47	0	2020	Michigan		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	48	0		29	10	S5810_048_0	3	1			05/29/2019	2020.01	05/29/2019 01:32:46 PM Eastern Daylight Time		07/06/2019 11:03:35 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	48	0	2020	Ohio		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	49	0		29	10	S5810_049_0	3	1			05/29/2019	2020.01	05/29/2019 01:32:42 PM Eastern Daylight Time		07/06/2019 11:04:09 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	49	0	2020	"Indiana, Kentucky"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	50	0		29	10	S5810_050_0	3	1			05/29/2019	2020.01	05/29/2019 01:32:39 PM Eastern Daylight Time		07/06/2019 11:04:44 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	50	0	2020	Wisconsin		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	51	0		29	10	S5810_051_0	3	1			05/29/2019	2020.01	05/29/2019 01:32:35 PM Eastern Daylight Time		07/06/2019 11:05:18 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	51	0	2020	Illinois		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	52	0		29	10	S5810_052_0	3	1			05/29/2019	2020.01	05/29/2019 01:32:32 PM Eastern Daylight Time		07/11/2019 09:53:10 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	52	0	2020	Missouri		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	53	0		29	10	S5810_053_0	3	1			05/29/2019	2020.01	05/29/2019 01:32:29 PM Eastern Daylight Time		07/11/2019 09:53:48 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	53	0	2020	Arkansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	54	0		29	10	S5810_054_0	3	1			05/29/2019	2020.01	05/29/2019 01:32:24 PM Eastern Daylight Time		07/11/2019 09:54:26 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	54	0	2020	Mississippi		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	55	0		29	10	S5810_055_0	3	1			05/29/2019	2020.01	05/29/2019 01:31:41 PM Eastern Daylight Time		07/06/2019 11:07:37 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	55	0	2020	Louisiana		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	56	0		29	10	S5810_056_0	3	1			05/29/2019	2020.01	05/29/2019 01:31:37 PM Eastern Daylight Time		07/06/2019 11:08:13 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	56	0	2020	Texas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	57	0		29	10	S5810_057_0	3	1			05/29/2019	2020.01	05/29/2019 01:31:32 PM Eastern Daylight Time		07/11/2019 09:55:03 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	57	0	2020	Oklahoma		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	58	0		29	10	S5810_058_0	3	1			05/29/2019	2020.01	05/29/2019 01:31:28 PM Eastern Daylight Time		07/06/2019 11:09:22 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	58	0	2020	Kansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	59	0		29	10	S5810_059_0	3	1			05/29/2019	2020.01	05/29/2019 01:31:24 PM Eastern Daylight Time		07/06/2019 11:09:56 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	59	0	2020	"Upper MW and N Plains (IA, MN, NE, SD, ND, WY, MT)"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	60	0		29	10	S5810_060_0	3	1			05/29/2019	2020.01	05/29/2019 01:31:19 PM Eastern Daylight Time		07/06/2019 11:10:32 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	60	0	2020	New Mexico		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	61	0		29	10	S5810_061_0	3	1			05/29/2019	2020.01	05/29/2019 01:31:15 PM Eastern Daylight Time		07/06/2019 11:11:06 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	61	0	2020	Colorado		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	62	0		29	10	S5810_062_0	3	1			05/29/2019	2020.01	05/29/2019 01:31:11 PM Eastern Daylight Time		07/06/2019 11:11:42 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	62	0	2020	Arizona		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	63	0		29	10	S5810_063_0	3	1			05/29/2019	2020.01	05/29/2019 01:31:08 PM Eastern Daylight Time		07/06/2019 11:12:16 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	63	0	2020	Nevada		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	64	0		29	10	S5810_064_0	3	1			05/29/2019	2020.01	05/29/2019 01:31:03 PM Eastern Daylight Time		07/11/2019 09:55:42 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	64	0	2020	"Oregon, Washington"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	65	0		29	10	S5810_065_0	3	1			05/29/2019	2020.01	05/29/2019 01:30:59 PM Eastern Daylight Time		07/11/2019 09:56:19 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	65	0	2020	"Idaho, Utah"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	66	0		29	10	S5810_066_0	3	1			05/29/2019	2020.01	05/29/2019 01:30:55 PM Eastern Daylight Time		07/06/2019 11:14:01 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	66	0	2020	California		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	67	0		29	10	S5810_067_0	3	1			05/29/2019	2020.01	05/29/2019 01:30:52 PM Eastern Daylight Time		07/11/2019 09:56:57 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	67	0	2020	Hawaii		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	68	0		29	10	S5810_068_0	3	1			05/29/2019	2020.01	05/29/2019 01:30:47 PM Eastern Daylight Time		07/06/2019 11:15:10 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Saver (PDP)	10	29					S5810	68	0	2020	Alaska		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	276	0		29	10	S5810_276_0	3	1			05/29/2019	2020.01	05/29/2019 01:30:40 PM Eastern Daylight Time		07/06/2019 11:15:44 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	276	0	2020	"Central New England (CT, RI, MA, VT)"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	277	0		29	10	S5810_277_0	3	1			05/29/2019	2020.01	05/29/2019 01:30:37 PM Eastern Daylight Time		07/06/2019 11:16:19 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	277	0	2020	New York		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	278	0		29	10	S5810_278_0	3	1			05/29/2019	2020.01	05/29/2019 01:30:20 PM Eastern Daylight Time		07/06/2019 11:16:54 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	278	0	2020	New Jersey		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	279	0		29	10	S5810_279_0	3	1			05/29/2019	2020.01	05/29/2019 01:30:16 PM Eastern Daylight Time		07/06/2019 11:17:30 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	279	0	2020	"Mid-Atlantic (DE, DC, MD)"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	280	0		29	10	S5810_280_0	3	1			05/29/2019	2020.01	05/29/2019 01:30:13 PM Eastern Daylight Time		07/06/2019 11:18:04 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	280	0	2020	"Pennsylvania, West Virginia"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	281	0		29	10	S5810_281_0	3	1			05/29/2019	2020.01	05/29/2019 01:29:42 PM Eastern Daylight Time		07/06/2019 11:18:38 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	281	0	2020	Virginia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	282	0		29	10	S5810_282_0	3	1			05/29/2019	2020.01	05/29/2019 01:29:37 PM Eastern Daylight Time		07/06/2019 11:19:12 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	282	0	2020	North Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	283	0		29	10	S5810_283_0	3	1			05/29/2019	2020.01	05/29/2019 01:29:33 PM Eastern Daylight Time		07/06/2019 11:19:47 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	283	0	2020	South Carolina		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	284	0		29	10	S5810_284_0	3	1			05/29/2019	2020.01	05/29/2019 01:29:29 PM Eastern Daylight Time		07/06/2019 11:20:21 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	284	0	2020	Georgia		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	285	0		29	10	S5810_285_0	3	1			05/29/2019	2020.01	05/29/2019 01:29:25 PM Eastern Daylight Time		07/06/2019 11:20:56 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	285	0	2020	Florida		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	286	0		29	10	S5810_286_0	3	1			05/29/2019	2020.01	05/29/2019 01:29:22 PM Eastern Daylight Time		07/06/2019 11:21:38 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	286	0	2020	"Alabama, Tennessee"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	287	0		29	10	S5810_287_0	3	1			05/29/2019	2020.01	05/29/2019 01:29:19 PM Eastern Daylight Time		07/06/2019 11:22:13 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	287	0	2020	Michigan		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	288	0		29	10	S5810_288_0	3	1			05/29/2019	2020.01	05/29/2019 01:29:16 PM Eastern Daylight Time		07/06/2019 11:22:47 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	288	0	2020	Ohio		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	289	0		29	10	S5810_289_0	3	1			05/29/2019	2020.01	05/29/2019 01:29:12 PM Eastern Daylight Time		07/06/2019 11:23:22 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	289	0	2020	"Indiana, Kentucky"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	290	0		29	10	S5810_290_0	3	1			05/29/2019	2020.01	05/29/2019 01:29:09 PM Eastern Daylight Time		07/06/2019 11:23:55 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	290	0	2020	Wisconsin		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	291	0		29	10	S5810_291_0	3	1			05/29/2019	2020.01	05/29/2019 01:29:05 PM Eastern Daylight Time		07/06/2019 11:24:31 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	291	0	2020	Illinois		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	292	0		29	10	S5810_292_0	3	1			05/29/2019	2020.01	05/29/2019 01:29:02 PM Eastern Daylight Time		07/06/2019 11:25:06 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	292	0	2020	Louisiana		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	293	0		29	10	S5810_293_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:58 PM Eastern Daylight Time		07/06/2019 11:25:41 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	293	0	2020	Texas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	294	0		29	10	S5810_294_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:54 PM Eastern Daylight Time		07/06/2019 11:26:28 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	294	0	2020	Arizona		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	295	0		29	10	S5810_295_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:50 PM Eastern Daylight Time		07/06/2019 11:27:07 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	295	0	2020	California		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	296	0		29	10	S5810_296_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:47 PM Eastern Daylight Time		07/06/2019 11:27:43 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	296	0	2020	"Northern New England (NH, ME)"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	297	0		29	10	S5810_297_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:43 PM Eastern Daylight Time		07/06/2019 11:28:20 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	297	0	2020	Missouri		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	298	0		29	10	S5810_298_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:40 PM Eastern Daylight Time		07/06/2019 11:28:59 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	298	0	2020	Arkansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	299	0		29	10	S5810_299_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:37 PM Eastern Daylight Time		07/06/2019 11:29:37 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	299	0	2020	Mississippi		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	300	0		29	10	S5810_300_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:33 PM Eastern Daylight Time		07/06/2019 11:30:16 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	300	0	2020	Oklahoma		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	301	0		29	10	S5810_301_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:29 PM Eastern Daylight Time		07/06/2019 11:30:56 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	301	0	2020	Kansas		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	302	0		29	10	S5810_302_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:26 PM Eastern Daylight Time		07/06/2019 11:31:34 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	302	0	2020	"Upper MW and N Plains (IA, MN, NE, SD, ND, WY, MT)"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	303	0		29	10	S5810_303_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:22 PM Eastern Daylight Time		07/06/2019 11:32:10 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	303	0	2020	New Mexico		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	304	0		29	10	S5810_304_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:19 PM Eastern Daylight Time		07/06/2019 11:32:45 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	304	0	2020	Colorado		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	305	0		29	10	S5810_305_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:15 PM Eastern Daylight Time		07/06/2019 11:33:20 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	305	0	2020	Nevada		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	306	0		29	10	S5810_306_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:12 PM Eastern Daylight Time		07/06/2019 11:33:55 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	306	0	2020	"Oregon, Washington"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	307	0		29	10	S5810_307_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:07 PM Eastern Daylight Time		07/06/2019 11:34:30 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	307	0	2020	"Idaho, Utah"		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	308	0		29	10	S5810_308_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:03 PM Eastern Daylight Time		07/06/2019 11:35:06 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	308	0	2020	Hawaii		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5810	309	0		29	10	S5810_309_0	3	1			05/29/2019	2020.01	05/29/2019 01:28:00 PM Eastern Daylight Time		07/06/2019 11:35:41 AM Eastern Daylight Time			07/12/2019 11:57:27 AM Eastern Daylight Time	"WELLCARE PRESCRIPTION INSURANCE, INC."	WellCare	www.wellcare.com/PDP	WellCare Medicare Rx Select (PDP)	10	29					S5810	309	0	2020	Alaska		2					2						www.wellcare.com/PDP	www.wellcare.com/PDP										(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(711)-		(711)-		(711)-		(711)-																
S5820	1	0		29	10	S5820_001_0	2	1			06/02/2019	2020.01	06/02/2019 10:12:03 AM Central Daylight Time		06/24/2019 11:42:38 AM Central Daylight Time			07/23/2019 08:36:34 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	1	0	2020	"Northern New England (NH, ME)"		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	2	0		29	10	S5820_002_0	2	1			05/27/2019	2020.01	05/27/2019 11:19:22 AM Central Daylight Time		06/24/2019 11:43:08 AM Central Daylight Time			07/23/2019 08:36:34 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	2	0	2020	"Central New England (CT, MA, RI, VT)"		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	3	0		29	10	S5820_003_0	2	1			05/28/2019	2020.01	05/28/2019 10:58:02 AM Central Daylight Time		06/24/2019 11:43:38 AM Central Daylight Time			07/23/2019 08:36:34 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	3	0	2020	New Jersey		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	4	0		29	10	S5820_004_0	2	1			05/27/2019	2020.01	05/27/2019 01:45:41 PM Central Daylight Time		06/24/2019 11:44:08 AM Central Daylight Time			07/23/2019 08:36:34 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	4	0	2020	"Mid-Atlantic (DE, DC, MD)"		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	5	0		29	10	S5820_005_0	2	1			05/27/2019	2020.01	05/27/2019 01:46:01 PM Central Daylight Time		06/24/2019 11:44:39 AM Central Daylight Time			07/23/2019 08:36:34 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	5	0	2020	"Pennsylvania, West Virginia"		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	6	0		29	10	S5820_006_0	2	1			05/28/2019	2020.01	05/28/2019 10:58:22 AM Central Daylight Time		06/24/2019 11:45:09 AM Central Daylight Time			07/23/2019 08:36:34 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	6	0	2020	Virginia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	7	0		29	10	S5820_007_0	2	1			05/27/2019	2020.01	05/27/2019 01:47:15 PM Central Daylight Time		06/24/2019 11:45:39 AM Central Daylight Time			07/23/2019 08:36:34 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	7	0	2020	North Carolina		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	8	0		29	10	S5820_008_0	2	1			05/27/2019	2020.01	05/27/2019 01:47:36 PM Central Daylight Time		06/24/2019 11:46:09 AM Central Daylight Time			07/23/2019 08:36:34 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	8	0	2020	South Carolina		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	9	0		29	10	S5820_009_0	2	1			05/27/2019	2020.01	05/27/2019 01:51:00 PM Central Daylight Time		06/24/2019 11:46:40 AM Central Daylight Time			07/23/2019 08:36:34 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	9	0	2020	Georgia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	10	0		29	10	S5820_010_0	2	1			05/27/2019	2020.01	05/27/2019 01:51:51 PM Central Daylight Time		06/24/2019 11:47:09 AM Central Daylight Time			07/23/2019 08:36:34 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	10	0	2020	Florida		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	11	0		29	10	S5820_011_0	2	1			05/28/2019	2020.01	05/28/2019 03:37:36 PM Central Daylight Time		06/24/2019 11:47:39 AM Central Daylight Time			07/23/2019 08:42:40 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	11	0	2020	"Alabama, Tennessee"		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	12	0		29	10	S5820_012_0	2	1			05/27/2019	2020.01	05/27/2019 01:52:28 PM Central Daylight Time		06/24/2019 11:48:08 AM Central Daylight Time			07/23/2019 08:42:40 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	12	0	2020	Michigan		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	13	0		29	10	S5820_013_0	2	1			05/27/2019	2020.01	05/27/2019 01:52:43 PM Central Daylight Time		06/24/2019 11:48:37 AM Central Daylight Time			07/23/2019 08:42:40 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	13	0	2020	Ohio		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	14	0		29	10	S5820_014_0	2	1			05/27/2019	2020.01	05/27/2019 01:53:04 PM Central Daylight Time		06/24/2019 11:49:06 AM Central Daylight Time			07/23/2019 08:42:40 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	14	0	2020	"Indiana, Kentucky"		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	15	0		29	10	S5820_015_0	2	1			05/27/2019	2020.01	05/27/2019 01:53:24 PM Central Daylight Time		06/24/2019 11:49:35 AM Central Daylight Time			07/23/2019 08:42:40 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	15	0	2020	Wisconsin		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	16	0		29	10	S5820_016_0	2	1			05/27/2019	2020.01	05/27/2019 01:53:51 PM Central Daylight Time		06/24/2019 11:50:05 AM Central Daylight Time			07/23/2019 08:42:40 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	16	0	2020	Illinois		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	17	0		29	10	S5820_017_0	2	1			05/27/2019	2020.01	05/27/2019 01:54:08 