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8/1/2014 L82 C69 J58 H19 J53 M60 N82 621 1 of 57 Street City State Zip Plus 4 Phone (CBSA) RX WEST (UHP) UNIVERSITY HEALTH PLAN INC *AETNA IN...
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8/1/2014

L82

C69 J58 H19 J53 M60 N82

621

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Plus 4 Phone

(CBSA) RX WEST (UHP) UNIVERSITY HEALTH PLAN INC *AETNA INSUR CO *BENECORP N/A *BENEFIT PLAN ADM./USI *BLUE CROSS BLUE SHIELD *SANICARD *SUBURBAN HEALTH PLAN 1199 NATL.BEN. FUND 6TH 21ST.CENTURY HLTH. BEN. 65 SECURITY PLAN A M LIFE INS CO A1 LIFE INSURANCE CO AAA LIFE INS CO OF DC AARP HEALTH CARE OPTIONS ABA ADMINISTRATORS ABA/PGT EMPLOYEE MED TRUS ABC INSURANCE ACADEMY LIFE INS CO ACCREDITED HOSP & LIFE ACEC LIFE HEALTH TRUST ACME CHASTON ACORDIA ACORDIA BENEFIT SERVICES ACORDIA/ANTHEM LIFE INS ACS CONSULTING ACTIVA BENEFIT SERVICES ACTUARIAL AND EMP. BEN. ADMAR MEDICAL NETWORK ADMINISTRATION & CONSLT. ADMINISTRATIVE CONCEPTS ADMINISTRATIVE SERV. PLAN ADMINISTRATIVE SOLUTIONS ADMINITRON INC.

P.O. BOX 4517 P.O. BOX 3004 CONNECTICUT GENERAL BLDG P.O. BOX 629 P.O. BOX 776 GENERIC CODE VIA VIRIANA 8 P.O. BOX 336 330 WEST 42ND. STREET 1760 MARKET ST. 14TH FL. 13 ASTOR PLACE WAKEFIELD MA 102 MAIDEN LANE 1750 PENNA AVE NW P.O. BOX 740819 C/O VIKING ADM P.O.BOX 8270 P.O. BOX 63059 1 VALLEY FORGE PLAZA 2360 HAMPTON AVE P.O. BOX 44109 LAKE RD PO BOX 419 BOX 3262/2801 P.O. BOX 528 PO BOX 2568 8025 N POINT BL STE 215E 2905 LUCERNE DRIVE 3481 CENTRAL PKWY.STE.100 P.O. BOX 478 P.O. BOX 4925 994 OLD EAGLE SCHOOL RD P.O. BOX 1263 P.O. BOX 2547 P.O. BOX 5095

ENGLEWOOD FARMINGTON HARTFORD AVON MELVILLE GENERIC ADDRESS MILANO ITALY 20124 DERBY NEW YORK PHILADELPHIA NEW YORK WAKEFIELD NEW YORK WASHINGTON ATLANTA KNOXVILLE MANCHESTER BALTIMORE VALLEYFORGE ST.LOUIS LAS VEGAS DAYVILLE CHARLESTON COLUMBUS JACKSONVILLE WINSTON SALEM GRAND RAPIDS CINCINNATI SANTA ANA LANCASTER WAYNE CROMWELL NORCROSS BRENTWOOD

CO MO CT CT NY CT CT CT NY PA NY MA NY DC GA IA CT MD PA MO NV CT WV OH FL NC MI OH CA PA PA CT GA TN

80112 53640 06152 06001 11747 99999 99999 06418 10036 19103 10003 01880 10005 20006 30374 50306 06040 21263 19482 53139 89116 06241 25332 43216 32203 27106 49546 45223 92702 17604 19087 06416 30091 37024

4517

ADP BENEFIT SERVICE

P.O. BOX 2998

ALPHARETTA

GA

30023

ADV.PARDIGM/CAREMARK ADVANCE PCS ADVANCED AUTO HLTH CARE ADVANCERX.COM ADVANTAGE HEALTH SOLUTIONS

P.O. BOX 686004 P.O. BOX 830070 P.O. BOX 145804 P.O. BOX 961066 P.O. BOX 50407

SAN ANTONIO BIRMINGHAM CINCINNATI FORT WORTH INDIANAPOLIS

TX AL OH TX IN

78268 35283 45250 76161 46250

ADVANTAGE PLAN/PHCS

P.O. BOX 503846

INDIANAPOLIS

IN

46250

ADVO MAIL ORDER HOUSE

239 WEST SERV RD

HARTFORD

CT

00000

Code Name M59 L64 007 864 C99 816 D19 879 K08 H52 825 071 001 002 813 M15 982 G45 003 004 I96 620 E67 945 B51 B25 L35 F86 D52 G39 N28 C68 H74 G29

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

8884792000 8005846847 8606780700 9999999999

2037344466 8005757771 8005339323 2126735120 6172456000

0819 0270

8005235800 8007823604 2036495344 8006212993 2153371400 8888137099

3262 4115 2568

3396

5095

8006248605 6144818391 8008885256 9197592013 6165885340 5138727505 7149539600 8002359562 8009647096 2036329582 8004516245 8007357340 8005226621

0070 0066

8009292524 8882916372 8774624671 8889637248 3175736228 8005538933

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Code Name 005 006 008 010 009 M61 L32 848 L69 622 L06 K06 K03 F32 A83 011 012 J87 588 M62 H23 G71 A10

014 L80 016 015 536 017 C32 E35 B88 018 019 044 N54 G33 C33 C97 M13 J23 L37

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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AETNA CAS & SURETY CO AETNA CAS&SUR CO OF IL AETNA LIFE & CASUALTY AETNA LIFE INSCO OF IL AETNA LIFE INSUR CO AETNA LONG TERM CARE AETNA PHARM. MGT. (AETNA RX) AETNA SELECT CHOICE SO NE AF&L INSURANCE CO AFFILIATED INS CO AFFINITY HEALTH PLAN AFFORDABLE HEALTH CARE AFFORDABLE HLTH SOLUTIONS AFLAC AFTRA HEALTH FUND AGRICULTURAL INS CO AGWAY INSUR CO AIG AIG LIFE INSURANCE CO AIG LONG TERM CARE AIR INC/FONTAINE TRUCKING ALBERT WOHLERS & CO. ADM.

151 FARMINGTON AVE 151 FARMINGTON AVE P. O. BOX 981109 151 FARMINGTON AVE 151 FARMINGTON AVE 151 FARMINGTON AVE 300 US HWY S STE 500 P.O.BOX 1111 1800 STREET RD 136 BANK ST P.O. BOX 811 65 ENTERPRISE DR. 5469 KEARNEY VILLE RD P.O. BOX 15087 260 MADISON AVE 215 WASHINGTON ST 5794 WIDEWATER PKWY P.O. BOX 5716 PO BX 1581 11000 PRAIRIE LAKES DRIVE P.O. BOX 660787 1440 N.W. HIGHWAY

HARTFORD HARTFORD EL PASO HARTFORD HARTFORD HARTFORD MINNEAPOLIS MIDDLETOWN WARRINGTON NEW LONDON NEW YORK ALISO VIEJO SAN DIEGO ALBANY NEW YORK WATERTOWN DEWITT NY HOPKINS NEPTUNE EDEN PRAIRIE BIRMINGHAM PARK RIDGE

CT CT TX CT CT CT MN CT PA CT NY CA CA NY NY NY NY MN NJ MN AL IL

06156 06156 79998 06156 06156 06156 55426 06457 18976 06320 10028 92656 92123 12212 10010 13602 13214 55343 07754 55344 35266 60068

ALDEN ASSOCIATES N/A

1525 HAMILTON AVE

WATERBURY

CT

06706

2037543333

ALEXANDER HMLT LIFE IN ALICARE ALL AMER LIFE&CAS CO ALL AMERICAN ASSUR CO ALLAMERICA FINANCIAL ALLEGHENY NATL LIFE IN ALLIANCE/AFFORDABLE HLTH ALLIANZ LIFE ALLIED BENEFIT SYSTEM ALLSTATE INS CO ALLSTATE LIFE INS CO ALLSTATE WORKPLACE ALLSTATE WORKPLACE DIVISION ALT PROS ALTA/RX ALTERNATIVE BEN.INC. ALTERNATIVE INSURANCE RESOURCES ALTIUS ALTUS DENTAL INSURANCE CO

33045 HAMILTON BLVD 730 BROADWAY 8501 W HIGGINS RD 2407 N TRYON ST 440 LINCOLN ST BOX1018 1 VALLEY FORGE PLAZA 4001 MCEWEN/STE 200 PO BOX 23907 222 S RIVERSIDE PLAZA ALLSTATE PLAZA SOUTH ALLSTATE PLAZA SOUTH 1776 AMER.HERITAGE LF. DR P.O. BOX 853916 P.O. BOX 542020 P.O. BOX 30081 2601 FLOWERS RD. P.O. BOX 660787 10421 S. JORDAN GATEWAY P.O. BOX 1557

FARMINGTON NEW YORK CHICAGO CHARLOTTE WORCESTER VALLEY FORGE DALLAS COLUMBIA CHICAGO NORTHBROOK NORTHBROOK JACKSONVILLE RICHARDSON OMAHA SALT LAKE CITY ATLANTA BIRMINGHAM SOUTH JORDAN PROVIDENCE

MI NY IL NC MA PA TX SC IL IL IL FL TX NE UT GA AL UT RI

48024 10003 60631 28206 01653 19482 75244 29224 60690 60062 60062 32224 75085 68130 84130 30341 35266 84093 02901

3135532000 8008885554 3123996625

8609525000

3705 1113

5087

5716

9525166257 8887928742 8002235097 2159180515 8662475678 8006415669 8669542273 8003663436 2124994800 3154777061 8007109876 8002213480 9525166257 8004514318 8005039228

8004236011

3907

6688

0081 0787 1557

8007331110 8007886557 3129068080 8474025000 8009377039 4023347288 8007223784 4044510376 2058713229 8003774161 8772230588

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Code Name D51 F39 H28 G76 020 021 N67 623 022 023 024 025 026 028 029 624 030 031 033 034 032 035 037 038 039 040 041 043 045 042 046 047 048 049 050 051 B34 052 053 054 055 056

