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0210601~DTP*290*RD8*20210401-20210430~DTP*290*RD8*20210301-20210331~LS*2120~NM1*
PR*2*HEALTHKEEPERS, INC.~N3*1330 Amerigroup Way~N4*Virginia Beach*VA*23464~LE*21
20~EB*R***HM~REF*18*H2802~REF*N6*030~DTP*290*RD8*20210501-20210531~LS*2120~NM1*P
R*2*UNITEDHEALTHCARE OF THE MIDLANDS, INC.~N3*10175 Little Patuxent Parkway~N4*C
olumbia*MD*21044~LE*2120~EB*R***HM~REF*18*H1608~DTP*290*RD8*20210201-20210228~DT
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COMPANY~N3*1405 Xenium Lane North*Suite 140~N4*Plymouth*MN*55441~LE*2120~EB*R***
HM~REF*18*H2802~REF*N6*031~DTP*290*RD8*20210101-20210131~DTP*290*RD8*20201101-20
201130~LS*2120~NM1*PR*2*UNITEDHEALTHCARE OF THE MIDLANDS, INC.~N3*10175 Little P
atuxent Parkway~N4*Columbia*MD*21044~LE*2120~EB*R***HM~REF*18*H4623~REF*N6*001~D
TP*290*RD8*20201201-20201231~LS*2120~NM1*PR*2*HUMANA REGIONAL HEALTH PLAN, INC.~
N3*515 West Market Street~N4*Louisville*KY*40202~LE*2120~EB*R***HM~REF*18*H9886~
REF*N6*004~DTP*290*RD8*20201001-20201031~LS*2120~NM1*PR*2*HMO MISSOURI, INC.~N3*
1330 Amerigroup Way~N4*Virginia Beach*VA*23464~LE*2120~EB*R***HM~REF*18*H2663~RE
F*N6*023~DTP*290*RD8*20200801-20200831~LS*2120~NM1*PR*2*COVENTRY HEALTH CARE OF
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B*R***HM~REF*18*H2649~REF*N6*059~DTP*290*RD8*20200701-20200731~LS*2120~NM1*PR*2*
HUMANA HEALTH PLAN, INC.~N3*515 West Market Street~N4*Louisville*KY*40202~LE*212
0~EB*R***OT~REF*18*H5141~REF*N6*004~DTP*290*D8*20210601~LS*2120~NM1*PR*2*CLOVER
INSURANCE COMPANY~N3*22 4th Street, 5th Floor~N4*San Francisco*CA*94103~LE*2120~
EB*R***OT~REF*18*H5141~REF*N6*007~DTP*290*RD8*20210501-20210531~LS*2120~NM1*PR*2
*CLOVER INSURANCE COMPANY~N3*22 4th Street, 5th Floor~N4*San Francisco*CA*94103~
LE*2120~EB*R***OT~REF*18*S5884~REF*N6*150~DTP*290*RD8*20210401-20210430~DTP*290*
RD8*20210301-20210331~DTP*290*RD8*20210101-20210131~LS*2120~NM1*PR*2*HUMANA INSU
RANCE COMPANY~N3*515 West Market Street~N4*Louisville*KY*40202~LE*2120~EB*R***OT
~REF*18*H3152~REF*N6*077~DTP*290*RD8*20210201-20210228~LS*2120~NM1*PR*2*AETNA HE
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EB*R***OT~REF*18*H3154~REF*N6*004~DTP*290*RD8*20201201-20201231~LS*2120~NM1*PR*2
*HORIZON INSURANCE COMPANY~N3*2900 Ames Crossing Rd~N4*Eagan*MN*55121~LE*2120~EB
*R***OT~REF*18*S5820~DTP*290*RD8*20201101-20201130~DTP*290*RD8*20200701-20200731
~LS*2120~NM1*PR*2*UNITEDHEALTHCARE INSURANCE COMPANY~N3*10175 Little Patuxent Pa
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CE COMPANY~N3*515 West Market Street~N4*Louisville*KY*40202~LE*2120~EB*R***OT~RE
F*18*H3107~REF*N6*004~DTP*290*RD8*20200901-20200930~LS*2120~NM1*PR*2*OXFORD HEAL
TH PLANS (NJ), INC.~N3*10175 Little Patuxent Parkway~N4*Columbia*MD*21044~LE*212
0~HL*4**20*1~NM1*PR*2******PI*CMS~HL*5*4*21*1~NM1*P5*2******PI*000048861~HL*6*5*
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2120~NM1*PR*2*BUCKEYE COMMUNITY HEALTH PLAN, INC.~N3*5520 Idlewild Avenue~N4*Tam
pa*FL*33634~LE*2120~EB*R***HM~REF*18*H0022~REF*N6*001~DTP*290*RD8*20210101-20210
531~LS*2120~NM1*PR*2*BUCKEYE COMMUNITY HEALTH PLAN, INC.~N3*5520 Idlewild Avenue
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1-20201231~DTP*290*RD8*20190601-20191231~LS*2120~NM1*PR*2*MOLINA HEALTHCARE OF O
HIO, INC.~N3*200 Oceangate*Suite 100~N4*Long Beach*CA*90802~LE*2120~EB*R***HM~RE
F*18*H5216~DTP*290*RD8*20200101-20200531~DTP*290*RD8*20190101-20190531~LS*2120~N
M1*PR*2*HUMANA INSURANCE COMPANY~N3*515 West Market Street~N4*Louisville*KY*4020
2~LE*2120~EB*R***HM~REF*18*H6622~REF*N6*012~DTP*290*RD8*20181001-20181231~LS*212
0~NM1*PR*2*HUMANA WI HEALTH ORGANIZATION INSURANCE CORP~N3*515 West Market Stree
t~N4*Louisville*KY*40202~LE*2120~EB*R***HM~REF*18*H4461~REF*N6*031~DTP*290*RD8*2
0180601-20180930~LS*2120~NM1*PR*2*CARITEN HEALTH PLAN INC.~N3*515 West Market St