PM Central Daylight Time		06/24/2019 11:50:34 AM Central Daylight Time			07/23/2019 08:42:40 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	17	0	2020	Missouri		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	18	0		29	10	S5820_018_0	2	1			05/27/2019	2020.01	05/27/2019 01:54:22 PM Central Daylight Time		06/24/2019 11:51:03 AM Central Daylight Time			07/23/2019 08:42:40 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	18	0	2020	Arkansas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	19	0		29	10	S5820_019_0	2	1			05/27/2019	2020.01	05/27/2019 01:54:38 PM Central Daylight Time		06/24/2019 11:51:32 AM Central Daylight Time			07/23/2019 08:42:40 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	19	0	2020	Mississippi		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	20	0		29	10	S5820_020_0	2	1			05/27/2019	2020.01	05/27/2019 01:54:57 PM Central Daylight Time		06/24/2019 11:52:01 AM Central Daylight Time			07/23/2019 08:42:40 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	20	0	2020	Louisiana		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	21	0		29	10	S5820_021_0	2	1			05/31/2019	2020.01	05/31/2019 05:19:04 PM Central Daylight Time		06/24/2019 11:52:30 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	21	0	2020	Texas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	22	0		29	10	S5820_022_0	2	1			05/27/2019	2020.01	05/27/2019 01:55:31 PM Central Daylight Time		06/24/2019 11:52:59 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	22	0	2020	Oklahoma		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	23	0		29	10	S5820_023_0	2	1			05/27/2019	2020.01	05/27/2019 01:55:46 PM Central Daylight Time		06/24/2019 11:53:29 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	23	0	2020	Kansas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	24	0		29	10	S5820_024_0	2	1			05/27/2019	2020.01	05/27/2019 01:56:05 PM Central Daylight Time		06/24/2019 11:53:59 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	24	0	2020	Upper Midwest and Northern Plains		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	25	0		29	10	S5820_025_0	2	1			05/27/2019	2020.01	05/27/2019 01:56:20 PM Central Daylight Time		06/24/2019 11:54:28 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	25	0	2020	New Mexico		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	26	0		29	10	S5820_026_0	2	1			05/27/2019	2020.01	05/27/2019 01:56:35 PM Central Daylight Time		06/24/2019 11:54:57 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	26	0	2020	Colorado		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	27	0		29	10	S5820_027_0	2	1			05/27/2019	2020.01	05/27/2019 01:56:52 PM Central Daylight Time		06/24/2019 11:55:26 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	27	0	2020	Arizona		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	28	0		29	10	S5820_028_0	2	1			05/27/2019	2020.01	05/27/2019 01:57:07 PM Central Daylight Time		06/24/2019 11:55:55 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	28	0	2020	Nevada		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	29	0		29	10	S5820_029_0	2	1			05/27/2019	2020.01	05/27/2019 01:57:23 PM Central Daylight Time		06/24/2019 11:56:24 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	29	0	2020	"Oregon, Washington"		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	30	0		29	10	S5820_030_0	2	1			05/27/2019	2020.01	05/27/2019 01:57:39 PM Central Daylight Time		06/24/2019 11:56:54 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	30	0	2020	"Idaho, Utah"		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	31	0		29	10	S5820_031_0	2	1			05/27/2019	2020.01	05/27/2019 01:57:54 PM Central Daylight Time		06/24/2019 11:57:23 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	31	0	2020	California		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	32	0		29	10	S5820_032_0	1	1			05/27/2019	2020.01	05/27/2019 01:58:10 PM Central Daylight Time		05/30/2019 12:02:56 AM Central Daylight Time			06/02/2019 11:27:07 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	32	0	2020	Hawaii		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)774-9679		(866)774-9679		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	33	0		29	10	S5820_033_0	1	1			05/27/2019	2020.01	05/27/2019 01:58:28 PM Central Daylight Time		05/30/2019 12:03:20 AM Central Daylight Time			06/02/2019 11:27:07 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	33	0	2020	Alaska		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)868-1394		(866)868-1394		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	34	0		29	10	S5820_034_0	2	1			05/27/2019	2020.01	05/27/2019 01:58:46 PM Central Daylight Time		06/24/2019 11:58:22 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	34	0	2020	American Samoa		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(877)521-7035		(877)521-7035		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	35	0		29	10	S5820_035_0	2	1			05/28/2019	2020.01	05/28/2019 01:34:58 PM Central Daylight Time		06/24/2019 11:58:52 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	35	0	2020	Guam		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(877)521-7034		(877)521-7034		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	36	0		29	10	S5820_036_0	1	1			05/28/2019	2020.01	05/28/2019 01:23:54 PM Central Daylight Time		05/31/2019 01:35:33 PM Central Daylight Time			06/02/2019 11:27:07 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	36	0	2020	Northern Mariana Islands		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(877)521-7034		(877)521-7034		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	37	0		29	10	S5820_037_0	2	1			05/28/2019	2020.01	05/28/2019 03:38:22 PM Central Daylight Time		06/24/2019 11:59:22 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	37	0	2020	Puerto Rico		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5820	38	0		29	10	S5820_038_0	2	1			05/27/2019	2020.01	05/27/2019 01:59:52 PM Central Daylight Time		06/24/2019 11:59:51 AM Central Daylight Time			07/23/2019 08:50:32 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	38	0	2020	US Virgin Islands		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.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			05/12/2019	2020.01	05/12/2019 07:16:45 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	803	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/12/2019	2020.01	05/12/2019 07:16:54 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	804	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/12/2019	2020.01	05/12/2019 07:17:04 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	807	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/12/2019	2020.01	05/12/2019 07:17:12 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	808	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/12/2019	2020.01	05/12/2019 07:17:27 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	810	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/12/2019	2020.01	05/12/2019 07:17:41 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	811	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/12/2019	2020.01	05/12/2019 07:17:52 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	812	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/12/2019	2020.01	05/12/2019 07:18:52 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	813	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/12/2019	2020.01	05/12/2019 07:19:05 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	814	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/12/2019	2020.01	05/12/2019 07:19:16 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	815	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/12/2019	2020.01	05/12/2019 07:19:26 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	816	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/12/2019	2020.01	05/12/2019 07:19:38 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	817	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/12/2019	2020.01	05/12/2019 07:19:50 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	818	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/12/2019	2020.01	05/12/2019 07:20:00 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	819	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/12/2019	2020.01	05/12/2019 07:20:11 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	820	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/12/2019	2020.01	05/12/2019 07:20:25 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	821	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/12/2019	2020.01	05/12/2019 07:20:36 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	822	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/12/2019	2020.01	05/12/2019 07:20:46 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	823	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/12/2019	2020.01	05/12/2019 07:20:59 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	824	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/12/2019	2020.01	05/12/2019 07:21:16 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	825	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	1	1			05/12/2019	2020.01	05/12/2019 07:21:31 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	826	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	827	0		29	10	S5820_827_0	1	1			05/12/2019	2020.01	05/12/2019 07:21:44 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	827	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	828	0		29	10	S5820_828_0	1	1			05/12/2019	2020.01	05/12/2019 07:21:55 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	828	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	829	0		29	10	S5820_829_0	1	1			05/12/2019	2020.01	05/12/2019 07:22:05 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	829	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	830	0		29	10	S5820_830_0	1	1			05/12/2019	2020.01	05/12/2019 07:22:24 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	830	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	831	0		29	10	S5820_831_0	1	1			05/12/2019	2020.01	05/12/2019 07:22:35 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	831	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	832	0		29	10	S5820_832_0	1	1			05/12/2019	2020.01	05/12/2019 07:22:54 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	832	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	833	0		29	10	S5820_833_0	1	1			05/12/2019	2020.01	05/12/2019 07:23:06 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	833	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	834	0		29	10	S5820_834_0	1	1			05/12/2019	2020.01	05/12/2019 07:23:22 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	834	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	835	0		29	10	S5820_835_0	1	1			05/12/2019	2020.01	05/12/2019 07:23:40 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	835	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5820	836	0		29	10	S5820_836_0	1	1			05/12/2019	2020.01	05/12/2019 07:23:52 PM Central Daylight Time					06/02/2019 05:23:21 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	836	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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	4	1			05/02/2019	2020.01	05/02/2019 08:56:58 AM Eastern Daylight Time					06/03/2019 04:15:06 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	2020	United States		1					2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com									(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-																
S5857	803	0		29	10	S5857_803_0	4	1			05/02/2019	2020.01	05/02/2019 08:58:40 AM Eastern Daylight Time					06/03/2019 04:15:06 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	2020	United States		1					2						www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com									(888)389-6648		(616)464-8820		(888)772-9596		(616)464-8850										(711)-		(711)-		(711)-		(711)-																
S5877	803	0		29	10	S5877_803_0	1	1			05/28/2019	2020.01	05/28/2019 01:43:22 PM Mountain Daylight Time					05/28/2019 01:59:46 PM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	www.emihealth.com	Alpine School District Retiree Plan (PDP)	10	29					S5877	803	0	2020	State of Utah and State of Idaho		1					2						http://www.express-scripts.com	https://medicare.emihealth.com/Formulary.aspx										(800)662-5851		(801)262-7476		(800)662-5851		(801)262-7476										(800)662-5851		(801)262-7476		(800)662-5851		(801)262-7476																
S5877	804	0		29	10	S5877_804_0	1	1			05/28/2019	2020.01	05/28/2019 01:43:36 PM Mountain Daylight Time					05/28/2019 01:59:46 PM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	www.emihealth.com	Educators Mutual Retiree Plan (PDP)	10	29					S5877	804	0	2020	State of Utah and State of Idaho		1					2						http://www.express-scripts.com	https://medicare.emihealth.com/Formulary.aspx										(800)662-5851		(801)262-7476		(800)662-5851		(801)262-7476										(800)662-5851		(801)262-7476		(800)662-5851		(801)262-7476																
S5884	101	0		29	10	S5884_101_0	2	1			05/28/2019	2020.01	05/28/2019 12:13:29 PM Eastern Daylight Time		05/31/2019 08:09:07 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	101	0	2020	States of Maine and New Hampshire		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:14:35 PM Eastern Daylight Time		05/31/2019 08:09:08 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	102	0	2020	"States of CT, MA, RI, VT"		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:15:44 PM Eastern Daylight Time		05/31/2019 08:09:09 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	103	0	2020	"States of DC, DE, MD"		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:16:19 PM Eastern Daylight Time		05/31/2019 08:09:10 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	104	0	2020	States of Pennsylvania and West Virginia		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:16:50 PM Eastern Daylight Time		05/31/2019 08:09:11 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	105	0	2020	State of Florida		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:17:39 PM Eastern Daylight Time		05/31/2019 08:09:12 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	106	0	2020	States of Alabama and Tennessee		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:19:27 PM Eastern Daylight Time		05/31/2019 08:09:13 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	107	0	2020	State of Illinois		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	108	0		29	10	S5884_108_0	2	1			07/26/2019	2020.01	07/26/2019 10:40:19 AM Eastern Daylight Time		07/25/2019 04:24:25 PM Eastern Daylight Time			07/26/2019 10:44:22 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	108	0	2020	State of Louisiana		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:22:01 PM Eastern Daylight Time		05/31/2019 08:09:15 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	109	0	2020	State of Kansas		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:22:46 PM Eastern Daylight Time		05/31/2019 08:09:17 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	110	0	2020	State of New Mexico		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:23:43 PM Eastern Daylight Time		05/31/2019 08:09:18 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	111	0	2020	State of Colorado		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:24:22 PM Eastern Daylight Time		05/31/2019 08:09:19 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	112	0	2020	State of Nevada		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:24:53 PM Eastern Daylight Time		05/31/2019 08:09:20 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	113	0	2020	States of Oregon and Washington		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:25:22 PM Eastern Daylight Time		05/31/2019 08:09:21 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	114	0	2020	State of California		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	115	0		29	10	S5884_115_0	2	1			06/01/2019	2020.01	06/01/2019 03:44:54 PM Eastern Daylight Time		06/01/2019 02:02:48 PM Eastern Daylight Time			06/01/2019 04:35:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	115	0	2020	State of Hawaii		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:26:14 PM Eastern Daylight Time		05/31/2019 08:09:23 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	116	0	2020	State of Alaska		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:26:46 PM Eastern Daylight Time		05/31/2019 08:09:25 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	131	0	2020	State of New Jersey		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	132	0		29	10	S5884_132_0	2	1			07/26/2019	2020.01	07/26/2019 10:39:52 AM Eastern Daylight Time		07/25/2019 04:24:26 PM Eastern Daylight Time			07/26/2019 10:44:22 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	132	0	2020	State of Virginia		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:27:42 PM Eastern Daylight Time		05/31/2019 08:09:27 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	133	0	2020	State of North Carolina		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:28:04 PM Eastern Daylight Time		05/31/2019 08:09:28 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	134	0	2020	State of South Carolina		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:28:33 PM Eastern Daylight Time		05/31/2019 08:09:29 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	135	0	2020	State of Georgia		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:29:07 PM Eastern Daylight Time		05/31/2019 08:09:30 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	136	0	2020	State of Michigan		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:29:33 PM Eastern Daylight Time		05/31/2019 08:09:31 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	137	0	2020	State of Ohio		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:29:57 PM Eastern Daylight Time		05/31/2019 08:09:32 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	138	0	2020	States of Indiana and Kentucky		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:30:22 PM Eastern Daylight Time		05/31/2019 08:09:33 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	139	0	2020	State of Wisconsin		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:30:54 PM Eastern Daylight Time		05/31/2019 08:09:34 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	140	0	2020	State of Missouri		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:31:22 PM Eastern Daylight Time		05/31/2019 08:09:35 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	141	0	2020	State of Arkansas		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:31:50 PM Eastern Daylight Time		05/31/2019 08:09:36 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	142	0	2020	State of Mississippi		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:32:47 PM Eastern Daylight Time		05/31/2019 08:09:37 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	143	0	2020	