ALUMAX EXTRUSIONS INC. ALVIN &CO.MEDICAL/DENTAL AMA INS AMAL.SVC/ALLIED IND. FUND AMALGAMATED LABOR LIFE AMALGAMATED LIFE INS AMALGAMATED NATIONAL HEALTH FUND AMALGAMATED WELFARE/TRUST AMER ACCIDT&HLTH INS AMER AMICABLE LIFE IN AMER ANNUITY LIFE INS AMER AUTOMOBILE INS CO AMER BANKERS INS CO AMER CENTENNIAL INS CO AMER COMMTY MUTUAL INS AMER CYANAMID BEN DEPT AMER DEFENDER LIFE INS AMER EMPLOYERS INS CO AMER FAMILY MUTUAL INS AMER FIDELITY ASSUR CO AMER FMLY LIFE ASSURCO AMER GENERAL LIFE INS AMER GNRL LIFE INS CO AMER GNRL LIFE INS CO AMER GNRL LIFE INS CO AMER GUARANTEE&LIABLTY AMER GUARANTY LIFE INS AMER HLTH&LIFE INS CO AMER HOME ASSURANCE CO AMER HRDWARE MUTUAL IN AMER INCOME LIFE INS AMER INS CO AMER INS CO OF TEXAS AMER INTGRTY INS CO AMER INTNL ASSUR ASSOC AMER LIFE ACCID INS CO AMER LIFE ASSURANCE CORP AMER LIFE CASUALTY INS AMER LIFE INS CO AMER MANUFTRS MUTUAL AMER MEDICAL LIFE INS. AMER MOTORISTS INS CO

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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1650 ALUMAX CIRCLEIND PK 1335 BLUE HILLS AVENUE 200 N. LASALLE ST. 275 7TH AVE. 15TH FL 7380 N LINCOLN AVE 730 BROADWAY 18 WASHINGTON PLACE 3RD FL PO BOX 470 501 FIFTH AVE AMICABLE LIFE BLDG 660 CASCADE W PARKWAY SE 110 WILLIAM ST 209 N EIGHT ST 1415 FOULK RD. STE.100 409 PLYMOUTH RD PO BOX 509 900 WADE AVE 1 BEACON ST 3099 E WASHINGTON AVE 2000 CLASSEN BLVD 1932 WYNTON RD 2727 ALLEN PARKWAY P.O. BOX 305293 2727 ALLEN PARKWAY 2727 ALLEN PARKWAY 4850 STREET RD 1433 SW SIXTH ST PO BOX 2548 102 MAIDEN LANE 5995 OPUS PARKWAY 1200 WOODED ACRES 110 WILLIAM ST PO BOX 2090 2 PENN CENTER PLAZA 102 MAIDEN LANE 100 N UNIVERSITY DR 7 CLAYTON ST 237 N FIFTH ST 102 MAIDEN LANE RT 2 P.O. BOX 546 RT 2

PLANT CITY BLOOMFIELD CHICAGO NEW YORK LINCOLNWOOD NEW YORK NEWARK WESTPORT NEW YORK WACO GRAND RAPIDS NEW YORK WACO WILMINGTON PLYMOUTH WAYNE RALEIGH BOSTON MADISON OKLAHOMA CITY COLUMBUS HOUSTON NASHVILLE HOUSTON HOUSTON TEVOSE PORTLAND FORT WORTH NEW YORK MINNETONKAS WACO NEW YORK DALLAS PHILADELPHIA NEW YORK FORT WORTH MONTGOMERY FARGO NEW YORK LONG GROVE HICKSVILLE LONG GROVE

FL CT IL NY IL NY NJ CT NY TX MI NY TX DE MI NJ NC MA WI OK GA TX TN TX TX PA OR TX NY MN TX NY TX PA NY TX AL ND NY IL NY IL

33567 06002 60601 10001 60646 10003 07102 06880 10017 76703 49506 10038 76703 19803 48170 07474 27605 01940 53701 73125 31906 77019 37250 77019 77019 19047 97201 76113 10005 55343 76710 10038 75221 19102 10005 76107 36104 58102 10005 60049 11802 60049

Plus 4 Phone

9798 6708

8137524117 8602438991 8004585736 2122068900 3126743000 8003334456 2122421387 8008825556

3024792100 0509 8003435660 8003740008 8005658802 8009923522 8008882452 7138312400 7138312400

2548

8004337090 6129351400

4089

2058321850

0546

5168228700

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Code Name 057 058 059 061 626 062 063 064 065 066 067 068 815 069 070 282 C17 E37 M04 I04 K55 M63 D08 I55 G19 027 861 E10 G56 H58 L96 D72 M14 D39 B52 A41 C39 I25 F95 E70 A50 B53

AMER MUTUAL LIABITY IN AMER MUTUAL LIFE INS AMER NATIONAL INS CO AMER POLICYHOLDER'S IN AMER POSTAL WORKERS UNION AMER PROGRSSVE HLTH IN AMER REPBL INSCO NATL AMER RESERVE LIFE INS AMER SECURITY INS CO AMER SECURITY LIFE INS AMER STAR INS CO AMER STATE INS CO AMER SUN LIFE INS AMER UNITED LIFE INS AMER VARBLE ANNTY LIFE AMER. EXPRS FIN. ADVISORS AMER.BAPTIST CHURCH OF NY AMERAPLAN INC. AMERI HEALTH AMERIBEN SOLUTIONS AMERICA HEALTHCARE AMERICA TPA AMERICAN ADM. GROUP AMERICAN ADMIN. GRP AMERICAN BENEFITS MGMT. AMERICAN CASUALTY CO AMERICAN CHAMBERS LIFE IN AMERICAN FAMILY LIFE AMERICAN HEALTH AMERICAN HEALTHCARE GRP AMERICAN HERITAGE LIFE INS. AMERICAN HLTH.ALTERNATIVE AMERICAN INCOME LIFE INS. CO AMERICAN INTERNATIONAL GP AMERICAN MEDICAL SECUR. AMERICAN PHOENIX CORP. AMERICAN PIONEER LIFE INS AMERICAN PROGRESSIVE HLTH AMERICAN RADIO ASS.WELF. AMERICAN REF./CRUCIBLE CO AMERICAN SELF-CARE CORP AMERICAN SPEC. CLAIMS

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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QUANNAPOWITT PKWY. LIBERTY BLDG P.O.BOX 1790 WAKEFIELD MA PO BOX 1350 6 INTERNATIONAL DR. #190 PO BOX 1 163 ASYLUM ST 3290 NORTHSIDE PKWY NY ONE MOODY PLAZA 350 SANSOME ST 500 N MERIDIAN ST 602 COURTLAND ST 1 W 26TH 3815 MONTROSE BLVD 70100 AXP FINANCIAL CTR 475 RIVERSIDE DR. 22580 METRO. PKWY STE.100 1900 MARKET STREET P.O. BOX 7186 2217 PLAZA DR P.O. BOX 398220 P.O. BOX 30087 P.O. BOX 268906 P.O. BOX 667 CNA PLAZA P.O.BOX 3048 P.O. BOX 15087 P.O. BOX 41574 P.O. BOX 1500 (DANA CORP) P.O. BOX 853916 P.O. BOX 41707 P.O. BOX 2608 1105 N MARKET ST P.O. BOX19032 10 STATE HOUSE SQ 3RD.FL. P.O. BOX 130. P.O. BOX 130 C/O N.AMER.HLTH. BOX 9501 345 WASHINGTON AVE. 800 ROOSEVELT RD STE 200 P.O. BOX 2228

WAKEFIELD DES MOINES GALVESTON WAKEFIELD GLEN BURNIE RYE BROOK DES MOINES HARTFORD ATLANTA GALVESTON SAN FRANCISCO INDIANAPOLIS ORLANDO INDIANAPOLIS HOUSTON MINNEAPOLIS NEW YORK CLINTON TOWNSHIP PHILADELPHIA BOISE ROCKLIN MINNEAPOLIS RENO OKLAHOMA CITY CHAGRIN FALLS CHICAGO NAPERVILLE ALBANY PHILADELPHIA MAUMEE RICHARDSON PHILADELPHIA WACO WILMINGTON GREEN BAY HARTFORD PENSACOLA PENSACOLA AMHERST NORTH HAVEN GLENN ELLIN DOILSTOWN

MA IA TX MA MD NY IA CT GA TX CA IN FL IN TX MN NY MI PA ID CA MN NV OK OH IL IL NY PA OH TX PA TX DE WI CT FL FL NY CT IL PA

01880 50307 77553 01880 21060 10573 50334 06102 30327 77553 94106 46207 32854 46206 77006 55474 10115 48035 19103 83707 95765 55439 89520 73126 44022 60685 60566 12205 19101 43537 75085 19101 76797 19899 54307 06103 32591 32591 14226 06473 60137 18901

Plus 4 Phone 6172456000 8008996803 8002222798 9149348300 8002472190

8008996803

3056473111

8906

1574 3916

9032 0130 9501

8004370602 2128707345 8002214254 8002752583 8007867930 8008728276 8009489450 8003153440 8886192332 8004564002 8008663808 8003363436 8008779829 4198911212 8009377039 6103582242 2547616400 3026550404 4144311111 2032781320 8009992224 8003323377 8008286922 2036970808 8003238092 8006480648

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Code Name H98 625 A07 L21 G02 M64 I38 A54 G80 084 B03 D28 791

792 M54 K02 M23 M49 E69 MBC M48 M47 M50 G81 M57 N62 277 N76 N68 A69 I86 072 826 E50 F25 921 K56 F60 953 627 628 M24

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AMERICAN SPEC. RISK MGMT. AMERICAN THREAD AMERICAN TRAVELERS AMERICAN WORKER AMERICAN'S CHOICE HLTH AMERICA'S CHOICE HEALTH PLAN AMERICORPS AMERIHEALTH (ICHP) AMERISCRIPT AMERITAS LIFE INS. AMERITAS LIFE INSURANCE AMEX LIFE ASSURANCE

509 SOUTH LENOLA RD BLG 2 HIGH RIDGE PARK 3220 TILLMAN DRIVE P.O. BOX 8006 P.O. BOX 60432 P.O. BOX 55690 P.O. BOX 33757 720 BLAIR MILL RD. P.O. BOX 2410 GP. CLMS/P.O.BOX 82520 5900 O STREET 1650 LOS GAMOS DRIVE

MOORESTOWN STAMFORD BENSALEM DUBLIN KING OF PRUSSIA KING PRUSSIA INDIANAPOLIS HORSHAM STOW LINCOLN LINCOLN SAN RAFAEL

NJ CT PA OH PA PA IN PA OH NE NE CA

08057 06069 19020 43016 19406 19406 46203 19044 44224 68501 68510 94903

ANCHOR FASTENERS

130 HUNTINGDON AVE

WATERBURY

CT

06708

2035741800

ANSONIA COPPER & BRASS ANTHEM ANTHEM B/C & B/S ANTHEM BC BS OF NEVADA ANTHEM BC CA FEDERAL EMP. ANTHEM BC/BS ANTHEM BC/BS MED BLUE CT ANTHEM BCBS OH FEDERAL EMP. ANTHEM BCBS CT FEDERAL EMP. ANTHEM BCBS VA FEDERAL EMP ANTHEM BENEFIT ADMIN ANTHEM BLUE CARE ANTHEM BLUE CROSS BLUE SHIELD ANTHEM HEALTH&LIFE INS ANTHEM SILVER ANTHEM-CDHP AON SELECT APA PARTNERS INC. APPALACHIAN NATL LIFE APS ARAMARK ARBELLA ARBOR ACRES FARM ARGUS HEALTH SYSTEMS ARKANSAS BEST BENEFITS ARMSTRONG WORLD IND. INC. ARNA MACHINE CO ASBESTOS UNION LOCAL 33 ASR BENEFITS (PHYSICIANS CARE)