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TP*290*RD8*20190701-20191231~LS*2120~NM1*PR*2*GATEWAY HEALTH PLAN, INC.~N3*Four
Gateway Center*444 Liberty Avenue, Suite 2100~N4*Pittsburgh*PA*15222~LE*2120~EB*
R***OT~REF*18*H6859~REF*N6*001~DTP*290*RD8*20210401-20210630~LS*2120~NM1*PR*2*HU
MANA MEDICAL PLAN OF PENNSYLVANIA, INC.~N3*515 West Market Street~N4*Louisville*
KY*40202~LE*2120~EB*R***OT~REF*18*H6859~REF*N6*007~DTP*290*RD8*20210101-20210331
~LS*2120~NM1*PR*2*HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.~N3*515 West Market S
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D8*20200701-20201231~LS*2120~NM1*PR*2*HUMANA INSURANCE COMPANY~N3*515 West Marke
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~LS*2120~NM1*PR*2*HUMANA INSURANCE COMPANY~N3*515 West Market Street~LE*2120~EB*
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1-20190331~LS*2120~NM1*PR*2*HUMANA INSURANCE COMPANY~N3*515 West Market Street~N
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0401-20190630~LS*2120~NM1*PR*2*HUMANA INSURANCE COMPANY~N3*515 West Market Stree
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0180701-20181231~LS*2120~NM1*PR*2*UPMC HEALTH PLAN, INC.~N3*USX Tower, 5th Floor
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TH AND LIFE INSURANCE COMPANY~N3*3721 TecPort Drive*PO Box 67103~N4*Harrisburg*P
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OT/MSHP MEDICAL AND LIFE INSURANCE PLAN~N3*1061 Peruque Crossing Ct.~N4*O'Fallon
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*HM~REF*18*H0150~REF*N6*007~DTP*290*D8*20210501~LS*2120~NM1*PR*2*HEALTHSPRING LI
FE & HEALTH INSURANCE COMPANY~N3*3601 O'Donnell Street~N4*Baltimore*MD*21224~LE*
2120~EB*R***OT~REF*18*S5660~REF*N6*801~DTP*290*D8*20210101~LS*2120~NM1*PR*2*MEDC
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ETNA HEALTH, INC. (PA)~N3*1405 Xenium Lane North*Suite 140~N4*Plymouth Meeting*M
N*55441~LE*2120~EB*R***OT~REF*18*S0043~REF*N6*003~DTP*290*RD8*20200601-20201231~
LS*2120~NM1*PR*2*PREFERRED MEDICARE CHOICE, INC.~N3*PO BOX 71114~N4*San Juan*PR*
009368014~LE*2120~HL*22**20*1~NM1*PR*2******PI*CMS~HL*23*22*21*1~NM1*P5*2******P
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*INSTIL HEALTH INSURANCE COMPANY~N3*P. O. Box 100294*Mail Code AG-A07~N4*Columbi
a*SC*29202~LE*2120~HL*28**20*1~NM1*PR*2******PI*CMS~HL*29*28*21*1~NM1*P5*2******
PI*000048861~HL*30*29*22*0~TRN*1*212230000000010*9000048861~NM1*IL*1*FEZZIW*J***
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**OT~REF*18*S6506~REF*N6*003~DTP*290*RD8*20210101-20210630~LS*2120~NM1*PR*2*BLUE
 CROSS AND BLUE SHIELD ARIZONA, INC.~N3*10181 Scripps Gateway Ct~N4*San Diego*CA
*92131~LE*2120~HL*31**20*1~NM1*PR*2******PI*CMS~HL*32*31*21*1~NM1*P5*2******PI*0
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19340415*M~EB*1***MA~DTP*356*D8*19990501~EB*1***MB~DTP*356*D8*19990501~EB*R***HM
~REF*18*H0301~REF*N6*003~DTP*290*D8*20210601~LS*2120~NM1*PR*2*CIGNA HEALTHCARE O
F ARIZONA, INC.~LE*2120~EB*R***HM~REF*18*H0318~REF*N6*001~DTP*290*RD8*20210101-2
0210531~DTP*290*RD8*20200601-20201231~LS*2120~NM1*PR*2*AETNA HEALTH, INC. (PA)~N
3*1405 Xenium Lane North*Suite 140~N4*Plymouth Meeting*MN*55441~LE*2120~EB*R***H
M~REF*18*H0301~DTP*290*RD8*20200101-20200531~LS*2120~NM1*PR*2*CIGNA HEALTHCARE O
F ARIZONA, INC.~LE*2120~EB*R***OT~REF*18*S0764~REF*N6*003~DTP*290*D8*20210601~LS
*2120~NM1*PR*2*MAGELLAN LIFE INSURANCE COMPANY, INC.~LE*2120~EB*R***OT~REF*18*S0
128~REF*N6*001~DTP*290*RD8*20210101-20210531~DTP*290*RD8*20200601-20201231~LS*21
20~NM1*PR*2*HEALTHMARKETS INSURANCE COMPANY~N3*500 West Main Street~N4*Louisvill
e*KY*40202~LE*2120~EB*R***OT~REF*18*S0764~DTP*290*RD8*20200101-20200531~LS*2120~
NM1*PR*2*MAGELLAN LIFE INSURANCE COMPANY, INC.~LE*2120~SE*728*0001~GE*1*0001~IEA
*1*000000001~