State of Texas		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 12:34:02 PM Eastern Daylight Time		05/31/2019 08:09:38 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	144	0	2020	State of Oklahoma		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	145	0		29	10	S5884_145_0	2	1			07/26/2019	2020.01	07/26/2019 10:38:55 AM Eastern Daylight Time		07/25/2019 04:24:27 PM Eastern Daylight Time			07/26/2019 10:44:22 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	145	0	2020	"States of IA, MN, MT, ND, NE, SD, WY"		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	146	0		29	10	S5884_146_0	2	1			07/26/2019	2020.01	07/26/2019 10:39:22 AM Eastern Daylight Time		07/25/2019 04:24:28 PM Eastern Daylight Time			07/26/2019 10:44:22 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	146	0	2020	State of Arizona		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/29/2019	2020.01	05/29/2019 02:06:14 PM Eastern Daylight Time		05/31/2019 08:09:41 AM Eastern Daylight Time			05/31/2019 07:15:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Basic Rx Plan (PDP)	10	29					S5884	147	0	2020	States of Idaho and Utah		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/31/2019	2020.01	05/31/2019 12:24:18 PM Eastern Daylight Time		06/01/2019 06:36:07 AM Eastern Daylight Time			06/01/2019 01:24:12 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	148	0	2020	States of Maine and New Hampshire		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	149	0		29	10	S5884_149_0	1	1			05/31/2019	2020.01	05/31/2019 12:24:43 PM Eastern Daylight Time		06/01/2019 06:36:14 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	149	0	2020	"States of CT, MA, RI, VT"		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	150	0		29	10	S5884_150_0	1	1			05/31/2019	2020.01	05/31/2019 12:25:08 PM Eastern Daylight Time		06/01/2019 06:36:22 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	150	0	2020	State of New Jersey		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	151	0		29	10	S5884_151_0	1	1			05/31/2019	2020.01	05/31/2019 12:25:34 PM Eastern Daylight Time		06/01/2019 06:36:28 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	151	0	2020	"States of DC, DE, MD"		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	152	0		29	10	S5884_152_0	1	1			05/31/2019	2020.01	05/31/2019 12:25:57 PM Eastern Daylight Time		06/01/2019 06:36:34 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	152	0	2020	States of Pennsylvania and West Virginia		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	153	0		29	10	S5884_153_0	1	1			05/28/2019	2020.01	05/28/2019 12:39:01 PM Eastern Daylight Time		06/01/2019 06:36:40 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	153	0	2020	State of Virginia		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	154	0		29	10	S5884_154_0	1	1			05/31/2019	2020.01	05/31/2019 12:26:29 PM Eastern Daylight Time		06/01/2019 06:36:45 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	154	0	2020	State of North Carolina		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	155	0		29	10	S5884_155_0	1	1			05/31/2019	2020.01	05/31/2019 12:26:53 PM Eastern Daylight Time		06/01/2019 06:36:51 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	155	0	2020	State of South Carolina		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	156	0		29	10	S5884_156_0	1	1			05/31/2019	2020.01	05/31/2019 12:27:16 PM Eastern Daylight Time		06/01/2019 06:36:57 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	156	0	2020	State of Georgia		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	157	0		29	10	S5884_157_0	1	1			05/31/2019	2020.01	05/31/2019 12:27:40 PM Eastern Daylight Time		06/01/2019 06:37:03 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	157	0	2020	State of Florida		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	158	0		29	10	S5884_158_0	1	1			05/31/2019	2020.01	05/31/2019 12:28:01 PM Eastern Daylight Time		06/01/2019 06:37:09 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	158	0	2020	States of Alabama and Tennessee		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	159	0		29	10	S5884_159_0	1	1			05/31/2019	2020.01	05/31/2019 12:28:26 PM Eastern Daylight Time		06/01/2019 06:37:14 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	159	0	2020	State of Michigan		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	160	0		29	10	S5884_160_0	1	1			05/31/2019	2020.01	05/31/2019 12:28:49 PM Eastern Daylight Time		06/01/2019 06:37:20 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	160	0	2020	State of Ohio		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	161	0		29	10	S5884_161_0	1	1			05/31/2019	2020.01	05/31/2019 12:29:12 PM Eastern Daylight Time		06/01/2019 06:37:29 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	161	0	2020	States of Indiana and Kentucky		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	162	0		29	10	S5884_162_0	1	1			05/31/2019	2020.01	05/31/2019 12:29:32 PM Eastern Daylight Time		06/01/2019 06:37:35 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	162	0	2020	State of Wisconsin		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	163	0		29	10	S5884_163_0	1	1			05/31/2019	2020.01	05/31/2019 07:52:40 PM Eastern Daylight Time		06/01/2019 06:37:41 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	163	0	2020	State of Illinois		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	164	0		29	10	S5884_164_0	1	1			05/31/2019	2020.01	05/31/2019 12:30:10 PM Eastern Daylight Time		06/01/2019 06:37:48 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	164	0	2020	State of Missouri		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	165	0		29	10	S5884_165_0	1	1			05/31/2019	2020.01	05/31/2019 12:30:33 PM Eastern Daylight Time		06/01/2019 06:37:56 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	165	0	2020	State of Arkansas		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	166	0		29	10	S5884_166_0	1	1			05/31/2019	2020.01	05/31/2019 12:31:02 PM Eastern Daylight Time		06/01/2019 06:38:03 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	166	0	2020	State of Mississippi		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	167	0		29	10	S5884_167_0	1	1			05/31/2019	2020.01	05/31/2019 12:31:26 PM Eastern Daylight Time		06/01/2019 06:38:09 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	167	0	2020	State of Louisiana		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	168	0		29	10	S5884_168_0	1	1			05/31/2019	2020.01	05/31/2019 12:31:48 PM Eastern Daylight Time		06/01/2019 06:38:16 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	168	0	2020	State of Texas		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	169	0		29	10	S5884_169_0	1	1			05/31/2019	2020.01	05/31/2019 12:32:10 PM Eastern Daylight Time		06/01/2019 06:38:24 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	169	0	2020	State of Oklahoma		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	170	0		29	10	S5884_170_0	1	1			05/31/2019	2020.01	05/31/2019 12:32:33 PM Eastern Daylight Time		06/01/2019 06:38:29 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	170	0	2020	State of Kansas		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	171	0		29	10	S5884_171_0	1	1			05/31/2019	2020.01	05/31/2019 12:32:58 PM Eastern Daylight Time		06/01/2019 06:38:36 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	171	0	2020	"States of IA, MN, MT, ND, NE, SD, WY"		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	172	0		29	10	S5884_172_0	1	1			05/31/2019	2020.01	05/31/2019 12:33:23 PM Eastern Daylight Time		06/01/2019 06:38:43 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	172	0	2020	State of New Mexico		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	173	0		29	10	S5884_173_0	1	1			05/31/2019	2020.01	05/31/2019 12:33:46 PM Eastern Daylight Time		06/01/2019 06:38:49 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	173	0	2020	State of Colorado		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	174	0		29	10	S5884_174_0	1	1			05/31/2019	2020.01	05/31/2019 12:34:08 PM Eastern Daylight Time		06/01/2019 06:38:54 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	174	0	2020	State of Arizona		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	175	0		29	10	S5884_175_0	1	1			05/31/2019	2020.01	05/31/2019 12:34:36 PM Eastern Daylight Time		06/01/2019 06:39:01 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	175	0	2020	State of Nevada		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	176	0		29	10	S5884_176_0	1	1			05/31/2019	2020.01	05/31/2019 12:34:59 PM Eastern Daylight Time		06/01/2019 06:39:10 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	176	0	2020	States of Oregon and Washington		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	177	0		29	10	S5884_177_0	1	1			05/31/2019	2020.01	05/31/2019 12:35:27 PM Eastern Daylight Time		06/01/2019 06:39:15 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	177	0	2020	States of Idaho and Utah		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	178	0		29	10	S5884_178_0	1	1			05/31/2019	2020.01	05/31/2019 12:35:53 PM Eastern Daylight Time		06/01/2019 06:39:23 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	178	0	2020	State of California		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			06/01/2019	2020.01	06/01/2019 03:45:19 PM Eastern Daylight Time		06/01/2019 02:02:49 PM Eastern Daylight Time			06/01/2019 04:35:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	179	0	2020	State of Hawaii		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	180	0		29	10	S5884_180_0	1	1			05/31/2019	2020.01	05/31/2019 12:36:47 PM Eastern Daylight Time		06/01/2019 06:39:37 AM Eastern Daylight Time			06/01/2019 01:04:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Premier Rx Plan (PDP)	10	29					S5884	180	0	2020	State of Alaska		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	181	0		29	10	S5884_181_0	2	1			05/31/2019	2020.01	05/31/2019 09:11:32 AM Eastern Daylight Time		05/31/2019 08:10:10 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	181	0	2020	States of Maine and New Hampshire		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	182	0		29	10	S5884_182_0	1	1			05/31/2019	2020.01	05/31/2019 09:11:57 AM Eastern Daylight Time		05/31/2019 08:10:11 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	182	0	2020	"States of CT, MA, RI, VT"		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	183	0		29	10	S5884_183_0	1	1			05/31/2019	2020.01	05/31/2019 10:31:54 AM Eastern Daylight Time		05/31/2019 08:10:12 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	183	0	2020	State of New Jersey		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	184	0		29	10	S5884_184_0	1	1			05/31/2019	2020.01	05/31/2019 09:12:34 AM Eastern Daylight Time		05/31/2019 08:10:13 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	184	0	2020	"States of DC, DE, MD"		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	185	0		29	10	S5884_185_0	1	1			05/31/2019	2020.01	05/31/2019 09:12:48 AM Eastern Daylight Time		05/31/2019 08:10:15 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	185	0	2020	States of Pennsylvania and West Virginia		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	186	0		29	10	S5884_186_0	1	1			05/31/2019	2020.01	05/31/2019 09:12:59 AM Eastern Daylight Time		05/31/2019 08:10:15 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	186	0	2020	State of Virginia		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	187	0		29	10	S5884_187_0	1	1			05/31/2019	2020.01	05/31/2019 10:32:22 AM Eastern Daylight Time		05/31/2019 08:10:16 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	187	0	2020	State of North Carolina		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	188	0		29	10	S5884_188_0	1	1			05/31/2019	2020.01	05/31/2019 09:13:31 AM Eastern Daylight Time		05/31/2019 08:10:18 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	188	0	2020	State of South Carolina		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	189	0		29	10	S5884_189_0	1	1			05/31/2019	2020.01	05/31/2019 09:13:46 AM Eastern Daylight Time		05/31/2019 08:10:18 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	189	0	2020	State of Georgia		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	190	0		29	10	S5884_190_0	1	1			05/31/2019	2020.01	05/31/2019 09:14:06 AM Eastern Daylight Time		05/31/2019 08:10:19 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	190	0	2020	State of Florida		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	191	0		29	10	S5884_191_0	1	1			05/31/2019	2020.01	05/31/2019 09:14:23 AM Eastern Daylight Time		05/31/2019 08:10:20 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	191	0	2020	States of Alabama and Tennessee		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	192	0		29	10	S5884_192_0	1	1			05/31/2019	2020.01	05/31/2019 09:14:35 AM Eastern Daylight Time		05/31/2019 08:10:21 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	192	0	2020	State of Michigan		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	193	0		29	10	S5884_193_0	1	1			05/31/2019	2020.01	05/31/2019 09:14:48 AM Eastern Daylight Time		05/31/2019 08:10:22 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	193	0	2020	State of Ohio		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	194	0		29	10	S5884_194_0	1	1			05/31/2019	2020.01	05/31/2019 09:15:00 AM Eastern Daylight Time		05/31/2019 08:10:23 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	194	0	2020	States of Indiana and Kentucky		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	195	0		29	10	S5884_195_0	1	1			05/31/2019	2020.01	05/31/2019 10:32:57 AM Eastern Daylight Time		05/31/2019 08:10:24 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	195	0	2020	State of Wisconsin		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	196	0		29	10	S5884_196_0	1	1			05/31/2019	2020.01	05/31/2019 09:15:27 AM Eastern Daylight Time		05/31/2019 08:10:25 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	196	0	2020	State of Illinois		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	197	0		29	10	S5884_197_0	1	1			05/31/2019	2020.01	05/31/2019 09:15:39 AM Eastern Daylight Time		05/31/2019 08:10:26 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	197	0	2020	State of Missouri		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	198	0		29	10	S5884_198_0	1	1			05/31/2019	2020.01	05/31/2019 09:15:52 AM Eastern Daylight Time		05/31/2019 08:10:27 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	198	0	2020	State of Arkansas		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	199	0		29	10	S5884_199_0	1	1			05/31/2019	2020.01	05/31/2019 09:16:12 AM Eastern Daylight Time		05/31/2019 08:10:28 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	199	0	2020	State of Mississippi		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	200	0		29	10	S5884_200_0	1	1			05/31/2019	2020.01	05/31/2019 09:16:33 AM Eastern Daylight Time		05/31/2019 08:10:29 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	200	0	2020	State of Louisiana		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	201	0		29	10	S5884_201_0	1	1			05/31/2019	2020.01	05/31/2019 09:16:45 AM Eastern Daylight Time		05/31/2019 08:10:30 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	201	0	2020	State of Texas		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	202	0		29	10	S5884_202_0	1	1			05/31/2019	2020.01	05/31/2019 09:16:58 AM Eastern Daylight Time		05/31/2019 08:10:31 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	202	0	2020	State of Oklahoma		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	203	0		29	10	S5884_203_0	1	1			05/31/2019	2020.01	05/31/2019 09:17:08 AM Eastern Daylight Time		05/31/2019 08:10:31 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	203	0	2020	State of Kansas		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	204	0		29	10	S5884_204_0	1	1			05/31/2019	2020.01	05/31/2019 09:17:18 AM Eastern Daylight Time		05/31/2019 08:10:32 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	204	0	2020	"States of IA, MN, MT, ND, NE, SD, WY"		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	205	0		29	10	S5884_205_0	1	1			05/31/2019	2020.01	05/31/2019 09:17:29 AM Eastern Daylight Time		05/31/2019 08:10:33 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	205	0	2020	State of New Mexico		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	206	0		29	10	S5884_206_0	1	1			05/31/2019	2020.01	05/31/2019 09:17:39 AM Eastern Daylight Time		05/31/2019 08:10:34 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	206	0	2020	State of Colorado		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	207	0		29	10	S5884_207_0	1	1			05/31/2019	2020.01	05/31/2019 09:17:50 AM Eastern Daylight Time		05/31/2019 08:10:35 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	207	0	2020	State of Arizona		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	208	0		29	10	S5884_208_0	1	1			05/31/2019	2020.01	05/31/2019 09:18:05 AM Eastern Daylight Time		05/31/2019 08:10:36 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	208	0	2020	State of Nevada		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	209	0		29	10	S5884_209_0	1	1			05/31/2019	2020.01	05/31/2019 09:18:17 AM Eastern Daylight Time		05/31/2019 08:10:37 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	209	0	2020	States of Oregon and Washington		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	210	0		29	10	S5884_210_0	1	1			05/31/2019	2020.01	05/31/2019 09:18:29 AM Eastern Daylight Time		05/31/2019 08:10:38 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	210	0	2020	States of Idaho and Utah		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	211	0		29	10	S5884_211_0	1	1			05/31/2019	2020.01	05/31/2019 09:18:40 AM Eastern Daylight Time		05/31/2019 08:10:39 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	211	0	2020	State of California		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	212	0		29	10	S5884_212_0	1	1			05/31/2019	2020.01	05/31/2019 09:18:52 AM Eastern Daylight Time		05/31/2019 08:10:40 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	212	0	2020	State of Hawaii		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-																
S5884	213	0		29	10	S5884_213_0	1	1			05/31/2019	2020.01	05/31/2019 09:19:03 AM Eastern Daylight Time		05/31/2019 08:10:41 AM Eastern Daylight Time			05/31/2019 09:16:32 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Walmart Value Rx Plan (PDP)	10	29					S5884	213	0	2020	State of Alaska		2					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(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			05/28/2019	2020.01	05/28/2019 08:08:30 AM Eastern Daylight Time					05/28/2019 08:08:43 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana	www.humana.com/medicare	Humana Medicare Employer (PDP)	10	29					S5884	834	0	2020	All Regions		1					2						https://www.humana.com/pharmacy/	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/										(888)396-8810		(888)396-8810		(800)824-8242		(800)824-8242										(711)-		(711)-		(711)-		(711)-																