75 LIBERTY ST 11 FAIRFIELD BLVD SUITE 1 555 MIDDLE CREEK PKWY 5250 S. VIRGINIA STREET P.O. BOX 60007 P.O. BOX 37010 BOX 533 13550 TRITON PARK BLVD. P.O. BOX 1091 2015 STAPLES MILL RD P.O. BOX 528 21555 OXNARD STREET P.O. BOX 105187 P.O. BOX 1370 P.O. OX 60007 220 VIRGINIA AVENUE 110 GIBRATAR RD. P.O. BOX 1506 810 MARKET ST 104 CHURCH LN. #200 PO BOX 8018 P.O. BOX 2075 439 MARLBOROUGH ROAD BOX 419019 DEPT 338 P.O. BOX 10048 P.O.BOX 3001 4 NORTHWEST DR 614 SOUTH COLONY RD. P.O. BOX 1565

ANSONIA WALLINGFORD COLORADO SPRINGS RENO LOS ANGELES LOUISVILLE NORTH HAVEN LOUISVILLE NORTH HAVEN RICHMOND COLUMBUS WOODLAND HILLS ATLANTA PISCATAWAY LOS ANGELES INDIANAPOLIS HORSHAM LANTHAM KNOXVILLE BALTIMORE PHILADELPHIA NASHUA GLASTONBURY KANSAS CITY FORT SMITH LANCASTER PLAINVILLE WALLINGFORD SANTA ANA

CT CT CO NV CA KY CT KY CT VA OH CA GA NJ CA IN PA NY TN MD PA NH CT MO AR PA CT CT CA

06401 06492 80921 89502 90060 40233 06473 40223 06473 23230 03216 91367 30348 08855 90060 46204 19044 12110 37902 21208 19101 03061 06033 64141 72917 17604 06062 06492 92735

2037362651 8882662896 8008283677 7024884000 8007776000 8008584948 8009224670 8002821016 8009222232 8043581551 8008246796 8778007087 8004385356 8002213231 8558042073 8775859567 8006664697 8008333650

8003597475

0757

1899

7010

5191 3119 0528

8006 3734

0048

8004413978 8662159300 8006334226 8006334226 8008478217 8003462513 8006816912 8004875553 4024671122 8004563399

8009623784 8009998989 8002375949 2036334681 8008068811 8004232221 7173970611 2032656673 8009907262

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Code Name H35 073 074 075 076 077 J06 D40 J07 I21 D53 911 L65 H40 D85 G79 J04 B38 F78 N44 M25 N31 078 C71 079 M01 080 L83 I63 927 C34 M65 629 L24 M66 A51 B26 A52 L76 B04 B27 H37

ASSOC ADMINSTRATORS ASSOC DRS HLTH&LIFE IN ASSOC INDEMNITY CORP ASSOC LIFE INS CO ASSOC LIFE INS CO ASSOC LIFE INS CO ASSOC. HLTH & PLAN WELFAR ASSOCIATE ADM. INC. ASSOCIATE BENEFIT TRUST ASSOCIATED ADMIN. GRP INC ASSOCIATED NAT'L SVCS.GP. ASSOCIATED PLAN ADMIN. ASSOCIATION FOR LIFESTYLE REFORM ASSOCIATION MASTER TRUST ASSOCIATION PLAN ADM. ASSURANCE EMP. BENEFITS ASSURANCE EMP. BENEFITS ASSURANCE HEALTH/FORTIS ASSURANCE HEALTH/FORTIS ASSURANT CORPORATE HEADQUARTERS ASSURANT GMS AT & T BENEFITS CENTER ATLANTA LIFE INS CO ATLANTIC ADMINISTRATORS ATLANTIC COAST LIFE IN ATLANTICARE ATLAS LIFE INS CO AULTCARE AUSA LIFE AUTO WAREH ASSOC OF N ENG AUTO. SCRIPT NETWORK AUTOMATED BENEFIT SERVICES AUTOMATION INDUSTRIES AUXIANT AVERA HEALTH PLAN AVESIS AVMA GRP HLTH/LIFE INS AV-MED HEALTH PLAN B/C B/S OF NEW MEXICO B/C-B/S OF ROCHESTER NY B/S OF CALIFORNIA B/S OF NORTHEASTERN NY

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P.O. BOX 8022 2607 S CLAIRMONT AVE 110 WILLIAM ST 10 E 40TH 3333 N MERIDIAN ST 749 N SECOND ST 922 WEST WALNUT SUITE A P.O. BOX3768 P.O. BOX 1439 P.O. BOX 700428 P.O. BOX 6039 4133 WHITNEY AVE. STE26 P.O. BOX 1606 P.O. BOX 359 5856 HERITAGE LANDING DR. P.O. BOX 2940 2323 GRAND BLVD. P O BOX 42033 501 WEST MICHIGAN ROAD 501 W. MICHIGAN ST. P.O. BOX 624 100 HALF DAY ROAD 148 AUBURN AVE NE 135 BEAVER ST. P.O.BOX 20010 P.O. BOX 613 ATLAS LIFE BLDG P.O. BOX 6910 P.O. BOX 97 P.O.BOX 838 1400 E. SCHAAF RD. 8220 IRVING ROAD SHELTER ROCK RD P.O. BOX 259710 P.O. BOX 381506 P O BX. 15999 PO BOX 909720 P.O. BOX 2939 P.O. BOX 27630 165 COURT ST. PO BOX 272540 P.O. BOX 15013

COCKEYSVILLE BIRMINGHAM NEW YORK NEW YORK INDIANAPOLIS MILWAUKEE ROGERS PORTLAND HENDERSONVILLE DALLAS INDIANAPOLIS HAMDEN TERRIO SPRINGFIELD EAST SYRACUSE CLINTON KANSAS CITY HAZELWOOD MILWAUKEE MILWAUKEE MILWAUKEE LINCOLN SHIRE ATLANTA WALTHAM CHARLESTON HAMMONTON TULSA CANTON SCRANTON PETERBOROUGH CLEVELAND STERLING HEIGHTS DANBURY MADISON BIRMINGHAM PHOENIX CHICAGO GAINESVILLE ALBUQUERQUE ROCHESTER CAICOBANK ALBANY

MD AL NY NY IN WI AR OR TN TX IN CT CA NJ NY IA MO MO WI WI WI IL GA MA SC NJ OK OH PA NH OH MI CT WI AL AZ IL FL NM NY CA NY

21030 35205 10038 10016 46208 53202 72756 97208 37077 75370 46206 06518 91762 07081 13057 52733 64108 63042 53203 53201 53201 60069 30301 02452 29413 08037 74103 44706 18504 03458 44131 48312 06810 53725 35238 85060 60690 32609 87125 14647 95927 12212

Plus 4 Phone 8006382972 2059409008

3206

1434

2670

0624 1459

4796212929 8008889603 8882295020 8002410150 8009921882 2032871272 8773789240 9733791090 3154465450 8007337879 8164742345 8003284316 8005537654 8008001212 4142713011 8777220020 8005481256 8007227727 6097047318

0910 0097

9720

2540

8003448858 8008540186 8002585318 8009442668 8002259369 8002450533 6053224545 8008289341 8006216360 8002371255 8008358699 8008471200 8004442595 5184535700

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Code Name A56 E68 A53 081 L14 082 085 086 087 981 881 A27 H49 B90 A15 N66 872 F62 D55 D56 636 C54 060 643 B28 895 K09 A33 635 I97 948 943 A30 C98 B29 F41 641 A55 637 644 992 B30

B`NAI B`RITH MEMBERS INC. BABB INC BAKERS CHOICE PROD. BANKERS COMMERCL LIFE BANKER'S FIDELITY BANKERS LIFE&CAS INS BANKERS MULTIPLE LINE BANKERS NATL LIFE INS BANKERS SECURITY LIFE BAXTER HEALTHLINE BAYSTATE/BC/BS MA BC OF CALIFORNIA BC OF IDAHO BC OF IOWA BC OF NE PENNSYLVANIA BC/BS BC/BS OF ALABAMA BC/BS OF ARIZONA BC/BS OF ARKANSAS BC/BS OF CALIFORNIA BC/BS OF CENTRAL NY INC BC/BS OF COLORADO BC/BS OF CONNECTICUT BC/BS OF DC BC/BS OF DELAWARE BC/BS OF FLORIDA BC/BS OF GA BC/BS OF GEORGIA BC/BS OF GREATER NY BC/BS OF IL BC/BS OF INDIANA BC/BS OF IOWA BC/BS OF KANSAS BC/BS OF KANSAS CITY BC/BS OF KENTUCKY BC/BS OF LOUISIANA BC/BS OF MAINE BC/BS OF MARYLAND BC/BS OF MASSACHUSETTS BC/BS OF MICHIGAN BC/BS OF MINNESOTA BC/BS OF MISSISSIPPI

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P.O. BOX 155 850 RIDGE AVE. P.O. BOX 236 5720 LBJ FREEWAY STE.200 P.O. BOX 105652 P.O. BOX 66927 P.O. BOX 655433 1599 LITTLETON RD 475 PARK AVE S P.O.BOX 26986 P.O.BOX 9198 P.O. BOX 60007 P.O. BOX 7408 HAMILTON BLVD & I-29 70 N MAIN STREET P.O. BOX 1220 P.O.BOX 360508 P.O. BOX 13466 P.O. BOX 2181 P.O. BOX 9083 344 SOUTH WARREN ST 700 BROADWAY PO BOX 5368 370 BASSETT RD CLAIM UNIT 550 12TH ST SW 1 BRANDYWINE GATEWAY PO BOX 44160 P.O. BOX 4445 PO BOX 9907 PO BX 1407 CHURCH ST. STA 2787 MCFARLAND RD. P.O. BOX 37180 636 GRAND AVE 1133 TOPEKA BLVD P.O. BOX 419315 P.O. BOX 37010 P.O. BOX 98029 2 GANNETT DRIVE P.O. BOX 9885 P.O. BOX 5000 600 LAFAYETTE EAST P.O.BOX 64338 PO BOX 1043

SCRANTON PITTSBURGH BEACON FALLS DALLAS ATLANTA CHICAGO DALLAS PARSIPPANY NEW YORK MILWAUKEE NORTH QUINCY LOS ANGELES BOISE SIOUX CITY WILKES BARRE CHICAGO BIRMINGHAM PHOENIX LITTLE ROCK OXNARD SYRACUSE DENVER NO HAVEN WASHINGTON WILMINGTON JACKSONVILLE ATLANTA COLUMBUS NEW YORK ROCKFORD LOUISVILLE DES MOINES TOPEKA KANSAS CITY LOUISEVILLE BATON ROUGE SOUTH PORTLAND BALTIMORE ROCKLAND DETROIT ST. PAUL JACKSON

PA PA CT TX GA IL TX NJ NY WI MA CA ID IA PA IL AL AZ AR CA NY CO CT DC DE FL GA GA NY IL KY IA KS MO KY LA ME MD MA MI MN MS

18504 15212 06403 75240 30348 60666 75265 07054 10016 53226 02171 90060 83707 51103 18711 60690 35236 85002 72203 93031 13022 80273 06473 20065 19899 32231 30302 31908 10008 61107 40233 50309 66629 64141 40223 70898 04106 21284 02370 48226 55164 39215

Plus 4 Phone 6095 6334 0927 5433

9198

1220

9083

4160

7370 7180

9885 5000

8007505973 8002456102 8607201000 2149801151 8664587500 8006213724 8006439917

8004485181 6179562374 8002897536 8002744018 8003622218 7178298500 8004147147 8003349041 6028644400 8006762583 8003881116 8005520053 8004236174 8009224670 2024798000 8003454293 8009266565 8006283988 8004412273 2124767111 8889494516 8004513096 8003622218 8004323990 8005668443 8667552657 5048325856 8004224304 8005244555 8002963917 8008837089 8008592126 8002575825

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Code Name A85 E38 E39 645 639 640 939 I70 A11 973 642 F17 638 871 960 925 D96 904 A81 968 C70 634 G21 978 646 D95 H15 882 D54 M26 D41 630 J75 I73 I74 F61 088 089 090 J45 900 917

BC/BS OF MISSOURI BC/BS OF MONTANA BC/BS OF NEBRASKA BC/BS OF NEW HAMPSHIRE BC/BS OF NEW JERSEY BC/BS OF NEW JERSEY BC/BS OF NORTH CAROLINA BC/BS OF NORTH DAKOTA BC/BS OF OKLAHOMA BC/BS OF OREGON BC/BS OF PENNSYLVANIA BC/BS OF PUERTO RICO BC/BS OF RHODE ISLAND BC/BS OF SOUTH CAROLINA BC/BS OF TENNESSEE BC/BS OF TEXAS BC/BS OF UTAH BC/BS OF VERMONT BC/BS OF VIRGINIA (TRIGON BC/BS OF W.PENNSYLVANIA BC/BS OF WEST VIRGINIA BC/BS OF WESTERN NEW YORK BC/BS PPO BC/BS TENNESSEE /TCHIP BC/BS UNITED OF WISCONSIN BC/BS UTICA WATERTOWN BCI ADMINISTRATORS BEACON CORP /FED.BC/BS BECKWITH HIGHWATER RENBEY BEECHSTREET CORP BEHREN'S BENE PLAN ADM/DIVERSIFIED BENECARD SERVICES BENECARE BENECARE DENTAL PLANS BENECORP INSURANCE CO. BENEFICIAL ASSUR CO BENEFICIAL NATL LIFE BENEFICIAL STNDRD LIFE BENEFIRST LLC BENEFIT ADMIN OF NEW EGLD BENEFIT ADMIN OF NEW ENG.

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1831 CHESTNUT STREET 404 FULLER AV. BOX8006 PO BOX 3248 3000 GOFFS FALLS RD PO BOX 435 PO BOX 435 P.O.BOX 35 4510 13TH AVE. SOUTH 1215 SOUTH BOULDER P.O.BOX 1271 1221 HAMILTON ST P.O. BOX 366068 444 WESTMINSTER STREET P.O.BOX 100605 P.O. BOX 180150 P.O.BOX 660044 PO BOX 30270 P.O.BOX 186 P.O. BOX 27401 P.O.BOX 1249 PO BOX7026 P. O. BOX 109 P.O. BOX 5068 P.O. BOX 6249 401 WEST MICHIGAN ST UTICA BUS.PK.12 RHOADS DR P.O. BOX 250878 P.O. BOX 1098 1617 SAINT MARKS PLZ ST.C P.O. BOX 853925 P.O. BOX 2520 PO BOX 419 168 FRANKLIN CORNER RD. 615 CHESTNUT ST 615 CHESTNUT ST. P.O. BOX 68917 3700 WILSHIRE BLVD TWO PARK AVE P.O. BOX 5008 1020 PLAIN ST SUITE 220 200 LEDGEWOOD ST BOX 557 200 LEDGEWOOD ST BOX 557

ST LOUIS HELENA OMAHA MANCHESTER NEWARK NEWARK DURHAM FARGO TULSA PORTLAND ALLENTOWN SAN JUAN PROVIDENCE COLUMBIA CHATTANOOGA DALLAS SALT LAKE CITY MONTPELIER RICHMOND PITTSBURG WHEELING BUFFALO MIDDLETOWN CHATTANOOGA MILWAUKEE UTICA WEST BLOOMFIELD NORTH HAVEN STOCKTON RICHARDSON WACO MARLBOROUGH LAWRENCEVILLE PHILADELPHIA PHILADELPHIA INDIANAPOLIS LOS ANGELES NEW YORK CAROL STREAM MARSHFIELD ROCKLAND ROCKLAND

MO MT NE NH NJ NJ NC ND OK OR PA PR RI SC TN TX UT VT VA PA WV NY NY TN WI NY MI CT CA TX TX CT NJ PA PA IN CA NY IL MA MA MA

2275

63103 59601 68013 03111 07101 07101 27702 58121 74119 97201 18102 00936 02903 29260 37401 75266 84130 05601 23279 15230 26003 14240 10940 37402 53201 13502 48325 06473 95207 75085 76702 06447 08648 19106 19106 46268 90010 10016 60197 02050 02370 02370

0001

6068 0605

0270

6398 0878

2520

5008

8006542613 8004477828 4023901800 8002252666 8006762583 8006241110 8002225028 7012821100 9185603535 5032255221 8009585558 7872729898 8006373718 8003342583 8005659140 8005212227 8014816198 8002472583 8004511527 8002871347 8008880757 2124767111 8005339892 8005484455 8007651718 2486268896 8002336183 8008283111 8662810585 8005260783 8004564342 8005227487 2154401000 2154401000 3172901205

8004213259 7818374402 8005330090 8005330090

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Code Name B55 964 C18 B56 H62 H80 D29 B89 C72 E91 B57 J69 J21 D73 BRC E41 I72 K86 K01 J24 B58 735 922 H72 J22 814 H45 B20 631 F14 092 901 918 F29 M67 093 B31 F40 M55 094 N81

L36

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BENEFIT ADMIN SYSTEMS BENEFIT ADMIN. TRUST BENEFIT CLAIMS PAYORS BENEFIT CONCEPTS BENEFIT CONCEPTS SYSTEMS BENEFIT COORDINATORS CORP BENEFIT GROUP BENEFIT MANAGEMENT CORP BENEFIT MANG'MT OF ME. BENEFIT MNGT SERV BENEFIT PLAN ADM OF COL. BENEFIT PLAN ADMIN. BENEFIT PLAN MANAGEMENT BENEFIT PLANNING SVCS. BENEFIT RECOVERY DW BENEFIT SERVICES BENEFIT SERVICES OF PA BENEFIT SOURCE INC. BENEFIT SUPPORT INC BENEFIT SYSTEM INC. BENEFIT SYSTEMS INC BENEFIT TRUST LIFE BENEFLEX ADMIN. SERVICES BENEMAX BENESCRIPT BENESIGHT BENESIGHT BENESIGHT/TPA BENIHANA BERKELEY RISK MANAGERS BERKSHIRE LIFE INS CO BEST PLAN BEST PLAN BINDLEY WESTERN INDUSTIES BIOSCRIP BIRMINGHAM FIRE INS CO BLDG SVC 32B-J HLTH FUND BLOCK VISION CARE BLUE ADVANTAGE ADMIN. OF AR BLUE ALLIANCE MUTL INS

17475 JOVANNA DR.STE 1B P.O.BOX 17748 P.O. BOX 37400 P.O. BOX 61505 P.O. BOX 246 111 RYAN COURT SUITE 300 11725 ARBOR STREET P.O. BOX 291558 P. O. BOX 3859 P.O. BOX 1178 1871 FOLSOM ST 101 S. JEFFERSON STREET P.O. BOX 536 145 N. CHURCH ST STE.300 DATA WAREHOUSE PO BOX 4360 1601 MARKET ST. P.O. BOX 240 P.O. BOX 2977 P.O. BOX 6001 760 PASQUINELLI DR STE320 400 FIELD DR. 5856 HERITAGE LANDING DR. 7 WEST MILL ST P.O. BOX 921229 P.O. BOX 360 P.O. BOX 360 116 WASHINGTON AV/BOX 638 8685 NORTH WEST 53RD TERR 270 DAVIDSON AV.PO BX6753 700 SOUTH ST 4201 BIRCH ST 4201 BIRCH ST 4212 WEST 71ST. STREET 10050 CROSSTOEN CIRCLE 102 MAIDEN LANE 101 AVE OF THE AMERICAS 120 W FAYETTE STE700 P.O. BOX 1460 110 FREE ST

HOMEWOODARK FORT MITCHELL PHOENIX KING OF PRUSSIA BARRINGTON PITTSBURG OMAHA FT. LAUDERDALE PORTLAND MATTHEWS BOULDER ROANOKE ROCKLAND SPARTANBURG DATA WAREHOUSE AKRON PHILADELPHIA MONROE GAINESVILLE INDIANAPOLIS WESTMONT LAKE FOREST EAST SYRACUSE MEDFIELD NORTHCROSS PUEBLO PUEBLO NORTH HAVEN MIAMI SOMERSET PITTSFIELD NEWPORT BEACH NEWPORT BEACH INDIANAPOLIS EDEN PRAIRIE NEW YORK NEW YORK BALTIMORE LITTLE ROCK PORTLAND

IL KY AZ PA RI PA NE FL ME NC CO VA MA SC CT OH PA MI GA IN IL IL NY MA GA CO CO CT FL NJ MA CA CA IN MN NY NY MD AZ ME

60430 41017 85069 19406 02806 15205 68144 33329 04104 28106 80302 24011 02370 29306 12345 44321 19103 48161 30503 46206 60559 60045 13057 02052 30010 81002 81002 06473 33166 08875 01201 52660 92660 46268 55344 10005 10013 21201 72203 04101

BLUE CHOICE HEALTH PLAN

P.O. BOX 6170

COLUMBIA

SC

29260

8037868476

BLUE CROSS BLUE SHIELD OF AK

P.O. BOX 240609

ANCHORAGE

AK

99524

8005084722

7400 0246

3859

6001 2581

0360 0219

7087997400 8004555981 6028616868 8002202600 8884386857 8006856100 8003338602 3054731000 8002453529 7048455608 8005370448 5403452721 8776427500 8003260905 8003673762 8004412980 8778571453 8007774782 3175732004 8004231841 8004586126 8002483539 5083594107 8003453189 8005335691 8778845293 8009928354 8005262918 8008547417 8008547417 8008000175 8004445951 2123883300 8004288789 8668233790