S5904	1	0		29	10	S5904_001_0	9	1			05/31/2019	2020.01	05/31/2019 04:12:06 PM Eastern Daylight Time		06/02/2019 08:50:11 AM Eastern Daylight Time			06/02/2019 06:55:39 PM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Premier Rx (PDP)	10	29					S5904	1	0	2020	State of Florida		2					2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare									(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	2	0		29	10	S5904_002_0	4	1			05/31/2019	2020.01	05/31/2019 04:14:52 PM Eastern Daylight Time		06/02/2019 08:50:57 AM Eastern Daylight Time			06/02/2019 06:55:39 PM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Complete Rx (PDP)	10	29					S5904	2	0	2020	State of Florida		2					2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare									(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	3	1			05/30/2019	2020.01	05/30/2019 10:06:42 AM Eastern Daylight Time					06/02/2019 06:55:39 PM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Group Rx (PDP)	10	29					S5904	801	0	2020	State of Florida with National Coverage		1					2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare									(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	3	1			04/09/2019	2020.01	04/09/2019 03:59:43 PM Eastern Daylight Time					06/02/2019 06:55:39 PM Eastern Daylight Time	"BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC."	Florida Blue	FloridaBlue.com/medicare	BlueMedicare Group Rx (PDP)	10	29					S5904	802	0	2020	State of Florida with National Coverage		1					2						FloridaBlue.com/medicare	MyPrime.com	FloridaBlue.com/medicare									(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	1	0		29	10	S5916_001_0	5	1			05/31/2019	2020.01	05/31/2019 09:42:56 AM Mountain Daylight Time		07/10/2019 12:02:21 PM Mountain Daylight Time			07/17/2019 11:23:17 AM Mountain 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	1	0	2020	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	2	0		29	10	S5916_002_0	8	1			05/29/2019	2020.01	05/29/2019 04:46:42 PM Mountain Daylight Time		07/10/2019 12:04:38 PM Mountain Daylight Time			07/17/2019 11:23:17 AM Mountain 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	2	0	2020	Region of Idaho and Utah		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)-																
S5916	3	0		29	10	S5916_003_0	8	1			05/31/2019	2020.01	05/31/2019 03:01:32 PM Mountain Daylight Time		07/10/2019 12:07:59 PM Mountain Daylight Time			07/17/2019 11:23:17 AM Mountain 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 Saver (PDP)	10	29					S5916	3	0	2020	Regions 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	3	1			05/08/2019	2020.01	05/08/2019 03:52:46 PM Mountain Daylight Time					06/03/2019 10:36:44 AM Mountain 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	2020	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)-																
S5916	804	0		29	10	S5916_804_0	2	1			04/30/2019	2020.01	04/30/2019 03:26:49 PM Mountain Daylight Time					06/03/2019 10:36:44 AM Mountain 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 02 (PDP)	10	29					S5916	804	0	2020	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)-																
S5916	805	0		29	10	S5916_805_0	2	1			04/30/2019	2020.01	04/30/2019 03:26:58 PM Mountain Daylight Time					06/03/2019 10:36:44 AM Mountain 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 03 (PDP)	10	29					S5916	805	0	2020	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			05/27/2019	2020.01	05/27/2019 02:00:08 PM Central Daylight Time		05/30/2019 12:05:48 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	348	0	2020	"Connecticut, Massachusetts, Rhode Island, Vermont"		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	349	0		29	10	S5921_349_0	1	1			05/30/2019	2020.01	05/30/2019 04:03:46 PM Central Daylight Time		05/30/2019 12:06:12 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	349	0	2020	New Jersey		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	350	0		29	10	S5921_350_0	1	1			05/27/2019	2020.01	05/27/2019 04:32:53 PM Central Daylight Time		05/30/2019 12:06:37 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	350	0	2020	"Delaware, Maryland and Washington D.C."		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	351	0		29	10	S5921_351_0	1	1			05/27/2019	2020.01	05/27/2019 04:33:23 PM Central Daylight Time		05/30/2019 12:07:02 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	351	0	2020	Pennsylvania and West Virginia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	352	0		29	10	S5921_352_0	2	1			05/27/2019	2020.01	05/27/2019 04:33:38 PM Central Daylight Time		07/25/2019 11:37:51 AM Central Daylight Time			07/26/2019 02:02:12 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	352	0	2020	Virginia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	353	0		29	10	S5921_353_0	1	1			05/27/2019	2020.01	05/27/2019 04:33:59 PM Central Daylight Time		05/30/2019 12:07:51 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	353	0	2020	North Carolina		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	354	0		29	10	S5921_354_0	1	1			05/27/2019	2020.01	05/27/2019 04:34:21 PM Central Daylight Time		05/30/2019 12:08:15 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	354	0	2020	South Carolina		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	355	0		29	10	S5921_355_0	1	1			05/27/2019	2020.01	05/27/2019 04:34:40 PM Central Daylight Time		05/30/2019 12:08:39 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	355	0	2020	Georgia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	356	0		29	10	S5921_356_0	1	1			05/27/2019	2020.01	05/27/2019 04:35:05 PM Central Daylight Time		05/30/2019 12:09:04 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	356	0	2020	Florida		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	357	0		29	10	S5921_357_0	1	1			05/30/2019	2020.01	05/30/2019 04:06:09 PM Central Daylight Time		05/30/2019 12:09:28 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	357	0	2020	Alabama and Tennessee		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	358	0		29	10	S5921_358_0	1	1			05/27/2019	2020.01	05/27/2019 04:35:43 PM Central Daylight Time		05/30/2019 12:09:52 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	358	0	2020	Michigan		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	359	0		29	10	S5921_359_0	1	1			05/27/2019	2020.01	05/27/2019 04:35:59 PM Central Daylight Time		05/30/2019 12:10:17 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	359	0	2020	Ohio		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	360	0		29	10	S5921_360_0	1	1			05/27/2019	2020.01	05/27/2019 04:36:15 PM Central Daylight Time		05/30/2019 12:10:42 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	360	0	2020	Indiana and Kentucky		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	361	0		29	10	S5921_361_0	1	1			05/27/2019	2020.01	05/27/2019 04:36:35 PM Central Daylight Time		05/30/2019 12:11:06 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	361	0	2020	Wisconsin		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	362	0		29	10	S5921_362_0	1	1			05/27/2019	2020.01	05/27/2019 04:36:54 PM Central Daylight Time		05/30/2019 12:11:31 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	362	0	2020	Illinois		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	363	0		29	10	S5921_363_0	1	1			05/27/2019	2020.01	05/27/2019 04:37:11 PM Central Daylight Time		05/30/2019 12:11:55 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	363	0	2020	Missouri		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	364	0		29	10	S5921_364_0	1	1			05/27/2019	2020.01	05/27/2019 04:37:27 PM Central Daylight Time		05/30/2019 12:12:20 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	364	0	2020	Arkansas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	365	0		29	10	S5921_365_0	1	1			05/27/2019	2020.01	05/27/2019 04:37:42 PM Central Daylight Time		05/30/2019 12:12:44 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	365	0	2020	Mississippi		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	366	0		29	10	S5921_366_0	1	1			05/27/2019	2020.01	05/27/2019 04:38:25 PM Central Daylight Time		05/30/2019 12:13:09 AM Central Daylight Time			06/02/2019 11:42:27 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	366	0	2020	Louisiana		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	367	0		29	10	S5921_367_0	1	1			05/27/2019	2020.01	05/27/2019 04:38:54 PM Central Daylight Time		05/30/2019 12:13:33 AM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	367	0	2020	Texas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	368	0		29	10	S5921_368_0	1	1			05/27/2019	2020.01	05/27/2019 04:39:09 PM Central Daylight Time		05/30/2019 12:13:58 AM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	368	0	2020	Oklahoma		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	369	0		29	10	S5921_369_0	1	1			05/21/2019	2020.01	05/21/2019 12:33:18 PM Central Daylight Time		05/30/2019 12:14:22 AM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	369	0	2020	Kansas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	370	0		29	10	S5921_370_0	1	1			05/27/2019	2020.01	05/27/2019 04:39:23 PM Central Daylight Time		05/30/2019 12:14:47 AM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	370	0	2020	"IA, MN, MT, ND, NE, SD, WY"		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	371	0		29	10	S5921_371_0	1	1			05/27/2019	2020.01	05/27/2019 04:39:38 PM Central Daylight Time		05/31/2019 05:11:05 PM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	371	0	2020	New Mexico		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	372	0		29	10	S5921_372_0	2	1			05/27/2019	2020.01	05/27/2019 04:39:52 PM Central Daylight Time		06/24/2019 12:00:21 PM Central Daylight Time			07/23/2019 08:53:57 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	372	0	2020	Colorado		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	373	0		29	10	S5921_373_0	1	1			05/27/2019	2020.01	05/27/2019 04:40:07 PM Central Daylight Time		05/30/2019 12:16:00 AM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	373	0	2020	Nevada		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	374	0		29	10	S5921_374_0	1	1			05/27/2019	2020.01	05/27/2019 04:40:22 PM Central Daylight Time		05/30/2019 12:16:24 AM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	374	0	2020	Oregon and Washington		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	375	0		29	10	S5921_375_0	1	1			06/02/2019	2020.01	06/02/2019 12:54:02 PM Central Daylight Time		05/31/2019 05:11:36 PM Central Daylight Time			06/02/2019 01:37:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	375	0	2020	Idaho and Utah		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	376	0		29	10	S5921_376_0	1	1			05/27/2019	2020.01	05/27/2019 04:40:52 PM Central Daylight Time		05/30/2019 12:17:13 AM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	376	0	2020	California		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	377	0		29	10	S5921_377_0	1	1			05/27/2019	2020.01	05/27/2019 04:41:10 PM Central Daylight Time		05/30/2019 12:17:38 AM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	377	0	2020	Alaska		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)868-1394		(866)868-1394		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	378	0		29	10	S5921_378_0	1	1			05/27/2019	2020.01	05/27/2019 04:41:31 PM Central Daylight Time		05/30/2019 12:18:02 AM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	378	0	2020	Maine and New Hampshire		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	379	0		29	10	S5921_379_0	1	1			05/27/2019	2020.01	05/27/2019 05:36:23 PM Central Daylight Time		05/30/2019 12:18:27 AM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	379	0	2020	New York		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	380	0		29	10	S5921_380_0	2	1			05/27/2019	2020.01	05/27/2019 05:36:39 PM Central Daylight Time		07/25/2019 11:38:37 AM Central Daylight Time			07/26/2019 02:02:12 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	380	0	2020	Arizona		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)460-8854		(866)460-8854		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	381	0		29	10	S5921_381_0	1	1			05/27/2019	2020.01	05/27/2019 05:37:17 PM Central Daylight Time		05/30/2019 12:19:16 AM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	381	0	2020	Hawaii		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)774-9679		(866)774-9679		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-																
S5921	382	0		29	10	S5921_382_0	1	1			05/28/2019	2020.01	05/28/2019 06:02:30 PM Central Daylight Time		05/30/2019 12:19:40 AM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	382	0	2020	New York		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	383	0		29	10	S5921_383_0	1	1			05/27/2019	2020.01	05/27/2019 05:37:55 PM Central Daylight Time		05/30/2019 12:20:04 AM Central Daylight Time			06/02/2019 12:48:33 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	383	0	2020	Florida		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	384	0		29	10	S5921_384_0	1	1			05/27/2019	2020.01	05/27/2019 05:38:12 PM Central Daylight Time		05/30/2019 12:20:29 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	384	0	2020	Northern New England		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	385	0		29	10	S5921_385_0	1	1			05/27/2019	2020.01	05/27/2019 05:38:30 PM Central Daylight Time		05/30/2019 12:20:53 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	385	0	2020	Central New England		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	386	0		29	10	S5921_386_0	1	1			05/27/2019	2020.01	05/27/2019 04:15:26 PM Central Daylight Time		05/30/2019 12:21:17 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	386	0	2020	New Jersey		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	387	0		29	10	S5921_387_0	1	1			05/27/2019	2020.01	05/27/2019 05:38:48 PM Central Daylight Time		05/30/2019 12:21:42 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	387	0	2020	Mid-Atlantic		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	388	0		29	10	S5921_388_0	1	1			05/27/2019	2020.01	05/27/2019 05:39:33 PM Central Daylight Time		05/30/2019 12:22:06 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	388	0	2020	Pennsylvania and West Virginia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	389	0		29	10	S5921_389_0	1	1			05/27/2019	2020.01	05/27/2019 05:39:49 PM Central Daylight Time		05/30/2019 12:22:30 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	389	0	2020	Virginia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	390	0		29	10	S5921_390_0	1	1			05/27/2019	2020.01	05/27/2019 05:40:25 PM Central Daylight Time		05/30/2019 12:22:54 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	390	0	2020	North Carolina		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	391	0		29	10	S5921_391_0	1	1			05/27/2019	2020.01	05/27/2019 05:40:39 PM Central Daylight Time		05/30/2019 12:23:19 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	391	0	2020	South Carolina		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	392	0		29	10	S5921_392_0	1	1			05/27/2019	2020.01	05/27/2019 05:40:56 PM Central Daylight Time		05/30/2019 12:23:43 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	392	0	2020	Georgia		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	393	0		29	10	S5921_393_0	1	1			05/27/2019	2020.01	05/27/2019 05:41:14 PM Central Daylight Time		05/30/2019 12:24:08 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	393	0	2020	Alabama and Tennessee		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	394	0		29	10	S5921_394_0	1	1			05/27/2019	2020.01	05/27/2019 05:41:48 PM Central Daylight Time		05/30/2019 12:24:32 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	394	0	2020	Michigan		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	395	0		29	10	S5921_395_0	1	1			05/27/2019	2020.01	05/27/2019 05:42:08 PM Central Daylight Time		05/30/2019 12:24:57 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	395	0	2020	Ohio		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	396	0		29	10	S5921_396_0	1	1			05/27/2019	2020.01	05/27/2019 05:42:25 PM Central Daylight Time		05/30/2019 12:25:21 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	396	0	2020	Indiana and Kentucky		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	397	0		29	10	S5921_397_0	1	1			05/27/2019	2020.01	05/27/2019 05:42:42 PM Central Daylight Time		05/30/2019 12:25:45 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	397	0	2020	Wisconsin		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	398	0		29	10	S5921_398_0	1	1			05/27/2019	2020.01	05/27/2019 05:42:59 PM Central Daylight Time		05/30/2019 12:26:10 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	398	0	2020	Illinois		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	399	0		29	10	S5921_399_0	1	1			05/27/2019	2020.01	05/27/2019 05:43:18 PM Central Daylight Time		05/30/2019 12:26:34 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	399	0	2020	Missouri		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	400	0		29	10	S5921_400_0	1	1			05/28/2019	2020.01	05/28/2019 06:08:05 PM Central Daylight Time		05/30/2019 12:26:59 AM Central Daylight Time			06/02/2019 01:45:25 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	400	0	2020	Arkansas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	401	0		29	10	S5921_401_0	1	1			05/27/2019	2020.01	05/27/2019 05:43:52 PM Central Daylight Time		05/30/2019 12:27:24 AM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	401	0	2020	Mississippi		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	402	0		29	10	S5921_402_0	1	1			05/27/2019	2020.01	05/27/2019 05:44:07 PM Central Daylight Time		05/30/2019 12:27:48 AM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	402	0	2020	Louisiana		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	403	0		29	10	S5921_403_0	1	1			05/27/2019	2020.01	05/27/2019 05:44:23 PM Central Daylight Time		05/30/2019 12:28:13 AM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	403	0	2020	Texas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	404	0		29	10	S5921_404_0	1	1			05/27/2019	2020.01	05/27/2019 05:45:23 PM Central Daylight Time		05/30/2019 12:28:37 AM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	404	0	2020	Oklahoma		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	405	0		29	10	S5921_405_0	1	1			05/27/2019	2020.01	05/27/2019 05:45:39 PM Central Daylight Time		05/30/2019 12:29:02 AM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	405	0	2020	Kansas		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	406	0		29	10	S5921_406_0	1	1			05/27/2019	2020.01	05/27/2019 05:45:55 PM Central Daylight Time		05/30/2019 12:29:26 AM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	406	0	2020	Upper Midwest and Northern Plains		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	407	0		29	10	S5921_407_0	1	1			05/27/2019	2020.01	05/27/2019 05:46:24 PM Central Daylight Time		05/31/2019 05:12:10 PM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	407	0	2020	New Mexico		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	408	0		29	10	S5921_408_0	2	1			05/27/2019	2020.01	05/27/2019 05:46:42 PM Central Daylight Time		06/24/2019 12:00:50 PM Central Daylight Time			07/23/2019 08:53:57 AM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	408	0	2020	Colorado		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	409	0		29	10	S5921_409_0	1	1			05/27/2019	2020.01	05/27/2019 05:46:58 PM Central Daylight Time		05/30/2019 12:30:40 AM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	409	0	2020	Arizona		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	410	0		29	10	S5921_410_0	1	1			05/27/2019	2020.01	05/27/2019 05:47:16 PM Central Daylight Time		05/30/2019 12:31:04 AM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	410	0	2020	Nevada		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	411	0		29	10	S5921_411_0	1	1			05/27/2019	2020.01	05/27/2019 05:47:34 PM Central Daylight Time		05/30/2019 12:31:29 AM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	411	0	2020	Oregon and Washington		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	412	0		29	10	S5921_412_0	1	1			05/27/2019	2020.01	05/27/2019 05:47:50 PM Central Daylight Time		05/31/2019 05:12:46 PM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	412	0	2020	Idaho and Utah		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	413	0		29	10	S5921_413_0	1	1			05/27/2019	2020.01	05/27/2019 05:48:15 PM Central Daylight Time		05/30/2019 12:32:18 AM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	413	0	2020	California		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)870-3470		(866)870-3470		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	414	0		29	10	S5921_414_0	1	1			05/28/2019	2020.01	05/28/2019 06:10:17 PM Central Daylight Time		05/30/2019 12:32:42 AM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	414	0	2020	Hawaii		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)774-9679		(866)774-9679		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	415	0		29	10	S5921_415_0	1	1			05/27/2019	2020.01	05/27/2019 05:49:02 PM Central Daylight Time		05/30/2019 12:33:07 AM Central Daylight Time			06/02/2019 01:52:48 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareRx Walgreens (PDP)	10	29					S5921	415	0	2020	Alaska		2					2						www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com									(866)868-1394		(866)868-1394		(800)753-8004		(800)753-8004										(711)-		(711)-		(711)-		(711)-																