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BLUE CROSS BLUE SHIELD OF OH BLUE CROSS/BLUE SHIELD OF IL TX BLUE VIEW VISION INSIGHT BLUEGRASS FAMILY HEALTH BLUELINK TPA BMS ADM. SVCS. BMS ADMINISTRATIVE SVS. BODINE CORP BOILER MAKERS HLTH & WELF BOISE CASCADE CORP BOLLINGER INSURANCE BOLLINGER INSURANCE BONNEVILLE-SYLVAN LIFE BOON-CHAPMAN BORDEN INC. BOSTITCH BOSTON MUTUAL LIFE INS BOSTON OLD COLONY INS BRICKLAYERS INS.WELFARE BRIDGESTONE/FIRESTONEER

13550 TRITON PARK BLVD C/O HEALTH CARE SERVICE CORP PO BOX 504 P.O BOX 21973 1750 YANKEE DOODLE RD 8725 W. HIGGINS BEECH ST. PO BOX 1106 317 MOUNTAIN GROVE 754 MINNESOTA AVE STE 522 P.O. BOX 61 830 MORRIS TURNPIKE P.O. BOX 52116 2900 S STATE ST P.O. BOX 9201 PO BOX 189 PO BOX 911 120 ROYALL ST 80 MAIDEN LANE 6605 WOODHAVEN P.O. BOX 26605 PKWY

LOUISVILLE RICHARDSON MANSON LEXINGTON EAGAN CHICAGO ADDISON BRIDGEPORT KANSAS CITY BOISE SHORT HILLS PHOENIX SALTLAKE CITY AUSTIN COLUMBUS CLINTON CANTON NEW YORK REGO PARK AKRON

KY TX OH KY MN IL TX CT KS ID NJ AZ UT TX OH CT MA NY NY OH

40223 75080 45040 40522 55121 60631 75001 06066 66101 83707 07078 85072 84115 78766 43216 06413 02021 10005 11374 44319

4194

L47

BRINKS RETIREE MEDICAL SERV.

P.O. BOX 1268

ABINGDON

VA

24212

8003835203

828 L07 C93 829 805 K28 E71 632 A16 B91 098 099 810 100 649 H01 D97 101 102 K88 M69

BRINTEC CORP BROKERAGE CONCEPTS BROKERAGE SERVICES BROKERS MARKET SEE CC 138 BRUNSWICK GOLF BS OF CA BS OF IDAHO BS OF NE NEW YORK BS OF PENNSYLVANIA BS OF SOUTH DAKOTA BUCKEYE UNION INS CO BUILDERS LIFE INS CO BURROUGH CO JAMES BENEFIT BUSINESS MEN'S ASSUR BUTCHERS & FOOD HANDLERS C&C NETWORK C&S WHOLESALE GROCERS CAL-FARM LIFE INS CO CALIFORNIA CASUALTY CALIFORNIA FIELD IRONWK CALIFORNIA IUOE

90 CONGRESS DR 1021 W8TH AVE PO BOX 11020 4860 STREET RD BOX 298 MIDGEON AVE P.O. BOX 272560 P.O. BOX 1106 PO BOX 15013 1800 CENTER STREET 1601 W. MADISON AVE. 80 MAIDEN LANE 1433 SW SIXTH ST P O BOX 30995 PO BOX 419269 91-31 QUEENS BLVD P.O. BOX 0917 OLD FERRY ROAD 2855 TELEGRAPH AVE 1900 ALAMEDA DE LAS PULGA 131 N ELMOLINO AVE STE330 P.O. BOX 7067

MANCHESTER KING OF PRUSSIA ALBURQUERQUE TREVOSE TORRINGTON CHICO LEWISTON ALBANY CAMPHILL SIOUX FALLS NEW YORK PORTLAND SALT LAKE CITY KANSAS CITY ELMHURST BROOKFIELD BRATTLEBORO BERKELEY SAN MATEO PASADENA PASADENA

CT PA NM PA CT CA ID NY PA SD NY OR UT MO NY WI VT CA CA CA CA

06040 19406 87192 19047 06790 95927 83501 12211 17089 57104 10005 97201 84130 64141 11373 53008 05302 94705 94402 91101 91109

8604568000 8002202600 5052925533 8006215122 2034899254 8004441409 2087462671 8008881238 7177633151 6053361976

Code Name L38 N46 N70 M68 N50 E72 D99 647 B59 B60 I67 J96 095 J44 D74 648 096 097 C75 811

1973 2789

2762

2116 9201

8002821016 9727668346 8776356403 8007872680 6126629935 7736935410 3126935410 9133426555 2083846161 8005261379 8003508005 8002529653 8008486181 8006692668 7184595800 8002378447

0020

2560

8003289669 8002625433 0917

8003544008 8022574370

1878

8005274613 8002515013

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Code Name M70 103 104 105 C19 971 106 I91 E40 C74 A34 E73 E92 107 A06 E42 I64 F37 L40 E43 G49 865 G24 L41 J63 A57 108 109 G72 I83 N25 C35 H76 F63 F88 866 E01 D75 110 817 E44 F42

CALIFORNIA LABORERS HEALTH CALIFORNIA LIFE INS CO CALIFORNIA PHYSICIANS CALIFORNIA-WESTERN ST CAMCO FITTINGS CAMELLIA FOOD STORES CANADA LIFE ASSUR CO CAPITAL ADMINISTRATORS CAPITAL AREA SERVICE CO. CAPITAL DIST. PHYS.HLTH CAPITOL BLUE CROSS/PENN CAPITOL CARE INC. CAPITOL L & SUPPLY CAPITOL LIFE INS CO CAPITOL MFG. CO. CARE AMERICA CARE FIRST/BLUE CHOICE CAREFIRST BC/BS OF MD. CARELINK HEALTH PLANS CAREMARK CARITEN HEALTH CARE CARNATION CO. CAROLINA BENEFIT ADM. CARPENTERS H & W/CMR CATALYST RX CATHOLIC ASS.OF FORESTERS CATHOLIC KNIGHTS INS CATHOLIC KNIGHTS OF CBA INC. CBCA ADMINISTRATOR CBIA/CONNECTICUT CCEBT CCN MOUNTAIN STATES ADMIN CELTIC LIFE CELTIC LIFE CELTIC LIFE INS. CELTIC LIFE INSURANCE CEMENT&CONCRETE WKRS.DIST CENTENNIAL LIFE INS CO CENTRA BENEFIT SERVICES CENTRA HLTH. ADM. CENTRAL BENEFITS

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4399 SANTA ANITA AVE. 3255 WILSHIRE BLVD 720 CALIFORNIA ST 202 L ST 2464 DIXWELL AVE. P.O.BOX 2320 P.O. BOX 105477 P.O. BOX 346 PO BOX 3742 1223 WASHINGTON AVE. 2500 ELMERTON AVE/MED DEP 550 12TH. ST. S.W. 270 LOCUS ST 1600 SHERMAN ST P.O. BOX 6103 6300 CANOGA AVE. 550 12TH STREET SW BOX 1725 P.O. BOX 7373 PO BOX 686005 1420 CENTERPOINT BLVD. 800 NO BRAND BLVD P.O. BOX 3257 P.O. BOX 42031 800 KING FARM BLVD 4TH FL 347 COMMONWEALTH AVE. 1100 W WELLS ST 709 BRIGHTON RD 3800 NW 12TH ST. STE A P.O. BOX 552 350 CHURCH ST. P.O. BOX 1755 P.O. BOX 32709 PO BOX 06410 P.O. BOX 46337 P.O. BOX 30082 P.O. BOX 06410 30-56 WHITESTONE EXPWY. 9000 W.67TH ST PO.BOX 470 PO BOX 940809 PO BOX 6000 P.O. BOX 182042

EL MONTE LOS ANGELES SAN FRANCISCO SAN FRANCISCO HAMDEN NORFOLK ATLANTA ALPHARETTA CHARLESTON ALBANY HARRISBURG WASHINGTON HARTFORD DENVER WESTERVILLE WOODLANDS HILLS WASHINGTON CUMBERLAND LONDON SAN ANTONIO KNOXVILLE GLENDALE SPARTANBURG HAZELWOOD ROCKVILLE BOSTON MILWAUKEE PITTSBURGH LINCOLN MINNEAPOLIS HARTFORD MINNEAPOLIS TUCSON CHICAGO MADISON TAMPA CHICAGO FLUSHING SHAWNEE MISSION PLANO DUNKIN COLUMBUS

CA CA CA CA CT VA GA GA WV NY PA DC CT CO OH CA DC MD KY TX TN CA SC MO MD MA WI PA NE MN CT MN AZ IL WI FL IL NY KS TX OH OH

91731 90010 94108 94108 06514 23501 30348 30009 25337 12206 17177 20065 06141 80201 43081 91367 20065 21501 40742 78268 37932 91203 29304 63042 20850 02115 53233 15233 68521 55440 06103 55440 85751 60606 53744 33630 60606 11354 66201 75086 73534 43218

Plus 4 Phone 6263506900

1055

6103

6005

1999

0552 1755 2709 6337 3082

6000 2042

8602816580 8048553371 3308678443 8886506566 8006219900 8007772273 8009585558 8002965555 8605491230 6148236691 8008272273 8003213497 8006288544 8003482922 8008415550 8009767747 8185496000 8645736937 8772323863 8888694600 8002822263

8888027789 9528293500 8605252242 6125405075 8008664731 3123325401 8007662525 8002377767 8003652365 7187626133 9136778800 8005274296 8008520910 8003334756

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Code Name 608 894 111 112 113 114 115 116 A88 F76 651 L95 652 117 G03 A47 812 B92 653 118 119 655 CHC J92 N40 120 121 654 A05 A02 B23 I87 B61 C55 656 B62 E62 M71 830 D30 J80 K14

CENTRAL LIFE CENTRAL MASS HEALTH CARE CENTRAL MUTUAL INS CO CENTRAL NATIONAL INS CENTRAL NATIONAL INS CENTRAL RESERVE LIFE CENTRAL SECURITY LIFE CENTRAL ST HLTH/LOCAL 92 CENTRAL STATE LIFE & HLTH CENTRAL UNITED LIFE CENTURY BRASS CENTURY HEALTHCARE LLC CENTURY LIFE INS CERTIFIED LIFE INS CO CHAMBER INS. TRUST CHAMPION INTERNATIONAL CHAMPUS/UNISYS CHAMPVA CENTER CHANDLER EVANS CHARLOTTE LIBERTY MUTU CHARTER NATIONAL LIFE CHASE ENTERPRISE CHC - ANTHEM BC/BS CHCS SERVICES INC. CHEROKEE INSURANCE COMPANY CHEROKEE NATL LIFE INS CHESAPEAKE LIFE INS CHESEBROUGH-POND USA CLMS CHESTERFIELD RESOURCE INC CHICAGO PAINTERS/DECORATO CHICKERING CLAIMS SVCS. CHOICENET/INTERCARE CHRISTIAN BROS. EMP BENEF CHRISTIAN FIDELITY LIFE CHUBB LIFE UNITED CIBA CENTRAL CLAIMS CNT CIGNA CIGNA DENTAL CIGNA HEALTH PLAN HMO CIGNA OF PUERTO RICO CIGNA POS CIGNET HEALTH PLAN

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709 N. SEGOE 300 MECHANICS TOWER 800 S WASHINGTON ST 105 S 17TH ST 110 EAST ST 1460 W LANE AVE 1418 W ROSEDALE PO BOX 5103 PO BOX 34350 P.O. BOX 2728 CENTURY PARK P.O. BOX 2256 1800 NORTH POINT DR 14724 VENTURA BLVD P.O. BOX 30634 KNIGHTSBRIDGE DRIVE PO BOX 870140 P.O. BOX 65024 CHARTER OAK BLVD 531 S TRYON ST 8301 MARYLAND AVE 1 COMMERCIAL PLAZA 221 WHITNEY AVE P.O. BOX 12467 P.O. BOX 159 1122 GRAY HWY 527 ST PAUL ST PO BOX 580470 PO BOX 1884 7045 N. WESTERN AVE PO BOX 410378 P.O. BOX 3559 1205 WINDHAM PKWY. 2001 BATES DR. P.O.BOX 2023 7 SKYLINE DRIVE PO BOX 55270 P.O. BOX 188037 P.O. BOX 800 P.O. BOX 71203 499 WASHINGTON BLVD. P.O. BOX 6500

MADISON WORCESTER VAN WERT OMAHA JACKSONVILLE COLUMBUS FORT WORTH DES PLAINS OMAHA HOUSTON WATERBURY GRAPEVINE STEVENS POINT SHERMAN OAKS HARTFORD HAMILTON SURFSIDE BEACH DENVER WEST HARTFORD CHARLOTTE ST LOUIS HARTFORD NEW HAVEN PENSACOLA WARREN MACON BALTIMORE MINNEAPOLIS AKRON CHICAGO CAMBRIDGE ENGLEWOOD ROMEOVILLE WAXAHACHIE CONCORD HAWTHORNE PHOENIX CHATTANOOGA UNIONVILLE SAN JUAN JERSEY CITY LARGO

WI MA OH NE IL OH TX IL NE TX CT TX WI CA CT OH SC CO CT NC MO CT CT FL MI GA MD MN OH IL MA CO IL TX NH NY AZ TN CT PR NJ MO

53705 01608 45891 68102 62650 43221 76104 60017 68134 77252 06720 76099 54481 91403 06150 45020 29587 80206 06101 28202 63105 06105 06511 32591 48093 31201 21202 55458 44309 60645 02141 80155 60441 75165 03302 10532 85078 37422 06085 00936 07310 20792

Plus 4 Phone 5087992642

2728

8003235000 8005412363 8006699030 4692891264

9740 5024

8003361904 5138684615 8005781294 3033317599

8003258405

2467

0470

3239

2188 5270

8009226621 8888031780 8002010450

8007520932 3308962232 3123388500 8009667772 8004267453 8008070400 2149374420 8002583648 8005488237 8003085948 9038928167 8003459458 8097536868 8002446224 3014234551

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Code Name 122 123 124 E51 H59 C76 125 G40 A58 D01 657 H88 658 M27 N41 126 127 D98 128 129 M72 F34 D76 135 130 131 B63 134 659 D77 136 137 138 139 140 141 660 L30 142 B93 143 144

CITADEL LIFE INS CO CITIZENS HOME INS CO CITIZENS LIFE & CASLTY CITY OF BRIDGEPORT BD.ED. CITY OF FORT LAUDERDALE CITY OF SPRINGFIELD CIVIL SERVICE EMPLOYEE CLAIM MANAGEMENT SVS. CLAIMS ADM. SERVICES CLAIMS PRO CLAIROL C/O PRUDENTIAL CLARITY VISION CLARK IND CLEARSCRIPT CMD HEALTH CNA INSURANCE COACHES OF AMERICA COALITION SERVICES COASTAL PLAIN LIFE INS COASTAL STATES LIFE IN COASTAL TPA COLBURN INS. SERVICES COLE VISION COLOMBIA ACCDT&HLTH IN COLONIAL LIFE & ACCIDT COLONIAL LIFE INS CO COLONNA ASSOCIATES COLONY CHARTER LIFE IN COLTEC COLUMBIA PHARM.SOLUTIONS COLUMBIAN MUTUAL LIFE COLUMBUS MUTUAL LIFE COMBINED AMER INS CO COMBINED INS CO OF COMBINED INS CO OF COMBINED LIFE INS CO COMBUSTION ENGINEERING COMMERCE BENEFITS GROUP COMMERCIAL INS CO OF COMMERCIAL LIFE INS. COMMERCIAL STATE LIFE COMMERCIAL TRAVELERS

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201 S TRYON ST 2601 FLOYD AVE 639 S SPRING ST 45 LYON TERRACE 100 NORTH ANDREWS AVE. P. O. BOX 26453 989 MARKET ST P.O. BOX 10888 P.O. BOX 3968 P.O. BOX 577 P.O. BOX 6200 P.O. BOX 890500 75 KINGS HIGHWAY 711 KASOTA AVE. SE 1890 STARRSHOT PARK P. O. BOX 305182 PO BOX 1889 315 WEST MAIN ST STE200 462 FALLS RD 260 PEACHTREE ST NW P.O. BOX 80308 201 CASTLE VILLAGE P.O. BOX 8504 RD #5 P.O. BOX 1365 PO BOX 328 P.O. BOX 4242 3243 WILSHIRE BLVD 430 PARK AVE P.O. BOX 30 1 COLUMBIAN MUTUAL PLAZA 303 E BROAD ST 5050 N. BROADWAY P.O. BOX 638 104 S MAIN ST 18 COMPUTER DR EAST PO BOX 3908 33479 LAKE RD. 180 MAIDEN LANE 79 BRIDGEPORT AVE. 100 N JEFFERSON BLVD 70 GENESEE ST

CHARLOTTE RICHMOND LOS ANGELES BRIDGEPORT FORT LAUDERDALE MINNEAPOLIS SAN FRANCISCO GREENBAY BOCA RATON SOUTHFIELD LINWOOD CAMPHILL ENFIELD MINNEAPOLIS LEXINGTON NASHVILLE EL PASO AVON ROCKY MOUNT ATLANTA SALINAS PITTSBURG MANSON BLOOMSBURG COLUMBIA PARSIPPANY HAMDEN LOS ANGELES NEW YORK GREENSBURG BINGHAMTON COLUMBUS CHICAGO BELLINGHAM FONDDULAC ALBANY STAMFORD AVON LAKE NEW YORK SHELTON ST LOUIS UTICA

NC VA CA CT FL MN CA WI FL MI NJ PA CT MN KY TN TX CT NC GA CA PA OH PA SC NJ CT CA NY PA NY OH IL WA WI NY CT OH NY CT MO NY

28234 23220 90014 06604 33301 55426 94103 54307 33427 48034 08221 17089 06082 55414 40507 37230 79950 06001 27801 30303 93912 15236 45040 17815 29202 07054 06514 90010 10022 15666 13902 43215 60640 98227 54935 12205 06904 44012 10038 06484 63103 13495

Plus 4 Phone

2035767326 9547615188 8004625821

3968 0922

8004727130 5612419500 8004519923 8008268151 8005412039

3686

6126726500 8007944668 8007751541 91553318800 8606789223

7111

8005647475 8003271550 8003347591 8008809325 2014551400 2032885936 7044237000 8007131983

0638

8002254500 8005445531 8005445531

8002239941 8609248436

8/1/2014

Code Name 145 146 147 149 148 G08 L78 D02 A59 909 K71 150 J11 898 B64 852 I62 G04 860 A60 G85 B65 151 152 153 154 661 671 CHP 662 664 663 665 G58 788 155 156 158 159 CHN 554 132

COMMERCIAL TRAVELERS COMMERCIAL UNION INS COMMERCIAL UNION LIFE COMMONWEALTH LIFE INS COMMONWEALTH LIFE&ACCD COMMUNITY CARE NETWORTH COMMUNITY CCRX COMMUNITY HLTH PLAN COMMUNITY MUT SER B/C B/S COMMUNITY MUTUAL INS. CO. COMP. BENEFITS COMPANION LIFE INS COMPASS GRP NTH AMER DIV COMPLETE CARE CONTROL COMPLETE HLTH DENTAL PLAN COMPREHENSIVE BENEFIT ADM COMPREHENSIVE BENEFITS COMPREHENSIVE CARE SVCS. COMPREHENSIVE MED EXPENSE CONCEPT ADMIN. CONCORDEA HEALTH PLAN CONFEDERATE ADM. SERVICE CONFEDERATION LIFE INS CONGER LIFE INS CO CONGRESS LIFE INS CO CONGRESSIONAL LIFE INS CONN BUSINESS & IND ASSOC CONN CARTING CORP CONN HEALTH PLAN CONN LABORERS HLTH/WELF CONN NATIONAL LIFE CONN RUBBER AND MOLD CONN STATE DENTAL ASSOC CONN. HEALTH PLAN CONNECTICARE INC CONNECTICUT COMMERCIAL CONNECTICUT GENERAL IN CONNECTICUT INDEMNITY CONNECTICUT MUTUAL CONS HEALTH CARE CONSECO CONSECO DIRECT LIFE INS

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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70 GENESEE ST 1 BEACON ST 1 BEACON ST COMMONWEALTH BLDG 3500 LINDELL BLVD P.O. BOX 945070 P.O. BOX 5202 P.O. BOX 15109 P.O. BOX 700 P.O.BOX 700 P.O. BOX 802199 230 PARK AVE 2400 YORKMONT RD SIMPLEX PLAZA 2160 HIGHLAND AVE STE 100 P.O.BOX 2365 1800 WALT WHITMAN RD. P.O. BOX 5190 1 LAKE ST. P.O. BOX 97044 P.O. BOX 229013 P.O. BOX 29419-03 280 INTERSTATE NORTH 5050 BISCAYNE BLVD 2100 N BROADWAY GOLDEN RULE BLDG P.O BOX 150417 ROUTE 32 4000 PARK AVE 435 CPTN TOM BLVD. 175 POWDER FOREST DR PO BOX 447 100 LAFAYETTE STREET 100 FONT ST. STE.600 P.O. BOX 546 154 DERBY AVE PO BOX 8013 9 FARMSPRINGS DR 140 GARDEN ST/STAT 195 P.O. BOX 720 P.O.BOX 66953 399 MARKET ST.