S5921	802	0		29	10	S5921_802_0	1	1			05/11/2019	2020.01	05/11/2019 07:47:24 AM Central Daylight Time					06/02/2019 05:58:50 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5921	802	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.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			05/11/2019	2020.01	05/11/2019 07:47:37 AM Central Daylight Time					06/02/2019 05:58:50 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	UnitedHealthcare	www.UHCRetiree.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5921	837	0	2020	National		1					2						www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com										(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-																
S5953	1	0		29	10	S5953_001_0	3	1			05/31/2019	2020.01	05/31/2019 03:29:32 PM Eastern Daylight Time		06/01/2019 05:17:14 PM Eastern Daylight Time			06/01/2019 05:27:22 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx20	BlueCross Rx Value (PDP)	10	29					S5953	1	0	2020	South Carolina		2					2						www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20										(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-																
S5953	2	0		29	10	S5953_002_0	3	1			05/17/2019	2020.01	05/17/2019 11:51:10 AM Eastern Daylight Time		06/01/2019 05:17:16 PM Eastern Daylight Time			06/01/2019 05:27:22 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx20	BlueCross Rx Plus (PDP)	10	29					S5953	2	0	2020	South Carolina		2					2						www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20										(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-																
S5953	801	0		29	10	S5953_801_0	1	1			05/24/2019	2020.01	05/24/2019 12:55:11 PM Eastern Daylight Time					05/31/2019 05:30:06 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx20	Group Blue Rx Plus (PDP)	10	29					S5953	801	0	2020	South Carolina		1					2						www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20										(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-																
S5953	802	0		29	10	S5953_802_0	1	1			05/24/2019	2020.01	05/24/2019 12:55:29 PM Eastern Daylight Time					05/31/2019 05:30:06 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx20	Group Blue Rx Plus (PDP)	10	29					S5953	802	0	2020	South Carolina		1					2						www.scbluesmedadvantage.com/marx20	www.scbluesmedadvantage.com/marx20										(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(711)-		(711)-		(711)-		(711)-																
S5960	167	0		29	10	S5960_167_0	3	1			06/01/2019	2020.01	06/01/2019 11:28:00 AM Eastern Daylight Time		07/10/2019 09:56:26 AM Eastern Daylight Time			07/17/2019 03:30:28 PM Eastern Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	Medicare Rx (PDP)	www.unicare.com/shop	Medicare Rx Basic (PDP)	10	29					S5960	167	0	2020	New Jersey		2					2						www.unicare.com/medicare	www.unicare.com/medicare										(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S5960	801	0		29	10	S5960_801_0	2	1			06/01/2019	2020.01	06/01/2019 11:28:04 AM Eastern Daylight Time					06/01/2019 11:28:38 AM Eastern Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	Medicare Rx (PDP)	www.unicare.com/shop	MedicareRx Rewards (PDP)	10	29					S5960	801	0	2020	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	2	1			06/01/2019	2020.01	06/01/2019 11:28:08 AM Eastern Daylight Time					06/01/2019 11:28:38 AM Eastern Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	Medicare Rx (PDP)	www.unicare.com/shop	MedicareRx Rewards (PDP)	10	29					S5960	803	0	2020	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	3	0		29	10	S5966_003_0	3	1			06/27/2019	2020.01	06/27/2019 04:19:43 PM Eastern Daylight Time		06/03/2019 06:26:37 PM Eastern Daylight Time			06/27/2019 04:24:00 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PDP	emblemhealth.com/medicare	EmblemHealth VIP Rx (PDP)	10	29					S5966	3	0	2020	New York		2					2						www.emblemhealth.com	emblemhealth.com/medicare										(800)585-5786		(800)585-5786		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-																
S5966	4	0		29	10	S5966_004_0	3	1			06/21/2019	2020.01	06/21/2019 11:30:55 AM US Eastern Daylight Time		07/18/2019 11:24:26 AM Eastern Daylight Time			07/18/2019 11:27:21 AM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PDP	emblemhealth.com/medicare	EmblemHealth VIP Rx Plus (PDP)	10	29					S5966	4	0	2020	New York		2					2						www.emblemhealth.com	emblemhealth.com/medicare										(800)585-5786		(800)585-5786		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-																
S5966	803	0		29	10	S5966_803_0	1	1			05/29/2019	2020.01	05/29/2019 04:27:04 PM US Eastern Daylight Time					06/02/2019 04:37:39 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PDP	www.emblemhealth.com	EmblemHealth National Drug Plan (PDP)	10	29					S5966	803	0	2020	United States		1					2						www.emblemhealth.com	www.emblemhealth.com										(800)585-5786		(800)585-5786		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-																
S5966	804	0		29	10	S5966_804_0	1	1			05/29/2019	2020.01	05/29/2019 05:11:16 PM US Eastern Daylight Time					06/02/2019 04:37:39 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PDP	www.emblemhealth.com	EmblemHealth National Drug Plan (PDP)	10	29					S5966	804	0	2020	United States		1					2						www.emblemhealth.com	www.emblemhealth.com										(800)585-5786		(800)585-5786		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-																
S5975	801	0		29	10	S5975_801_0	1	1			05/23/2019	2020.01	05/23/2019 01:36:43 PM Pacific Daylight Time					06/01/2019 10:24:11 PM Pacific Daylight Time	"MODA HEALTH PLAN, INC."	"Moda Health Plan, Inc."	www.modahealth.com/medicare	PERS Moda Health Rx (PDP)	10	29					S5975	801	0	2020	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	4	0		29	10	S5983_004_0	2	1			05/27/2019	2020.01	05/27/2019 12:29:59 PM Eastern Daylight Time		05/27/2019 12:10:22 PM Eastern Daylight Time			06/02/2019 03:25:39 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	4	0	2020	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	6	0		29	10	S5983_006_0	1	1			05/26/2019	2020.01	05/26/2019 08:34:09 PM Eastern Daylight Time		05/27/2019 12:10:50 PM Eastern Daylight Time			06/02/2019 03:25:39 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	6	0	2020	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	7	0		29	10	S5983_007_0	1	1			05/27/2019	2020.01	05/27/2019 03:26:25 PM Eastern Daylight Time		05/27/2019 12:11:18 PM Eastern Daylight Time			06/02/2019 03:25:39 PM Eastern Daylight Time	MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare - Saver (PDP)	10	29					S5983	7	0	2020	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	805	0		29	10	S5983_805_0	1	1			05/31/2019	2020.01	05/31/2019 02:18:12 PM Eastern Daylight Time					06/02/2019 03:25:39 PM Eastern Daylight Time	MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5983	805	0	2020	Premier Performance Closed 5 Tier - Calendar		1					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	1	0		29	10	S5993_001_0	6	1			05/29/2019	2020.01	05/29/2019 10:17:11 AM Eastern Daylight Time		07/18/2019 01:18:16 PM Eastern Daylight Time			07/18/2019 01:35:27 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com/Medicare	Horizon Medicare Blue Rx Standard (PDP)	10	29					S5993	1	0	2020	New Jersey		2					2						http://www.horizonblue.com/pdp-pharmacy-search	http://www.horizonblue.com/pdp-drug-search										(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-																
S5993	3	0		29	10	S5993_003_0	6	1			05/30/2019	2020.01	05/30/2019 12:27:55 PM Eastern Daylight Time		07/18/2019 01:17:53 PM Eastern Daylight Time			07/18/2019 01:35:27 PM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com/Medicare	Horizon Medicare Blue Rx Enhanced (PDP)	10	29					S5993	3	0	2020	New Jersey		2					2						http://www.horizonblue.com/pdp-pharmacy-search	http://www.horizonblue.com/pdp-drug-search										(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-																
S5993	801	0		29	10	S5993_801_0	1	1			05/27/2019	2020.01	05/27/2019 11:45:19 AM Eastern Daylight Time					05/27/2019 11:48:05 AM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com	Horizon Medicare Blue Group Rx (PDP)	10	29					S5993	801	0	2020	National		1					2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en/find-medicine.html										(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-																
S5993	804	0		29	10	S5993_804_0	1	1			05/22/2019	2020.01	05/22/2019 10:53:35 AM Eastern Daylight Time					05/27/2019 11:48:05 AM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com	Horizon Medicare Blue Group Rx Plus (PDP)	10	29					S5993	804	0	2020	National		1					2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en/find-medicine.html										(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-																
S5993	805	0		29	10	S5993_805_0	1	1			05/22/2019	2020.01	05/22/2019 10:53:41 AM Eastern Daylight Time					05/27/2019 11:48:05 AM Eastern Daylight Time	HORIZON INSURANCE COMPANY	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com	Horizon Medicare Blue Group Rx Value (PDP)	10	29					S5993	805	0	2020	National		1					2						https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en.html	https://www.myprime.com/v/HBCBSNJ/MEDICARE_D/NJPDPG/en/find-medicine.html										(800)391-1906		(800)391-1906		(888)765-7134		(888)765-7134										(711)-		(711)-		(711)-		(711)-																
S6506	1	0		29	10	S6506_001_0	3	1			05/31/2019	2020.01	05/31/2019 12:38:51 PM Eastern Daylight Time		06/01/2019 02:52:36 PM Central Daylight Time			06/02/2019 08:56:59 PM Central Daylight Time	"BLUE CROSS AND BLUE SHIELD ARIZONA, INC."	Blue Cross Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx Value (PDP)	10	29					S6506	1	0	2020	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	2	0		29	10	S6506_002_0	3	1			05/31/2019	2020.01	05/31/2019 12:48:38 PM Eastern Daylight Time		06/02/2019 06:16:16 PM Central Daylight Time			06/02/2019 08:56:59 PM Central Daylight Time	"BLUE CROSS AND BLUE SHIELD ARIZONA, INC."	Blue Cross Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx Enhanced (PDP)	10	29					S6506	2	0	2020	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	3	0		29	10	S6506_003_0	3	1			05/31/2019	2020.01	05/31/2019 11:35:05 AM Eastern Daylight Time		06/01/2019 02:54:16 PM Central Daylight Time			06/02/2019 08:56:59 PM Central Daylight Time	"BLUE CROSS AND BLUE SHIELD ARIZONA, INC."	Blue Cross Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx Essential (PDP)	10	29					S6506	3	0	2020	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			06/02/2019	2020.01	06/02/2019 08:34:56 PM Central Daylight Time					06/02/2019 08:56:59 PM Central Daylight Time	"BLUE CROSS AND BLUE SHIELD ARIZONA, INC."	Blue Cross Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx for Groups (PDP)	10	29					S6506	801	0	2020	Nationwide		1					2						www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com										(877)853-7693		(877)853-7693		(800)422-9990		(800)422-9990										(711)-		(711)-		(711)-		(711)-																
S6875	801	0		29	10	S6875_801_0	1	1			05/30/2019	2020.01	05/30/2019 04:01:18 PM Eastern Daylight Time					05/30/2019 04:12:50 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	2020	National		1					2						http://www.ibxmedicare.com	http://www.ibxmedicare.com	http://www.ibxmedicare.com									(888)678-7009		(888)678-7009		(888)678-7009		(888)678-7009										(711)-		(711)-		(711)-		(711)-																
S6875	802	0		29	10	S6875_802_0	1	1			05/30/2019	2020.01	05/30/2019 04:01:30 PM Eastern Daylight Time					05/30/2019 04:12:50 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	2020	National		1					2						http://www.ibxmedicare.com	http://www.ibxmedicare.com	http://www.ibxmedicare.com									(888)678-7009		(888)678-7009		(888)678-7009		(888)678-7009										(711)-		(711)-		(711)-		(711)-																
S6946	1	0		29	10	S6946_001_0	5	1			06/02/2019	2020.01	06/02/2019 02:52:45 PM Central Daylight Time		07/17/2019 02:57:27 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	1	0	2020	New Jersey		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	2	0		29	10	S6946_002_0	6	1			06/02/2019	2020.01	06/02/2019 02:55:05 PM Central Daylight Time		06/03/2019 12:50:22 PM Central Daylight Time			06/03/2019 08:39:13 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	2	0	2020	"D.C., Delaware, Maryland"		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	3	0		29	10	S6946_003_0	4	1			06/02/2019	2020.01	06/02/2019 02:56:43 PM Central Daylight Time		06/02/2019 12:19:08 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	3	0	2020	"Pennsylvania, West Virginia"		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	4	0		29	10	S6946_004_0	6	1			06/02/2019	2020.01	06/02/2019 02:58:23 PM Central Daylight Time		06/03/2019 12:50:22 PM Central Daylight Time			06/03/2019 08:39:13 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	4	0	2020	Virginia		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	5	0		29	10	S6946_005_0	6	1			06/02/2019	2020.01	06/02/2019 02:59:49 PM Central Daylight Time		06/03/2019 12:50:22 PM Central Daylight Time			06/03/2019 08:39:13 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	5	0	2020	North Carolina		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	6	0		29	10	S6946_006_0	4	1			06/02/2019	2020.01	06/02/2019 03:05:30 PM Central Daylight Time		06/02/2019 12:19:09 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	6	0	2020	South Carolina		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	7	0		29	10	S6946_007_0	4	1			06/02/2019	2020.01	06/02/2019 03:09:41 PM Central Daylight Time		06/02/2019 12:19:09 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	7	0	2020	Georgia		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	8	0		29	10	S6946_008_0	4	1			06/02/2019	2020.01	06/02/2019 03:12:03 PM Central Daylight Time		06/02/2019 12:19:09 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	8	0	2020	Florida		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	9	0		29	10	S6946_009_0	4	1			06/02/2019	2020.01	06/02/2019 03:13:00 PM Central Daylight Time		06/02/2019 12:19:09 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	9	0	2020	Alabama and Tennessee		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	10	0		29	10	S6946_010_0	4	1			06/02/2019	2020.01	06/02/2019 03:14:27 PM Central Daylight Time		06/02/2019 12:19:09 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	10	0	2020	Michigan		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	11	0		29	10	S6946_011_0	4	1			06/02/2019	2020.01	06/02/2019 03:15:58 PM Central Daylight Time		06/02/2019 12:19:09 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	11	0	2020	Ohio		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	12	0		29	10	S6946_012_0	4	1			06/02/2019	2020.01	06/02/2019 03:17:35 PM Central Daylight Time		06/02/2019 12:19:09 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	12	0	2020	Kentucky and Indiana		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	13	0		29	10	S6946_013_0	5	1			06/02/2019	2020.01	06/02/2019 03:19:32 PM Central Daylight Time		07/17/2019 02:57:27 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	13	0	2020	Wisconsin		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	14	0		29	10	S6946_014_0	6	1			06/02/2019	2020.01	06/02/2019 03:21:49 PM Central Daylight Time		06/03/2019 12:50:22 PM Central Daylight Time			06/03/2019 08:39:13 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	14	0	2020	Illinois		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	15	0		29	10	S6946_015_0	4	1			06/02/2019	2020.01	06/02/2019 03:23:41 PM Central Daylight Time		06/02/2019 12:19:10 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	15	0	2020	Missouri		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	16	0		29	10	S6946_016_0	6	1			06/02/2019	2020.01	06/02/2019 03:24:39 PM Central Daylight Time		06/03/2019 12:50:22 PM Central Daylight Time			06/03/2019 08:39:13 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	16	0	2020	Arkansas		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	17	0		29	10	S6946_017_0	6	1			06/02/2019	2020.01	06/02/2019 03:26:10 PM Central Daylight Time		06/03/2019 12:50:22 PM Central Daylight Time			06/03/2019 08:39:13 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	17	0	2020	Mississippi		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	18	0		29	10	S6946_018_0	4	1			06/02/2019	2020.01	06/02/2019 03:28:50 PM Central Daylight Time		06/02/2019 12:19:10 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	18	0	2020	Louisiana		