UTICA BOSTON BOSTON LOUISVILLE ST LOUIS MAITLAND RENSSELAER ALBANY WORTHINGTON WORTHINGTON CHICAGO NEW YORK CHARLOTTE GARDNER BIRMINGHAM SOUTH BURLINGTON MELVILLE TAMPA UPPER SADDLE RIVER KIRKLAND ST. LOUIS NORTH CHARLESTON ATLANTA MIAMI SANTA ANA LAWRENCEVILE HARTFORD NORTH FRANKLIN BRIDGEPORT WEST HAVEN SIMSBURY DANIELSON PAWCATUCK WORCESTER FARMINGTON NEW HAVEN PLAINVILLE FARMINGTON HARTFORD NORTH HAVEN CHICAGO PHILADELPHIA

NY MA MA KY MO FL NY NY OH OH IL NY NC MA AL VT NY FL NJ WA MO SC GA FL CA IL CT CT CT CT CT CT RI MA CT CT CT CT CT CT IL PA

13502 01940 01940 40402 63101 32794 12144 12212 43085 43085 60680 10017 28217 01441 35205 05407 11747 33675 07458 98083 63122 29419 30339 33137 92706 62439 06115 06254 06604 06516 06070 06239 02860 01608 06032 06509 06062 06032 06115 06473 60666 19181

Plus 4 Phone 8004226200

8006822273 5070 5109

2199

5190 9744 9003

8778011500 8666845353 5184363447 8008489510 8008489510 8008372341 8003417763 5086328244 8002393215 8005258788 8002317269 8003652735 2018255000 8004263070 3149657580 8004411172 7709535100

8009224670 8606925000 2032398467 8009223240

8008282732 8883359400 8606745757 8605833874

0953

8008311212 8002273246 8004412251 8005239100

8/1/2014

Code Name 133 K78 G31 478 M73 H63 666 983 859 D71 161 160 M12 C36 162 165 167 170 171 172 173 J97 164 166 168 169 D42 J78 N27 667 J76 G34 M08 B66 E52 G05 J26 I77 431 K39 I50 793

CONSECO DIRECT LIFE INS CONSECO INS. CO. CONSECO MEDICAL INS. CONSECO/PIONEER LIFE CONSOCIATE GROUP CONSOL. ASSOC OF RR EMP. CONSOLIDATED CONTROL CONSOLIDATED FRTWY/GBBA CONSOLIDATED GRP/TRAVELER CONSOLIDATED HLTH PLAN CONSOLIDATED MUTUAL CONSTITUTION LIFE INS CONSTRUCTION INDUSTRY LAB. CONSUL TECH INC. CONSUMERS UNITED INSCO CONT BANKERS LIFE CONT FIDELITY LIFE INS CONT LIFE & ACCIDENT CONT LIFE INS CO. CONT SERV LIFE/HEALTH CONT WESTERN LIFE INS CONTINENTAL AMER. INS. CONTINENTAL ASSURANCE CONTINENTAL CASUALTY CONTINENTAL GEN INS CONTINENTAL INS CO CONTINENTAL LIFE INS. CO. CONTRACTORS EMP.BEN.ADM. CONVENTRY HEALTHCARE LOUISIANA COOPER IND/ARROW HART COORDINATED CARE SOLUTION CORAM PRESCRIPTION CORE PPO CORE SOURCE CORE SOURCE CORE SOURCE CORE SOURCE CORE SOURCE INC CORESOURCE CORESOURCE CORESOURCE INC COROMETRICS MEDICAL SYS

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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399 MARKET ST P.O. BOX 2034 P.O. BOX 1250 PO BOX 61105 P.O. BOX 1068 PO 6130 4912 MIDWAY DR 15 DURANT AVE P.O.BOX 41 P.O. BOX 2070 195 STAFFORD ST. 345 ADAMS ST 4423 W LAWRENCE AVE 116 COMMERCE DRIVE P.O. BOX 7456 2009 N 14TH ST HIGHWAY 70 EAST PO BOX 2090 CONTINENTAL LIFE BLDG CNA PLAZA PO BOX 3397 11201 DOUGLAS P.O. BOX 427 CNA PLAZA CNA PLAZA P.O. BOX 247007 P.O.BOX 1209 101 CONTINENTAL PLACE 6300 BRIDGEPOINT PKWY. P.O. BOX 7707 103 HAWTHORN ST 12301NW 39 STREET 7101 TPC BLVD. 450 RIVERCHASE PARKWAY P.O. BOX 83301 PO BOX 1504 P.O. BOX6118 4940 CAMPELL BLVD. 146 INDUSTRIAL PARK P.O.BOX 1195 P.O. BOX 2920 6100 FAIRVIEW DR STE1000 61 BARNES PK RD NO

PHILADELPHIA CARMEL ROCKFORD ROCKFORD DECATUR TEMPLE BETHEL MINNEAPOLIS NASHUA SPRINGFIELD BROOKLYN CHICAGO JEFFERSON CITY TALLAHASSEE ARLINGTON JACKSON DALLAS BOISE CHICAGO BATON ROUGE DES MOINES COLUMBIA CHICAGO CHICAGO OMAHA PISCATAWAY BRENTWOOD AUSTIN LONDON HARTFORD CORAL SPRINGS ORLANDO BIRMINGHAM LANCASTER ANDERSON WESTERVILLE BALTIMORE JACKSON MINNEAPOLIS CLINTON CHARLOTTE WALLINGFORD

PA IN IL IL IL TX CT MN NH MA NY IL MO FL VA TN TX ID IL LA IA SC IL IL NE NJ TN TX KY CT FL FL AL PA IN OH MD MN MN IA NC CT

19181 46082 61105 61105 62525 76503 06801 55440 03061 01104 11201 60630 65109 32314 22201 38301 75221 83702 60685 70821 50306 29202 60685 60685 68124 08855 37027 78730 40472 06104 33065 32822 35244 17608 46015 43086 21236 56143 55440 52733 28210 06492

Plus 4 Phone

6130

8005239100 8002266082 8009470319 8004413978 8007982422 8003341330

0041 2067 3500

8002870298 8008328333 8006337867

1260

8006242356 9049214603 8007331773

7007 1188

2858

8511 2920

8004333036 3128224603 8002622800 8003256933 9089814000 6153771300 8002477724 8009693343 9543442444 8007981109 8882521431 8002233943 8003311199 8002823920 8004806658 8002746965 8004446965 8668934472 8003275462 2032655631

8/1/2014

Code Name E45 989 668 F43 B06 669 174 175 A89 176 177 I79 K05 C77 B07 670 H06 D31 B87 K68 G86 B08 A90 977 157 B05 179 D58 N69 N29 M28 L48 L84 L89 B33 F36 G87 D57 I53 D32 J94 M02

CORP.BEN.SVC.OF AMERICA CORP.HLTH. ADM./AETNA CORPORATE BENEFIT ADM INC CORPORATE BENEFITS CORPORATE GROUP SYSTEMS CORPORATE HEALTH INS COSMOPOLITIAN LIFE COSMOPOLITIAN MUTUAL COTTER MEMBERS INS COTTON STATES LIFE COUNTRY LIFE INS CO COVENTRY HEALTHCARE IOWA COVENTRY HEALTHCARE OF DE CRA HEALTH PLAN CRAWFORD & SONS CROUSE HINDS CO CROWN CORK & SEAL CROWN LIFE CT BRICKLAYERS HLTH FD CT GEN. LIFE INS CT LONGSHOREMAN'S/LOC1398 CT PIPE TRADES HEALTH CT STATE BUILDERS TRADE CT. CARPENTERS 210/24/43 CT. GENERAL/BRISTOL SVC CTRL ST HLTH & LIFE/OMAHA CUNA MUTUAL INS SOC CURA FLEX CVS CAREMARK CLAIM DEPT. CWI BENEFITS DAKOTACARE DANA CORP. NON-UNION RETIREE DARDEN DARDEN DAVIS VISION CARE/IESS DAY ONE MEDICAL DBL SERVICES INC. DC 1707 HEALTH INS. FUND DC37 HLTH & SEC. PLAN DCA HEALTH CARE DEAN HMO DEARBORN NATIONAL

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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Plus 4 Phone

PO BOX 27267 P.O.BOX 14586 PO BOX 326 139 S. TRYON ST. PO BOX 5710 2464 WHITNEY AVE 6505 WILSHIRE BLVD 10 COLUMBUS CIRCLE 203 JANDUS RD 244 PERIMETER CTR PKWY NE 1701 TOWANDA AVE/PO 2000 P.O. BOX 8400 P.O. BOX 7713 312 UNION WHARF PO BOX 5047 PO BOX 4999 ONE CROWN WAY P.O. BOX 13965 PO BOX 3574 AMITY STA P.O. BOX 5132 100 WATERFRONT ST 1155 SILAS DEAN HWY. PO BOX 545 10 BROADWAY PO BOX 901 PO BOX 34350 PO BOX 1648 4955 F STREET P.O. BOX 52196 P.O. BOX 6125 1323 S MINNESOTA AVE P.O. BOX 9008 P.O. BOX 30530 P.O. BOX 695011 P.O. BOX 1525 P.O. BOX 9137 P.O. BOX 66714 75 VARICK ST. 125 BARCLAY ST P.O. BOX 3501 P.O. BOX 56099 1020 31ST STREET

MINNEAPOLIS LEXINGTON WELLESLEY HILLS CHARLOTTE LIVONIA HAMDEN LOS ANGELES NEW YORK CARY ATLANTA BLOOMINGTON LONDON LONDON BOSTON ATLANTA SYRACUSE PHILADELPHIA SAN JUAN NEW HAVEN SOUTHFIELD NEW HAVEN WETHERSFIELD WEST HAVEN HAMDEN PLAINVILLE OMAHA MADISON OMAHA PHOENIX GREENVILLE SIOUX FALLS MELVILLE SALT LAKE CITY ORLANDO LATHAM FORT WORTH ST. LOUIS NEW YORK NEW YORK CITY HOPKINS MADISON DOWNERS GROVE

MN KY MA NC MI CT CA NY IL GA IL KY KY MA GA NY PA PR CT MI CT CT CT CT CT NE WI NE AZ SC SD NY UT FL NY TX MO NY NY MN WI IL

0267

55427 40512 02181 28202 48151 06518 90048 10019 60013 30301 61701 40742 40742 02109 30302 13221 19154 00908 06525 48037 06511 06109 06516 06518 06062 68134 53701 68117 85072 29606 57105 11747 84130 32869 12110 76147 63166 10013 10007 55343 53705 60515

5710

8009252272 8002350123 8002779476 3139651540 2032484499

8003230131

5003

0350

6714

9501 5591

8002574692 8008337423 8006772459 8002412541 3154775567 8005072359 7877537780 2033973470 8005234826 2034691391 8605719191 8603894528 8009226026 8605833874 4023971111 8005489390 8007981109 8777755635 8009928088 8006283778 8009143768 8883743343 4072454000 8009995431 8002524698 3142418665 2123340096 2128151234 8002747005 6088281301 8003484512