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	19	0		29	10	S6946_019_0	6	1			06/02/2019	2020.01	06/02/2019 03:30:09 PM Central Daylight Time		06/03/2019 12:50:21 PM Central Daylight Time			06/03/2019 08:39:13 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	19	0	2020	Texas		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	20	0		29	10	S6946_020_0	4	1			06/02/2019	2020.01	06/02/2019 03:31:43 PM Central Daylight Time		06/02/2019 12:19:10 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	20	0	2020	Oklahoma		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	21	0		29	10	S6946_021_0	4	1			06/02/2019	2020.01	06/02/2019 03:33:47 PM Central Daylight Time		06/02/2019 12:19:10 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	21	0	2020	Kansas		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	22	0		29	10	S6946_022_0	4	1			06/02/2019	2020.01	06/02/2019 03:35:04 PM Central Daylight Time		06/02/2019 12:19:10 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	22	0	2020	"IA, MT, MN, NE, ND, SD, WY"		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	23	0		29	10	S6946_023_0	4	1			06/02/2019	2020.01	06/02/2019 03:37:49 PM Central Daylight Time		06/02/2019 12:19:11 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	23	0	2020	Arizona		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	24	0		29	10	S6946_024_0	6	1			06/02/2019	2020.01	06/02/2019 03:40:08 PM Central Daylight Time		06/03/2019 12:50:21 PM Central Daylight Time			06/03/2019 08:39:13 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	24	0	2020	Nevada		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	25	0		29	10	S6946_025_0	4	1			06/02/2019	2020.01	06/02/2019 03:41:10 PM Central Daylight Time		06/02/2019 12:19:07 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	25	0	2020	Oregon and Washington		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	26	0		29	10	S6946_026_0	5	1			06/02/2019	2020.01	06/02/2019 03:43:07 PM Central Daylight Time		07/17/2019 02:57:27 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	26	0	2020	Idaho and Utah		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	27	0		29	10	S6946_027_0	4	1			06/02/2019	2020.01	06/02/2019 03:45:30 PM Central Daylight Time		06/02/2019 12:19:07 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	27	0	2020	California		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	28	0		29	10	S6946_028_0	4	1			06/02/2019	2020.01	06/02/2019 03:46:49 PM Central Daylight Time		06/02/2019 12:19:07 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	28	0	2020	Hawaii		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	29	0		29	10	S6946_029_0	4	1			06/02/2019	2020.01	06/02/2019 03:48:27 PM Central Daylight Time		06/02/2019 12:19:08 PM Central Daylight Time			06/03/2019 10:34:33 AM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Value Rx (PDP)	10	29					S6946	29	0	2020	Alaska		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	30	0		29	10	S6946_030_0	4	1			06/02/2019	2020.01	06/02/2019 03:54:17 PM Central Daylight Time		07/17/2019 02:57:27 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	30	0	2020	New Jersey		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	31	0		29	10	S6946_031_0	4	1			06/02/2019	2020.01	06/02/2019 03:56:08 PM Central Daylight Time		07/17/2019 02:57:27 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	31	0	2020	"D.C., Delaware, Maryland"		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	32	0		29	10	S6946_032_0	4	1			06/02/2019	2020.01	06/02/2019 03:58:13 PM Central Daylight Time		07/17/2019 02:57:27 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	32	0	2020	"Pennsylvania, West Virginia"		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	33	0		29	10	S6946_033_0	4	1			06/02/2019	2020.01	06/02/2019 04:00:57 PM Central Daylight Time		07/17/2019 02:57:27 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	33	0	2020	Virginia		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	34	0		29	10	S6946_034_0	4	1			06/02/2019	2020.01	06/02/2019 04:01:57 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	34	0	2020	North Carolina		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	35	0		29	10	S6946_035_0	4	1			06/02/2019	2020.01	06/02/2019 04:04:17 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	35	0	2020	South Carolina		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	36	0		29	10	S6946_036_0	4	1			06/02/2019	2020.01	06/02/2019 04:06:09 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	36	0	2020	Georgia		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	37	0		29	10	S6946_037_0	5	1			06/03/2019	2020.01	06/03/2019 08:48:01 AM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	37	0	2020	Florida		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	38	0		29	10	S6946_038_0	4	1			06/02/2019	2020.01	06/02/2019 04:10:44 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	38	0	2020	Alabama and Tennessee		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	39	0		29	10	S6946_039_0	4	1			06/02/2019	2020.01	06/02/2019 04:12:01 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	39	0	2020	Michigan		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	40	0		29	10	S6946_040_0	4	1			06/02/2019	2020.01	06/02/2019 04:13:05 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	40	0	2020	Ohio		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	41	0		29	10	S6946_041_0	4	1			06/02/2019	2020.01	06/02/2019 04:22:34 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	41	0	2020	Kentucky and Indiana		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	42	0		29	10	S6946_042_0	4	1			06/02/2019	2020.01	06/02/2019 04:24:57 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	42	0	2020	Wisconsin		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	43	0		29	10	S6946_043_0	4	1			06/02/2019	2020.01	06/02/2019 04:26:52 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	43	0	2020	Illinois		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	44	0		29	10	S6946_044_0	4	1			06/02/2019	2020.01	06/02/2019 04:28:38 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	44	0	2020	Missouri		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	45	0		29	10	S6946_045_0	4	1			06/02/2019	2020.01	06/02/2019 04:29:57 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	45	0	2020	Arkansas		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	46	0		29	10	S6946_046_0	4	1			06/02/2019	2020.01	06/02/2019 04:31:11 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	46	0	2020	Mississippi		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	47	0		29	10	S6946_047_0	4	1			06/02/2019	2020.01	06/02/2019 04:32:53 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	47	0	2020	Louisiana		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	48	0		29	10	S6946_048_0	4	1			06/02/2019	2020.01	06/02/2019 04:34:45 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	48	0	2020	Texas		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	49	0		29	10	S6946_049_0	4	1			06/02/2019	2020.01	06/02/2019 04:36:34 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	49	0	2020	Oklahoma		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	50	0		29	10	S6946_050_0	4	1			06/02/2019	2020.01	06/02/2019 04:38:12 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	50	0	2020	Kansas		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	51	0		29	10	S6946_051_0	4	1			06/02/2019	2020.01	06/02/2019 04:39:56 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	51	0	2020	"IA, MT, MN, NE, ND, SD, WY"		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	52	0		29	10	S6946_052_0	4	1			06/02/2019	2020.01	06/02/2019 04:41:17 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	52	0	2020	Arizona		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	53	0		29	10	S6946_053_0	4	1			06/02/2019	2020.01	06/02/2019 04:42:47 PM Central Daylight Time		07/17/2019 02:57:28 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	53	0	2020	Nevada		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	54	0		29	10	S6946_054_0	6	1			06/02/2019	2020.01	06/02/2019 04:44:32 PM Central Daylight Time		07/17/2019 02:57:29 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	54	0	2020	Oregon and Washington		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	55	0		29	10	S6946_055_0	4	1			06/02/2019	2020.01	06/02/2019 04:46:16 PM Central Daylight Time		07/17/2019 02:57:29 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	55	0	2020	Idaho and Utah		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	56	0		29	10	S6946_056_0	6	1			06/02/2019	2020.01	06/02/2019 04:48:32 PM Central Daylight Time		07/17/2019 02:57:29 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	56	0	2020	California		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	57	0		29	10	S6946_057_0	4	1			06/02/2019	2020.01	06/02/2019 04:50:22 PM Central Daylight Time		07/17/2019 02:57:29 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	57	0	2020	Hawaii		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6946	58	0		29	10	S6946_058_0	4	1			06/02/2019	2020.01	06/02/2019 04:51:18 PM Central Daylight Time		07/17/2019 02:57:29 PM Central Daylight Time			07/17/2019 03:11:32 PM Central Daylight Time	CORVESTA LIFE INSURANCE COMPANY	Clear Spring Health	www.clearspringhealthcare.com	Clear Spring Health Premier Rx (PDP)	10	29					S6946	58	0	2020	Alaska		2					2						www.clearspringhealthcare.com	www.clearspringhealthcare.com										(833)459-4421		(833)459-4421		(877)384-1241		(877)384-1241										(711)-		(711)-		(711)-		(711)-																
S6986	1	0		29	10	S6986_001_0	2	1			06/01/2019	2020.01	06/01/2019 04:37:54 PM Central Daylight Time		06/01/2019 09:59:56 PM Central Daylight Time			06/02/2019 08:12:11 PM Central Daylight Time	"MII LIFE INSURANCE, INCORPORATED"	"MII Life Insurance, Incorporated"	www.journeyrxmedicare.com	Journey Rx Standard (PDP)	10	29					S6986	1	0	2020	Michigan		2					2						www.journeyrxmedicare.com	www.journeyrxmedicare.com										(877)690-8196		(877)690-8196		(888)575-7530		(888)575-7530										(711)-		(711)-		(711)-		(711)-																
S6986	2	0		29	10	S6986_002_0	2	1			06/01/2019	2020.01	06/01/2019 04:38:27 PM Central Daylight Time		06/01/2019 10:01:22 PM Central Daylight Time			06/02/2019 08:12:11 PM Central Daylight Time	"MII LIFE INSURANCE, INCORPORATED"	"MII Life Insurance, Incorporated"	www.basicbluerx.com	Basic Blue Rx Standard (PDP)	10	29					S6986	2	0	2020	North Carolina		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	3	0		29	10	S6986_003_0	1	1			06/01/2019	2020.01	06/01/2019 04:39:00 PM Central Daylight Time		06/01/2019 10:02:58 PM Central Daylight Time			06/02/2019 08:12:11 PM Central Daylight Time	"MII LIFE INSURANCE, INCORPORATED"	"MII Life Insurance, Incorporated"	www.basicbluerx.com	Basic Blue Rx Standard (PDP)	10	29					S6986	3	0	2020	Pennsylvania and West Virginia		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	4	0		29	10	S6986_004_0	1	1			06/01/2019	2020.01	06/01/2019 04:39:37 PM Central Daylight Time		06/01/2019 10:04:30 PM Central Daylight Time			06/02/2019 08:12:11 PM Central Daylight Time	"MII LIFE INSURANCE, INCORPORATED"	"MII Life Insurance, Incorporated"	www.basicbluerx.com	Basic Blue Rx Standard (PDP)	10	29					S6986	4	0	2020	Louisiana		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	6	0		29	10	S6986_006_0	1	1			06/01/2019	2020.01	06/01/2019 04:40:16 PM Central Daylight Time		06/01/2019 10:06:06 PM Central Daylight Time			06/02/2019 08:12:11 PM Central Daylight Time	"MII LIFE INSURANCE, INCORPORATED"	"MII Life Insurance, Incorporated"	www.journeyrxmedicare.com	Journey Rx Standard (PDP)	10	29					S6986	6	0	2020	California		2					2						www.journeyrxmedicare.com	www.journeyrxmedicare.com										(877)690-8196		(877)690-8196		(888)575-7530		(888)575-7530										(711)-		(711)-		(711)-		(711)-																
S6986	7	0		29	10	S6986_007_0	1	1			06/01/2019	2020.01	06/01/2019 04:41:11 PM Central Daylight Time		06/02/2019 10:00:16 PM Central Daylight Time			06/02/2019 10:38:21 PM Central Daylight Time	"MII LIFE INSURANCE, INCORPORATED"	"MII Life Insurance, Incorporated"	www.journeyrxmedicare.com	Journey Rx Standard (PDP)	10	29					S6986	7	0	2020	"States of IA, MN, MT, ND, NE, SD and WY"		2					2						www.journeyrxmedicare.com	www.journeyrxmedicare.com										(877)690-8196		(877)690-8196		(888)575-7530		(888)575-7530										(711)-		(711)-		(711)-		(711)-																
S6986	8	0		29	10	S6986_008_0	2	1			06/01/2019	2020.01	06/01/2019 04:42:19 PM Central Daylight Time		06/01/2019 10:09:30 PM Central Daylight Time			06/02/2019 08:12:11 PM Central Daylight Time	"MII LIFE INSURANCE, INCORPORATED"	"MII Life Insurance, Incorporated"	www.journeyrxmedicare.com	Journey Rx Value (PDP)	10	29					S6986	8	0	2020	Michigan		2					2						www.journeyrxmedicare.com	www.journeyrxmedicare.com										(877)690-8196		(877)690-8196		(888)575-7530		(888)575-7530										(711)-		(711)-		(711)-		(711)-																
S6986	10	0		29	10	S6986_010_0	1	1			06/01/2019	2020.01	06/01/2019 04:43:15 PM Central Daylight Time		06/01/2019 10:11:18 PM Central Daylight Time			06/02/2019 08:12:11 PM Central Daylight Time	"MII LIFE INSURANCE, INCORPORATED"	"MII Life Insurance, Incorporated"	www.basicbluerx.com	Basic Blue Rx Value (PDP)	10	29					S6986	10	0	2020	Pennsylvania and West Virginia		2					2						www.basicbluerx.com	www.basicbluerx.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	12	0		29	10	S6986_012_0	1	1			06/01/2019	2020.01	06/01/2019 04:44:00 PM Central Daylight Time		06/01/2019 10:13:08 PM Central Daylight Time			06/02/2019 08:12:11 PM Central Daylight Time	"MII LIFE INSURANCE, INCORPORATED"	"MII Life Insurance, Incorporated"	www.journeyrxmedicare.com	Journey Rx Value (PDP)	10	29					S6986	12	0	2020	California		2					2						www.journeyrxmedicare.com	www.journeyrxmedicare.com										(877)690-8196		(877)690-8196		(888)575-7530		(888)575-7530										(711)-		(711)-		(711)-		(711)-																
S6986	13	0		29	10	S6986_013_0	1	1			06/01/2019	2020.01	06/01/2019 04:44:37 PM Central Daylight Time		06/02/2019 10:00:17 PM Central Daylight Time			06/02/2019 10:38:21 PM Central Daylight Time	"MII LIFE INSURANCE, INCORPORATED"	"MII Life Insurance, Incorporated"	www.journeyrxmedicare.com	Journey Rx Value (PDP)	10	29					S6986	13	0	2020	"States of IA, MN, MT, ND, NE, SD and WY"		2					2						www.journeyrxmedicare.com	www.journeyrxmedicare.com										(877)690-8196		(877)690-8196		(888)575-7530		(888)575-7530										(711)-		(711)-		(711)-		(711)-																
S6986	14	0		29	10	S6986_014_0	1	1			06/01/2019	2020.01	06/01/2019 04:45:19 PM Central Daylight Time		06/01/2019 10:16:22 PM Central Daylight Time			06/02/2019 08:12:11 PM Central Daylight Time	"MII LIFE INSURANCE, INCORPORATED"	"MII Life Insurance, Incorporated"	www.journeyrxmedicare.com	Journey Rx Standard (PDP)	10	29					S6986	14	0	2020	New York		2					2						www.journeyrxmedicare.com	www.journeyrxmedicare.com										(877)376-2185		(877)376-2185		(888)575-7519		(888)575-7519										(711)-		(711)-		(711)-		(711)-																
S6986	15	0		29	10	S6986_015_0	1	1			06/01/2019	2020.01	06/01/2019 04:46:00 PM Central Daylight Time		06/01/2019 10:18:10 PM Central Daylight Time			06/02/2019 08:12:11 PM Central Daylight Time	"MII LIFE INSURANCE, INCORPORATED"	"MII Life Insurance, Incorporated"	www.journeyrxmedicare.com	Journey Rx Value (PDP)	10	29					S6986	15	0	2020	New York		2					2						www.journeyrxmedicare.com	www.journeyrxmedicare.com										(877)690-8196		(877)690-8196		(888)575-7530		(888)575-7530										(711)-		(711)-		(711)-		(711)-																
S6986	801	0		29	10	S6986_801_0	1	1			05/23/2019	2020.01	05/23/2019 01:55:49 PM Central Daylight Time					06/02/2019 08:12:11 PM Central Daylight Time	"MII LIFE INSURANCE, INCORPORATED"	"MII Life Insurance, Incorporated"	www.MIIRx.com	Group JourneyRx (PDP)	10	29					S6986	801	0	2020	"MI, NC, PA, WV, LA, CA, NY, Upper Midwest"		1					2						www.MIIRx.com	www.MIIRx.com										(877)690-8196		(877)690-8196		(888)575-7530		(888)575-7530										(711)-		(711)-		(711)-		(711)-																
S7126	1	0		29	10	S7126_001_0	1	1			05/29/2019	2020.01	05/29/2019 12:07:37 PM Eastern Daylight Time		05/31/2019 11:21:12 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	1	0	2020	Northern New England		2					2						www.mutualofomaha.com	mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	2	0		29	10	S7126_002_0	1	1			05/29/2019	2020.01	05/29/2019 12:08:01 PM Eastern Daylight Time		05/31/2019 11:21:40 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	2	0	2020	Central New England		2					2						www.mutualofomaha.com	mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	3	0		29	10	S7126_003_0	1	1			05/29/2019	2020.01	05/29/2019 12:08:53 PM Eastern Daylight Time		05/31/2019 11:22:08 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	3	0	2020	State of New Jersey		2					2						www.mutualofomaha.com	mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	4	0		29	10	S7126_004_0	1	1			05/29/2019	2020.01	05/29/2019 12:09:03 PM Eastern Daylight Time		05/31/2019 11:22:36 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	4	0	2020	Mid-Atlantic		2					2						www.mutualofomaha.com	mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	5	0		29	10	S7126_005_0	1	1			05/29/2019	2020.01	05/29/2019 12:09:19 PM Eastern Daylight Time		05/31/2019 11:23:04 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	5	0	2020	States of Pennsylvania and West Virginia		2					2						www.mutualofomaha.com	mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	6	0		29	10	S7126_006_0	1	1			05/29/2019	2020.01	05/29/2019 12:09:29 PM Eastern Daylight Time		05/31/2019 11:23:30 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	6	0	2020	State of Virginia		2					2						www.mutualofomaha.com	mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	7	0		29	10	S7126_007_0	1	1			05/29/2019	2020.01	05/29/2019 12:09:39 PM Eastern Daylight Time		05/31/2019 11:23:58 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	7	0	2020	State of North Carolina		2					2						www.mutualofomaha.com	mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	8	0		29	10	S7126_008_0	1	1			05/29/2019	2020.01	05/29/2019 12:09:52 PM Eastern Daylight Time		05/31/2019 11:24:26 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	8	0	2020	State of South Carolina		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	9	0		29	10	S7126_009_0	1	1			05/29/2019	2020.01	05/29/2019 12:10:26 PM Eastern Daylight Time		05/31/2019 11:24:54 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	9	0	2020	State of Georgia		2					2						www.mutualofomaha.com	mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	10	0		29	10	S7126_010_0	1	1			05/29/2019	2020.01	05/29/2019 12:10:38 PM Eastern Daylight Time		05/31/2019 11:25:20 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	10	0	2020	State of Florida		2					2						www.mutualofomaha.com	mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	11	0		29	10	S7126_011_0	1	1			05/29/2019	2020.01	05/29/2019 12:10:51 PM Eastern Daylight Time		05/31/2019 11:25:50 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	11	0	2020	States of Alabama and Tennessee		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	12	0		29	10	S7126_012_0	1	1			05/29/2019	2020.01	05/29/2019 12:11:01 PM Eastern Daylight Time		05/31/2019 11:26:18 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	12	0	2020	State of Michigan		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	13	0		29	10	S7126_013_0	1	1			05/29/2019	2020.01	05/29/2019 12:11:14 PM Eastern Daylight Time		05/31/2019 11:26:48 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	13	0	2020	State of Ohio		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	14	0		29	10	S7126_014_0	1	1			05/29/2019	2020.01	05/29/2019 12:11:26 PM Eastern Daylight Time		05/31/2019 11:27:16 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	14	0	2020	States of Indiana and Kentucky		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	15	0		29	10	S7126_015_0	1	1			05/29/2019	2020.01	05/29/2019 12:11:37 PM Eastern Daylight Time		05/31/2019 11:27:44 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	15	0	2020	State of Wisconsin		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	16	0		29	10	S7126_016_0	1	1			05/29/2019	2020.01	05/29/2019 12:11:50 PM Eastern Daylight Time		05/31/2019 11:28:12 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	16	0	2020	State of Illinois		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	17	0		29	10	S7126_017_0	1	1			05/29/2019	2020.01	05/29/2019 12:12:00 PM Eastern Daylight Time		05/31/2019 11:28:38 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	17	0	2020	State of Missouri		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	18	0		29	10	S7126_018_0	1	1			05/29/2019	2020.01	05/29/2019 12:12:09 PM Eastern Daylight Time		05/31/2019 11:29:06 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	18	0	2020	State of Arkansas		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	19	0		29	10	S7126_019_0	1	1			05/29/2019	2020.01	05/29/2019 12:12:21 PM Eastern Daylight Time		05/31/2019 11:29:34 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	19	0	2020	State of Mississippi		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	20	0		29	10	S7126_020_0	1	1			05/29/2019	2020.01	05/29/2019 12:12:32 PM Eastern Daylight Time		05/31/2019 11:30:00 AM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	20	0	2020	State of Louisiana		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	21	0		29	10	S7126_021_0	1	1			05/29/2019	2020.01	05/29/2019 12:12:46 PM Eastern Daylight Time		05/31/2019 12:00:18 PM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	21	0	2020	State of Texas		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	22	0		29	10	S7126_022_0	1	1			05/29/2019	2020.01	05/29/2019 12:12:57 PM Eastern Daylight Time		05/31/2019 12:00:46 PM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	22	0	2020	State of Oklahoma		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	23	0		29	10	S7126_023_0	1	1			05/29/2019	2020.01	05/29/2019 12:13:08 PM Eastern Daylight Time		05/31/2019 12:01:12 PM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	23	0	2020	State of Kansas		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	24	0		29	10	S7126_024_0	1	1			05/29/2019	2020.01	05/29/2019 12:13:17 PM Eastern Daylight Time		05/31/2019 12:01:40 PM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	24	0	2020	Upper Midwest and Northern Plains		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	25	0		29	10	S7126_025_0	1	1			05/29/2019	2020.01	05/29/2019 12:13:28 PM Eastern Daylight Time		05/31/2019 12:02:08 PM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	25	0	2020	State of New Mexico		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	26	0		29	10	S7126_026_0	1	1			05/29/2019	2020.01	05/29/2019 12:13:37 PM Eastern Daylight Time		05/31/2019 12:02:34 PM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	26	0	2020	State of Colorado		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	27	0		29	10	S7126_027_0	1	1			05/29/2019	2020.01	05/29/2019 12:13:48 PM Eastern Daylight Time		05/31/2019 12:03:00 PM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	27	0	2020	State of Arizona		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	28	0		29	10	S7126_028_0	1	1			05/29/2019	2020.01	05/29/2019 12:13:57 PM Eastern Daylight Time		05/31/2019 12:03:28 PM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	28	0	2020	State of Nevada		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	29	0		29	10	S7126_029_0	1	1			05/29/2019	2020.01	05/29/2019 12:14:09 PM Eastern Daylight Time		05/31/2019 12:03:56 PM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	29	0	2020	States of Oregon and Washington		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	30	0		29	10	S7126_030_0	1	1			05/29/2019	2020.01	05/29/2019 12:14:20 PM Eastern Daylight Time		05/31/2019 12:04:22 PM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	30	0	2020	States of Idaho and Utah		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	31	0		29	10	S7126_031_0	1	1			05/29/2019	2020.01	05/29/2019 12:14:30 PM Eastern Daylight Time		05/31/2019 12:04:50 PM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	31	0	2020	State of California		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	32	0		29	10	S7126_032_0	1	1			05/29/2019	2020.01	05/29/2019 12:14:40 PM Eastern Daylight Time		05/31/2019 12:05:18 PM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	32	0	2020	State of Hawaii		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	33	0		29	10	S7126_033_0	1	1			05/29/2019	2020.01	05/29/2019 12:14:49 PM Eastern Daylight Time		05/31/2019 12:03:46 PM Eastern Daylight Time			06/02/2019 03:28:59 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Plus (PDP)	10	29					S7126	33	0	2020	State of Alaska		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	34	0		29	10	S7126_034_0	3	1			06/01/2019	2020.01	06/01/2019 10:01:37 AM Eastern Daylight Time		07/01/2019 03:15:09 PM Eastern Daylight Time			07/01/2019 03:17:51 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	34	0	2020	Northern New England		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	35	0		29	10	S7126_035_0	2	1			06/01/2019	2020.01	06/01/2019 10:05:44 AM Eastern Daylight Time		06/15/2019 03:25:14 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	35	0	2020	Central New England		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	36	0		29	10	S7126_036_0	2	1			06/01/2019	2020.01	06/01/2019 10:11:23 AM Eastern Daylight Time		06/15/2019 03:25:40 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	36	0	2020	State of New Jersey		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	37	0		29	10	S7126_037_0	2	1			06/01/2019	2020.01	06/01/2019 10:15:37 AM Eastern Daylight Time		06/15/2019 03:26:08 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	37	0	2020	Mid-Atlantic		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	38	0		29	10	S7126_038_0	2	1			06/01/2019	2020.01	06/01/2019 10:18:08 AM Eastern Daylight Time		06/15/2019 03:26:34 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	38	0	2020	States of Pennsylvania and West Virginia		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	39	0		29	10	S7126_039_0	2	1			06/01/2019	2020.01	06/01/2019 10:20:07 AM Eastern Daylight Time		06/15/2019 03:27:00 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	39	0	2020	State of Virginia		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	40	0		29	10	S7126_040_0	2	1			06/01/2019	2020.01	06/01/2019 10:21:03 AM Eastern Daylight Time		06/15/2019 03:27:28 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	40	0	2020	State of North Carolina		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	41	0		29	10	S7126_041_0	2	1			06/01/2019	2020.01	06/01/2019 10:22:06 AM Eastern Daylight Time		06/15/2019 03:27:54 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	41	0	2020	State of South Carolina		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	42	0		29	10	S7126_042_0	2	1			06/01/2019	2020.01	06/01/2019 10:23:07 AM Eastern Daylight Time		06/15/2019 03:28:22 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	42	0	2020	State of Georgia		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	43	0		29	10	S7126_043_0	2	1			06/01/2019	2020.01	06/01/2019 10:24:09 AM Eastern Daylight Time		06/15/2019 03:28:48 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	43	0	2020	State of Florida		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	44	0		29	10	S7126_044_0	2	1			06/01/2019	2020.01	06/01/2019 10:25:04 AM Eastern Daylight Time		06/15/2019 03:30:44 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	44	0	2020	States of Alabama and Tennessee		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	45	0		29	10	S7126_045_0	2	1			06/01/2019	2020.01	06/01/2019 10:26:00 AM Eastern Daylight Time		06/15/2019 03:31:10 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	45	0	2020	State of Michigan		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	46	0		29	10	S7126_046_0	2	1			06/01/2019	2020.01	06/01/2019 10:26:56 AM Eastern Daylight Time		06/15/2019 03:31:36 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	46	0	2020	State of Ohio		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	47	0		29	10	S7126_047_0	2	1			06/01/2019	2020.01	06/01/2019 10:28:35 AM Eastern Daylight Time		06/15/2019 03:32:02 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	47	0	2020	States of Indiana and Kentucky		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	48	0		29	10	S7126_048_0	2	1			06/01/2019	2020.01	06/01/2019 10:29:32 AM Eastern Daylight Time		06/15/2019 03:32:30 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	48	0	2020	State of Wisconsin		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	49	0		29	10	S7126_049_0	2	1			06/01/2019	2020.01	06/01/2019 10:30:38 AM Eastern Daylight Time		06/15/2019 03:32:56 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	49	0	2020	State of Illinois		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	50	0		29	10	S7126_050_0	2	1			06/01/2019	2020.01	06/01/2019 10:31:34 AM Eastern Daylight Time		06/15/2019 03:33:22 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	50	0	2020	State of Missouri		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	51	0		29	10	S7126_051_0	2	1			06/01/2019	2020.01	06/01/2019 10:32:24 AM Eastern Daylight Time		06/15/2019 03:33:48 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	51	0	2020	State of Arkansas		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	52	0		29	10	S7126_052_0	2	1			06/01/2019	2020.01	06/01/2019 10:33:20 AM Eastern Daylight Time		06/15/2019 03:34:14 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	52	0	2020	State of Mississippi		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	53	0		29	10	S7126_053_0	3	1			06/01/2019	2020.01	06/01/2019 10:34:13 AM Eastern Daylight Time		06/15/2019 03:34:40 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	53	0	2020	State of Louisiana		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	54	0		29	10	S7126_054_0	2	1			06/01/2019	2020.01	06/01/2019 10:35:01 AM Eastern Daylight Time		06/15/2019 03:35:08 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	54	0	2020	State of Texas		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	55	0		29	10	S7126_055_0	3	1			06/01/2019	2020.01	06/01/2019 10:35:58 AM Eastern Daylight Time		07/01/2019 03:15:41 PM Eastern Daylight Time			07/01/2019 03:17:51 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	55	0	2020	State of Oklahoma		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	56	0		29	10	S7126_056_0	2	1			06/01/2019	2020.01	06/01/2019 10:36:48 AM Eastern Daylight Time		06/15/2019 03:36:00 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	56	0	2020	State of Kansas		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	57	0		29	10	S7126_057_0	2	1			06/01/2019	2020.01	06/01/2019 10:37:49 AM Eastern Daylight Time		06/15/2019 03:36:26 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	57	0	2020	Upper Midwest and Northern Plains		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	58	0		29	10	S7126_058_0	2	1			06/01/2019	2020.01	06/01/2019 10:38:41 AM Eastern Daylight Time		06/15/2019 03:37:08 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	58	0	2020	State of New Mexico		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	59	0		29	10	S7126_059_0	2	1			06/01/2019	2020.01	06/01/2019 10:39:30 AM Eastern Daylight Time		06/15/2019 03:38:36 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	59	0	2020	State of Colorado		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	60	0		29	10	S7126_060_0	2	1			06/01/2019	2020.01	06/01/2019 10:40:19 AM Eastern Daylight Time		06/15/2019 03:39:04 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	60	0	2020	State of Arizona		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	61	0		29	10	S7126_061_0	2	1			06/01/2019	2020.01	06/01/2019 10:41:13 AM Eastern Daylight Time		06/15/2019 03:39:32 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	61	0	2020	State of Nevada		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	62	0		29	10	S7126_062_0	2	1			06/01/2019	2020.01	06/01/2019 10:42:04 AM Eastern Daylight Time		06/15/2019 03:39:58 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	62	0	2020	States of Oregon and Washington		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	63	0		29	10	S7126_063_0	2	1			06/01/2019	2020.01	06/01/2019 10:42:55 AM Eastern Daylight Time		06/15/2019 03:40:26 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	63	0	2020	States of Idaho and Utah		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	64	0		29	10	S7126_064_0	2	1			06/01/2019	2020.01	06/01/2019 10:43:42 AM Eastern Daylight Time		06/15/2019 03:40:54 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	64	0	2020	State of California		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	65	0		29	10	S7126_065_0	2	1			06/01/2019	2020.01	06/01/2019 10:44:31 AM Eastern Daylight Time		06/15/2019 03:41:20 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	65	0	2020	State of Hawaii		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7126	66	0		29	10	S7126_066_0	2	1			06/01/2019	2020.01	06/01/2019 10:45:25 AM Eastern Daylight Time		06/15/2019 03:41:46 PM Eastern Daylight Time			07/01/2019 01:49:23 PM Eastern Daylight Time	OMAHA HEALTH INSURANCE COMPANY	Mutual of Omaha Rx	mutualofomaharx.com	Mutual of Omaha Rx Value (PDP)	10	29					S7126	66	0	2020	State of Alaska		2					2						www.mutualofomaha.com	www.mutualofomaharx.com										(855)864-6797		(855)864-6797		(800)961-9006		(800)961-9006										(800)716-3231		(800)716-3231		(800)584-6939		(800)584-6939																
S7694	1	0		29	10	S7694_001_0	3	1			06/27/2019	2020.01	06/27/2019 12:26:28 PM Eastern Daylight Time		05/31/2019 05:02:16 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	1	0	2020	"Northern New England Region 01 - ME, NH"		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	2	0		29	10	S7694_002_0	3	1			05/28/2019	2020.01	05/28/2019 03:58:21 PM Eastern Daylight Time		05/31/2019 05:02:16 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	2	0	2020	Central N England Region 02 - CT/MA/RI/VT		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	3	0		29	10	S7694_003_0	3	1			05/29/2019	2020.01	05/29/2019 08:15:56 AM Eastern Daylight Time		05/31/2019 05:02:16 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxSecure (PDP)	10	29					S7694	3	0	2020	New York EnvisionRxSecure Region 03		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	4	0		29	10	S7694_004_0	3	1			05/29/2019	2020.01	05/29/2019 08:18:45 AM Eastern Daylight Time		05/31/2019 05:02:16 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	4	0	2020	New Jersey EnvisionRxPlus Region 04		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	5	0		29	10	S7694_005_0	3	1			05/29/2019	2020.01	05/29/2019 08:21:47 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxSecure (PDP)	10	29					S7694	5	0	2020	Mid-Atlantic EnvisionRxSecure Region 05 - DE/DC/MD		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	6	0		29	10	S7694_006_0	3	1			05/28/2019	2020.01	05/28/2019 04:04:59 PM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	6	0	2020	"Pennsylvania, WV EnvisionRxPlus Region 06"		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	7	0		29	10	S7694_007_0	3	1			05/28/2019	2020.01	05/28/2019 04:09:00 PM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	7	0	2020	Virginia EnvisionRxPlus Region 07		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	8	0		29	10	S7694_008_0	3	1			05/28/2019	2020.01	05/28/2019 04:14:31 PM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	8	0	2020	North Carolina EnvisionRxPlus Region 08		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	9	0		29	10	S7694_009_0	3	1			05/29/2019	2020.01	05/29/2019 08:23:36 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxSecure (PDP)	10	29					S7694	9	0	2020	South Carolina EnvisionRxSecure Region 09		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	10	0		29	10	S7694_010_0	3	1			05/28/2019	2020.01	05/28/2019 04:18:16 PM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	10	0	2020	Georgia EnvisionRxPlus Region 10		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	11	0		29	10	S7694_011_0	3	1			05/29/2019	2020.01	05/29/2019 08:27:22 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	11	0	2020	Florida EnvisionRxPlus Region 11		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	12	0		29	10	S7694_012_0	3	1			05/28/2019	2020.01	05/28/2019 04:21:02 PM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	12	0	2020	"Alabama,Tennessee EnvisionRxPlus Region 12"		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	14	0		29	10	S7694_014_0	3	1			05/28/2019	2020.01	05/28/2019 04:23:39 PM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	14	0	2020	Ohio EnvisionRxPlus Region 14		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	15	0		29	10	S7694_015_0	3	1			05/28/2019	2020.01	05/28/2019 04:26:24 PM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	15	0	2020	"Indiana, Kentucky EnvisionRxPlus Region 15"		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	16	0		29	10	S7694_016_0	3	1			05/29/2019	2020.01	05/29/2019 08:28:52 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	16	0	2020	Wisconsin EnvisionRxPlus Region 16		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	17	0		29	10	S7694_017_0	3	1			05/29/2019	2020.01	05/29/2019 09:15:37 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	17	0	2020	Illinois EnvisionRxPlus Region 17		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	18	0		29	10	S7694_018_0	3	1			05/29/2019	2020.01	05/29/2019 09:17:25 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	18	0	2020	Missouri EnvisionRxPlus Region 18		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	19	0		29	10	S7694_019_0	3	1			05/29/2019	2020.01	05/29/2019 09:38:30 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	19	0	2020	Arkansas EnvisionRxPlus Region 19		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	20	0		29	10	S7694_020_0	3	1			05/28/2019	2020.01	05/28/2019 04:31:22 PM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	20	0	2020	Mississippi EnvisionRxPlus Region 20		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	21	0		29	10	S7694_021_0	3	1			05/29/2019	2020.01	05/29/2019 09:40:21 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	21	0	2020	Louisiana EnvisionRxPlus Region 21		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	22	0		29	10	S7694_022_0	3	1			05/28/2019	2020.01	05/28/2019 04:35:06 PM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	22	0	2020	Texas EnvisionRxPlus Region 22		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	23	0		29	10	S7694_023_0	3	1			05/29/2019	2020.01	05/29/2019 09:42:04 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	23	0	2020	Oklahoma EnvisionRxPlus Region 23		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	24	0		29	10	S7694_024_0	3	1			05/29/2019	2020.01	05/29/2019 09:43:38 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	24	0	2020	Kansas EnvisionRxPlus Region 24		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	25	0		29	10	S7694_025_0	3	1			05/29/2019	2020.01	05/29/2019 09:45:09 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	25	0	2020	Midwest/Plains EnvisionRxPlus IA/MN/MT/NE/ND/SD/WY		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	26	0		29	10	S7694_026_0	3	1			05/29/2019	2020.01	05/29/2019 11:04:35 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	26	0	2020	New Mexico EnvisionRxPlus Region 26		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	27	0		29	10	S7694_027_0	3	1			05/29/2019	2020.01	05/29/2019 11:05:57 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	27	0	2020	Colorado EnvisionRxPlus Region 27		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	28	0		29	10	S7694_028_0	3	1			05/29/2019	2020.01	05/29/2019 11:07:27 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	28	0	2020	Arizona EnvisionRxPlus Region 28		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	29	0		29	10	S7694_029_0	3	1			05/29/2019	2020.01	05/29/2019 11:09:07 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	29	0	2020	Nevada EnvisionRxPlus Region 29		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	30	0		29	10	S7694_030_0	3	1			05/29/2019	2020.01	05/29/2019 11:09:47 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	30	0	2020	"Oregon, Washington EnvisionRxPlus Region 30"		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	31	0		29	10	S7694_031_0	3	1			05/29/2019	2020.01	05/29/2019 11:13:12 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	31	0	2020	"Idaho, Utah EnvisionRxPlus Region 31"		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	32	0		29	10	S7694_032_0	3	1			05/28/2019	2020.01	05/28/2019 04:52:11 PM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	32	0	2020	California EnvisionRxPlus Region 32		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	33	0		29	10	S7694_033_0	3	1			05/29/2019	2020.01	05/29/2019 11:14:35 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	33	0	2020	Hawaii EnvisionRxPlus Region 33		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	34	0		29	10	S7694_034_0	3	1			05/29/2019	2020.01	05/29/2019 11:16:04 AM Eastern Daylight Time		05/31/2019 05:02:17 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	34	0	2020	Alaska EnvisionRxPlus Region 34		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	70	0		29	10	S7694_070_0	3	1			05/28/2019	2020.01	05/28/2019 04:54:38 PM Eastern Daylight Time		05/31/2019 05:02:18 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus (PDP)	10	29					S7694	70	0	2020	Michigan EnvisionRxPlus Region 13		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	105	0		29	10	S7694_105_0	3	1			05/29/2019	2020.01	05/29/2019 11:17:32 AM Eastern Daylight Time		05/31/2019 05:02:18 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus (PDP)	10	29					S7694	105	0	2020	Puerto Rico EnvisionRxPlus Region 38		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	106	0		29	10	S7694_106_0	3	1			05/29/2019	2020.01	05/29/2019 11:19:00 AM Eastern Daylight Time		05/31/2019 05:02:18 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus (PDP)	10	29					S7694	106	0	2020	Guam EnvisionRxPlus Region 36		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#	envision.promptpa.com									(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	121	0		29	10	S7694_121_0	3	1			06/06/2019	2020.01	06/06/2019 12:57:24 PM Eastern Daylight Time		05/31/2019 05:02:18 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus (PDP)	10	29					S7694	121	0	2020	New York EnvisionRxPlus Region 3		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	122	0		29	10	S7694_122_0	3	1			05/28/2019	2020.01	05/28/2019 02:08:07 PM Eastern Daylight Time		05/31/2019 05:02:18 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus (PDP)	10	29					S7694	122	0	2020	Mid-Atlantic EnvisionRxPlus Regon - 05 DE/DC/MD		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	123	0		29	10	S7694_123_0	3	1			05/28/2019	2020.01	05/28/2019 02:12:20 PM Eastern Daylight Time		05/31/2019 05:02:18 PM Eastern Daylight Time			06/27/2019 12:33:32 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus (PDP)	10	29					S7694	123	0	2020	South Carolina EnvisionRxPlus Region 09		2					2						envisionrxplus.com/en/pharmacy.aspx	envisionrxplus.com/en/pdl.aspx#										(866)250-2005		(866)250-2005		(888)377-1439		(888)377-1439										(711)-		(711)-		(711)-		(711)-																
S7694	801	0		29	10	S7694_801_0	1	1			05/21/2019	2020.01	05/21/2019 10:52:04 AM Eastern Daylight Time					05/30/2019 12:36:52 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	Employer Plan Calendar Year (PDP)	10	29					S7694	801	0	2020	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	EnvisionRxPlus.com	envision.promptpa.com									(844)293-4760		(844)293-4760		(844)293-4760		(844)293-4760										(711)-		(711)-		(711)-		(711)-																
S7694	802	0		29	10	S7694_802_0	1	1			05/21/2019	2020.01	05/21/2019 10:52:12 AM Eastern Daylight Time					05/30/2019 12:36:52 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	Employer Group Non-Calendar Year (PDP)	10	29					S7694	802	0	2020	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	EnvisionRxPlus.com	envision.promptpa.com									(844)293-4760		(844)293-4760		(844)293-4760		(844)293-4760										(711)-		(711)-		(711)-		(711)-																
S7694	803	0		29	10	S7694_803_0	1	1			05/21/2019	2020.01	05/21/2019 10:52:19 AM Eastern Daylight Time					05/30/2019 12:36:52 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	retireerxcare.amwins.com	Retiree RxCare 4TC (PDP)	10	29					S7694	803	0	2020	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	retireerxcare.amwins.com/	envision.promptpa.com									(855)693-3921		(855)693-3921		(855)693-3921		(855)693-3921										(711)-		(711)-		(711)-		(711)-																
S7694	804	0		29	10	S7694_804_0	1	1			05/21/2019	2020.01	05/21/2019 10:52:27 AM Eastern Daylight Time					05/30/2019 12:36:52 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	retireerxcare.amwins.com	Retiree RxCare 5TC (PDP)	10	29					S7694	804	0	2020	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	retireerxcare.amwins.com	envision.promptpa.com									(855)693-3921		(855)693-3921		(855)693-3921		(855)693-3921										(711)-		(711)-		(711)-		(711)-																
S7694	805	0		29	10	S7694_805_0	1	1			05/21/2019	2020.01	05/21/2019 10:52:38 AM Eastern Daylight Time					05/30/2019 12:36:52 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	retireerxcare.amwins.com	Retiree RxCare 4TO (PDP)	10	29					S7694	805	0	2020	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	retireerxcare.amwins.com	envision.promptpa.com									(855)693-3921		(855)693-3921		(855)693-3921		(855)693-3921										(711)-		(711)-		(711)-		(711)-																
S7694	806	0		29	10	S7694_806_0	1	1			05/21/2019	2020.01	05/21/2019 10:52:49 AM Eastern Daylight Time					05/30/2019 12:36:52 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	retireerxcare.amwins.com	Retiree RxCare 5TO (PDP)	10	29					S7694	806	0	2020	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	retireerxcare.amwins.com	envision.promptpa.com									(855)693-3921		(855)693-3921		(855)693-3921		(855)693-3921										(711)-		(711)-		(711)-		(711)-																
S7694	807	0		29	10	S7694_807_0	1	1			05/21/2019	2020.01	05/21/2019 10:52:56 AM Eastern Daylight Time					05/30/2019 12:36:52 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	retireerxcare.amwins.com	Retiree RxCare Bronze (PDP)	10	29					S7694	807	0	2020	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	retireerxcare.amwins.com	envision.promptpa.com									(855)693-3921		(855)693-3921		(855)693-3921		(855)693-3921										(711)-		(711)-		(711)-		(711)-																
S7694	808	0		29	10	S7694_808_0	1	1			05/21/2019	2020.01	05/21/2019 10:53:03 AM Eastern Daylight Time					05/30/2019 12:36:52 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	Employer Group Broad (PDP)	10	29					S7694	808	0	2020	National EGWP		1					2						envisionrxplus.com/en/pharmacy.aspx	EnvisionRxPlus.com	envision.promptpa.com									(844)293-4760		(844)293-4760		(844)293-4760		(844)293-4760										(711)-		(711)-		(711)-		(711)-																
S8067	1	0		29	10	S8067_001_0	1	1			06/02/2019	2020.01	06/02/2019 04:13:36 PM Eastern Daylight Time		06/01/2019 08:48:22 PM Eastern Daylight Time			06/02/2019 05:45:11 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - Option 3 (PDP)	10	29					S8067	1	0	2020	"Region 6 - Pennsylvania, West Virginia"		2					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	3	0		29	10	S8067_003_0	1	1			06/02/2019	2020.01	06/02/2019 04:14:18 PM Eastern Daylight Time		06/01/2019 08:49:10 PM Eastern Daylight Time			06/02/2019 05:45:11 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx - Option 1 (PDP)	10	29					S8067	3	0	2020	Region 06 - Pennsylvania and West Virginia		2					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	801	0		29	10	S8067_801_0	1	1			06/02/2019	2020.01	06/02/2019 03:52:42 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Silver Rx (PDP)	10	29					S8067	801	0	2020	National		1					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	802	0		29	10	S8067_802_0	1	1			06/02/2019	2020.01	06/02/2019 03:52:50 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Bronze Rx FY (PDP)	10	29					S8067	802	0	2020	National		1					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	803	0		29	10	S8067_803_0	1	1			06/01/2019	2020.01	06/01/2019 07:21:32 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Gold Rx (PDP)	10	29					S8067	803	0	2020	National		1					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	804	0		29	10	S8067_804_0	1	1			06/01/2019	2020.01	06/01/2019 07:20:58 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Bronze Rx (PDP)	10	29					S8067	804	0	2020	National		1					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	805	0		29	10	S8067_805_0	1	1			06/02/2019	2020.01	06/02/2019 03:53:16 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Platinum Rx (PDP)	10	29					S8067	805	0	2020	National		1					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	806	0		29	10	S8067_806_0	1	1			06/01/2019	2020.01	06/01/2019 07:20:40 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Platinum Rx FY (PDP)	10	29					S8067	806	0	2020	National		1					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	807	0		29	10	S8067_807_0	1	1			06/01/2019	2020.01	06/01/2019 07:20:31 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Gold Rx FY (PDP)	10	29					S8067	807	0	2020	National		1					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8067	808	0		29	10	S8067_808_0	1	1			06/01/2019	2020.01	06/01/2019 07:20:24 PM Eastern Daylight Time					06/02/2019 05:45:11 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.avalonsecurerxpdp.com	SecureRx Group PDP Silver Rx FY (PDP)	10	29					S8067	808	0	2020	National		1					2						www.avalonsecurerxpdp.com	www.avalonsecurerxpdp.com										(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(711)-		(711)-		(711)-		(711)-																
S8182	1	0		29	10	S8182_001_0	4	1			06/14/2019	2020.01	06/14/2019 11:14:33 AM Eastern Daylight Time		07/10/2019 09:57:38 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerivantage Rx (PDP)	https://shop.anthem.com/medicare	Amerivantage Rx Basic (PDP)	10	29					S8182	1	0	2020	Texas		2					2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S8182	2	0		29	10	S8182_002_0	4	1			05/26/2019	2020.01	05/26/2019 09:11:13 PM Eastern Daylight Time		07/10/2019 09:58:47 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerivantage Rx (PDP)	https://shop.anthem.com/medicare	Amerivantage Rx Enhanced (PDP)	10	29					S8182	2	0	2020	Texas		2					2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S8182	3	0		29	10	S8182_003_0	4	1			06/14/2019	2020.01	06/14/2019 11:17:49 AM Eastern Daylight Time		07/10/2019 09:59:57 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerivantage Rx (PDP)	https://shop.anthem.com/medicare	Amerivantage Rx Basic (PDP)	10	29					S8182	3	0	2020	Arizona		2					2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S8182	4	0		29	10	S8182_004_0	4	1			05/26/2019	2020.01	05/26/2019 08:07:14 PM Eastern Daylight Time		07/10/2019 10:01:08 AM Eastern Daylight Time			07/17/2019 06:06:00 PM Eastern Daylight Time	AMERIGROUP INSURANCE COMPANY	Amerivantage Rx (PDP)	https://shop.anthem.com/medicare	Amerivantage Rx Enhanced (PDP)	10	29					S8182	4	0	2020	Arizona		2					2						https://shop.amerigroup.com/medicare	https://shop.amerigroup.com/medicare										(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-																
S8677	803	0		29	10	S8677_803_0	2	1			05/20/2019	2020.01	05/20/2019 10:47:55 AM Pacific Daylight Time					05/31/2019 08:05:08 PM Pacific Daylight Time	PROVIDENCE HEALTH ASSURANCE	Providence Health Assurance	www.providencehealthassurance.com	Providence Medicare Part D Group Plan (PDP)	10	29					S8677	803	0	2020	National		1					2						www.providencehealthassurance.com	www.providencehealthassurance.com										(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551										(711)-		(711)-		(711)-		(711)-																
S8841	803	0		29	10	S8841_803_0	1	1			06/03/2019	2020.01	06/03/2019 10:35:49 AM Eastern Daylight Time					06/03/2019 10:41:04 AM Eastern Daylight Time	"OPTUM INSURANCE OF OHIO, INC."	"Optum Insurance of Ohio, Inc."	www.optum.com	2020 EGWP 4-Tier Silver Plan - CY (PDP)	10	29					S8841	803	0	2020	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	804	0		29	10	S8841_804_0	1	1			06/03/2019	2020.01	06/03/2019 10:36:06 AM Eastern Daylight Time					06/03/2019 10:41:04 AM Eastern Daylight Time	"OPTUM INSURANCE OF OHIO, INC."	"Optum Insurance of Ohio, Inc."	www.optum.com	2020 EGWP 4-Tier Silver Plan - NCY (PDP)	10	29					S8841	804	0	2020	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	807	0		29	10	S8841_807_0	1	1			06/03/2019	2020.01	06/03/2019 10:36:50 AM Eastern Daylight Time					06/03/2019 10:41:04 AM Eastern Daylight Time	"OPTUM INSURANCE OF OHIO, INC."	"Optum Insurance of Ohio, Inc."	www.optum.com	2020 EGWP 5-Tier Bronze Plan - CY (PDP)	10	29					S8841	807	0	2020	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	808	0		29	10	S8841_808_0	1	1			06/03/2019	2020.01	06/03/2019 10:37:29 AM Eastern Daylight Time					06/03/2019 10:41:04 AM Eastern Daylight Time	"OPTUM INSURANCE OF OHIO, INC."	"Optum Insurance of Ohio, Inc."	www.optum.com	2020 EGWP 5-Tier Bronze Plan - NCY (PDP)	10	29					S8841	808	0	2020	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	810	0		29	10	S8841_810_0	1	1			06/03/2019	2020.01	06/03/2019 10:37:51 AM Eastern Daylight Time					06/03/2019 10:41:04 AM Eastern Daylight Time	"OPTUM INSURANCE OF OHIO, INC."	"Optum Insurance of Ohio, Inc."	www.optum.com	2020 MPSERS EGWP Plan (PDP)	10	29					S8841	810	0	2020	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(855)577-6517		(855)577-6517		(855)577-6517		(855)577-6517										(711)-		(711)-		(711)-		(711)-																
S8841	812	0		29	10	S8841_812_0	1	1			06/03/2019	2020.01	06/03/2019 10:38:01 AM Eastern Daylight Time					06/03/2019 10:41:04 AM Eastern Daylight Time	"OPTUM INSURANCE OF OHIO, INC."	"Optum Insurance of Ohio, Inc."	www.optum.com	2020 EGWP 5-Tier Gold Plan - CY (PDP)	10	29					S8841	812	0	2020	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	813	0		29	10	S8841_813_0	1	1			06/03/2019	2020.01	06/03/2019 10:38:12 AM Eastern Daylight Time					06/03/2019 10:41:04 AM Eastern Daylight Time	"OPTUM INSURANCE OF OHIO, INC."	"Optum Insurance of Ohio, Inc."	www.optum.com	2020 EGWP 5-Tier Gold Plan - NCY (PDP)	10	29					S8841	813	0	2020	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	814	0		29	10	S8841_814_0	1	1			06/03/2019	2020.01	06/03/2019 10:38:21 AM Eastern Daylight Time					06/03/2019 10:41:04 AM Eastern Daylight Time	"OPTUM INSURANCE OF OHIO, INC."	"Optum Insurance of Ohio, Inc."	www.optum.com	2020 EGWP PDP plan - CY (PDP)	10	29					S8841	814	0	2020	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S8841	815	0		29	10	S8841_815_0	1	1			06/03/2019	2020.01	06/03/2019 10:38:45 AM Eastern Daylight Time					06/03/2019 10:41:04 AM Eastern Daylight Time	"OPTUM INSURANCE OF OHIO, INC."	"Optum Insurance of Ohio, Inc."	www.optum.com	2020 EGWP PDP plan - NCY (PDP)	10	29					S8841	815	0	2020	National		1					2						www.optumrx.com/myCatamaranRx	www.optumrx.com/myCatamaranRx										(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-																
S9701	801	0		29	10	S9701_801_0	1	1			05/09/2019	2020.01	05/09/2019 11:08:55 AM Central Daylight Time					05/31/2019 09:40:44 AM Central Daylight Time	"DEAN HEALTH INSURANCE, INC."	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	801	0	2020	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	1	1			05/09/2019	2020.01	05/09/2019 11:09:35 AM Central Daylight Time					05/31/2019 09:40:44 AM Central Daylight Time	"DEAN HEALTH INSURANCE, INC."	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	802	0	2020	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	1	1			05/09/2019	2020.01	05/09/2019 11:09:54 AM Central Daylight Time					05/31/2019 09:40:44 AM Central Daylight Time	"DEAN HEALTH INSURANCE, INC."	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	803	0	2020	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	1	1			05/09/2019	2020.01	05/09/2019 11:10:06 AM Central Daylight Time					05/31/2019 09:40:44 AM Central Daylight Time	"DEAN HEALTH INSURANCE, INC."	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	804	0	2020	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	807	0		29	10	S9701_807_0	1	1			05/09/2019	2020.01	05/09/2019 11:10:20 AM Central Daylight Time					05/31/2019 09:40:44 AM Central Daylight Time	"DEAN HEALTH INSURANCE, INC."	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	807	0	2020	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)-																