8/1/2014

Code Name J77 D78 180 I18 J51 J61 K38 L17 N52 M74 C38 L51 C56 K22 D04 L81 E03 B94 L75 D59 C62 G25 E21 G48 K48 944 I49 E02 B67 C20 J62 I48 181 G57 672 G67 H20 D03 H79 H95 D33 K89

DEFINITY HEALTH DEKALB GENETICS CORP. DELAWARE AMERICAN LIFE DELTA DENTAL DELTA DENTAL DELTA DENTAL DELTA DENTAL DELTA DENTAL DELTA DENTAL DELTA DENTAL AARP DELTA DENTAL OF AK. DELTA DENTAL OF ARIZONA DELTA DENTAL OF CA. DELTA DENTAL OF HAWAII DELTA DENTAL OF IOWA DELTA DENTAL OF MICHIGAN DELTA DENTAL OF MISSOURI DELTA DENTAL OF NJ DELTA DENTAL OF OREGON DELTA DENTAL OF PA. DELTA DENTAL OF R.I. DELTA DENTAL OF TENN. DELTA DENTAL OF TX. DELTA DENTAL OF VA. DELTA DENTAL OF WI DELTA DENTAL PLAN DELTA DENTAL PLAN DELTA DENTAL PLAN OF IL. DELTA DENTAL PLAN OF MA DELTA DENTAL PLAN S/D DELTA DENTAL PLANS OF CO DELTA HEALTH GROUP DELTA LIFE INS CO DELTA USA DENNYS CORPORATE GROUP DENTAL & CONSUMER BENE. DENTAL BENEFIT PROVIDERS DENTAL CARE PLUS DENTAL CLAIM PAYORS DENTAL DELIVERY SERVICES DESERET MUTUAL INS. DESTINY HEALTH PLAN

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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P.O. BOX 9525 3100 SYCAMORE RD. 102 MAIDEN LANE P.O. BOX 242810 P.O. BOX 75983 P.O. BOX 997330 P.O.BOX 1809 555 EAST PARKCENTER BLVD P.O. BOX 9304 P.O. BOX 740819 P.O. BOX16450 P.O. BOX 43000 P.O. BOX 997330 700 BISHOP ST 636 GRAND AVE. P.O. BOX 330 PO BOX 8690 P.O. BOX 222 601 SW SECOND AVE 1 DELTA DRIVE P.O. BOX 1517 240 VENTURE CIRCLE P.O. BOX 152140 4818 STARKEY RD. P.O. BOX 828 P.O.BOX 9085 P.O. BOX 49198 P.O. BOX 5402 P.O. BOX 9104 P.O. BOX 1157 P.O. BOX 173803 2 NORTH PALAFAX ST 4370 PEACHTREE RD NE P.O. BOX 59238 PO BOX 3711 P.O. BOX 10626 P.O. BOX 389 P.O. BOX 4677 P.O. BOX 25415 1640 HEMPSTEAD TPKE. P.O. BOX 45530 P.O. BOX 934

AMHERST DEKALB NEW YORK LOUISVILLE SEATTLE SACRAMENTO ALPHARETTA BOISE MINNEAPOLIS ATLANTA NO. LITTLE ROCK PHOENIX SACRAMENTO HONOLULU DES MOINES MINNEAPOLIS ST. LOUIS PARSIPPANY PORTLAND MECHANICSBURG PROVIDENCE NASHVILLE IRVING ROANOKE STEVENS POINT FARMINGTON HILLS WICHITA LISLE MEDFORD PIERRE DENVER PENSACOLA ATLANTA MINNEAPOLIS LA MIRADA BIRMINGHAM ROCKVILLE CHICAGO ROCHESTER EAST MEADOW SALT LAKE CITY FREDERICK

NY IL NY KY WA CA GA ID MN GA AR AZ CA HI IA MN MO NJ OR PA RI TN TX VA WI MI KS IL MA SD CO FL GA MN CA AL MD IL NY NY UT MD

9525

14226 60115 10005 40224 98125 95899 30023 83706 55440 30374 72231 85080 94120 98613 50309 55440 63126 07054 97204 17055 02901 37228 75015 24014 54481 48333 67201 60532 02155 57501 80217 32501 30319 55459 90637 35283 20848 60680 14625 11554 84145 21705

1809

0819 6450

8663334648 8157567333 8009552030 8005541907 8774427462 8005109938 8003567586 6514065901 8005235800 8004625410 6029383131 8007656003 8002322533 8005321514 8004930513 8003921167 8003465377 8888731393 8009320783 8008433582 8002233104 8005212651 8002376060 8002363712 8009420667 8002343375 8003987203 8008720500 60522473455 8006100201 8504320660

0238

8004483815

0626

8008762840 8778163596 8009991669 8006666690 8002555681 8005785600 8668269345

0415

8/1/2014

Code Name I44 794 H91 K23 D79 723 913 I43 I36 673 J81 B32 869 A49 M75 182 K54 A37 795 183 E04 184 F28 B09 888 D60 818 831 674 D43 K41 185 C78 796 L55 K82 186 675 676 677 D81 B10

DEXTER CO. HLTH PLAN DIAMOND BATHURST DIRECT DENTAL DIRECTORS GUILD OF AMER. DISNEY GROUP DISTRICT 6 DISTRICT 65 U.A.W. DISTRICT CONS. OF NE DISTRICT COUNSEL OF NE DIVERSIFIED DIVERSIFIED GROUP DIVERSIFIED PHAR/CAREMARK DIVERSIFIED PHARM DEL.N/A DIVERSIFIED PHARMACY SVS. DOMINION DENTAL SERVICES DOMINION LIFE ASSURAN DORAL DENTAL DUNN&BRADSTREET PLAN SVS. DURACELL USA DURHAM LIFE INS CO EAGLE LEASING COMPANY EAGLE LIFE INS CO/TEX EAGLE MANAGED CARE EAGLE-PICHER/ORCOMATIC EAGLES ADMIN. LIMITED EASTCORE INC. EASTERN BEN SYSTEMS EASTERN BUSINESS FORMS EASTERN SMALL BUSINESS EBA&M CORP. EBS BENEFIT SOLUTIONS INC EDUCATORS MUT LIFE INS EDUCATORS MUTUAL INS. EDWARDS COMPANY ELCA HEALTH PLAN MARSH AFFINITY GRP. ELDERPLAN ELDORADO INS CO ELEC BOAT DIV/GEN DYN ELECTRONIC DATA SYSTEMS ELI LILLY COMPANY EMERSON ELEC.CO.BENFITS EMP BENE PLAN ADM (EBPA)

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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P.O. BOX 247017 ROUTE 101 P.O. BOX 1938 P.O. BOX 48127 PO BOX 10130 18 E. 31ST. ST. 13 ASTOR PLACE 161 GRANITE AVE 161 GRANITE AVE PO BOX 299 P.O. BOX 330 P.O. BOX 686005 P.O.BOX 1002 PO BOX 390873 P.O. BOX 1126 111 WESTMOUNT RD S 12121 N. CORPORATE PKWY P.O. BOX 730 BERSHIRE IND PARK PO BOX 27807 1 IRVING EAGLE PL.PO 923 PO BOX 32565 P.O. BOX 546 19 OHIO AVE PO BOX 13307 P.O. BOX 8658 200 FREEWAY DR EAST P O BOX 10 60 WASHINGTON ST BOX5079 P.O. BOX 4863 P O BOX 3149 852 EAST ARROWHEAD LA. P O BOX 1188 P.O. BOX 14426 P.O. BOX 73111 525 UNIVERSITY AVE ESTRN PT. RD PO BOX 1127 5400 LEGACY DRIVE LILLY CORP CTR 10795 WATSON RD PO BOX 2000

OMAHA DAYVILLE NEWARK LOS ANGELES LAKE BUENA VISTA NEW YORK NEW YORK DORCHESTER DORCHESTER MARLBOROUGH CANONSBURG SAN ANTONIO HORSHAM MINNEAPOLIS ELK GROVE VILLAGE WATLOOONTARIO CA N2J MEQUON PUEBLO BETHEL CT RALEIGH ORANGE SAN ANTONIO CAMP HILL NORWICH LEXINGTON ALEXANDRIA EAST ORANGE MAULDIN HARTFORD WEST LAKE VILLAGE SYRACUSE LANCASTER MURRAY FARMINGTON DES MOINES NEWNAN PALO ALTO GROTON PLANOS INDIANAPOLIS ST. LOUIS EXETER

NE CT NJ CA FL NY NY MA MA CT PA TX PA MN IL C WI CO CT NC CT TX PA CT CT VA NJ SC CT CA NY PA UT CT IA GA CA CT TX IN MO NH

7017

68124 06241 07101 90068 32830 10016 10003 02124 02124 06447 15317 78268 19044 55439 60009 00000 53092 81002 06801 27611 06477 78284 17001 06360 40583 22306 07018 29662 00000 91359 13221 17604 84107 06034 50306 30271 94301 06340 75024 46285 63127 03833

1938 0130

9320 0873

8004574726 2037749636 8004336825 8778662200 4078246000 2124899540 8002215011 6172653757 6172653757 8602950238 7247468700 8008246349 8004418976 8002338065 8885185338 8004365294 8008355509 2037964000 9197826110 8607955661

0546

8658

4863 3149 5298 3426

8005455591 2038862451 2032486346 7036605900 8005240227 8032882451 8007761545 8008035773 7173972751 8012627475 2036780410 8002456728 8003533765 8006549385

8003659036 6037787106

8/1/2014

Code Name B68 B11 B95 991 C79 633 187 I46 B36 F64 H39 E95 H38 N35 910 B35

G83 H99 993 I35 I78 188 M76 M77 H33 I92 H10 I14 189 190 191 193 194 195

N75 678 E96 L18 A04 969 197 196

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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EMP HLTH INS CLAIMS DEPT EMP SEC FND/ELEC PROD IND EMP. BEN. PLAN HLTH EMP. BENEFIT CONSULTANTS EMPERION INS. CO. EMPIRE BC BS EMPIRE STATE MUT LIFE EMPL BEN SOLUTIONS EMPL FIN SVCS HLTH CARE EMPLOYEE BEN. MANAGEMENT EMPLOYEE BEN. MGMT(EBMS) EMPLOYEE BEN.ADMIN. EMPLOYEE BENE MGMT EMPLOYEE BENEFIT CONCEPTS EMPLOYEE BENEFIT PLAN

1100 EMPLOYERS BLVD 158-11 H VAN ARSDALE JR P.O. BOX 392 3301 EAST ROYALTON RD P.O. BOX39846 PO.BOX1407 CHURCH ST.STA. 315 N. MAIN ST 47 OLD RIDGEFIELD RD PO BOX 85585 4789 RINGS ROAD P.O. BOX 21367 64 SCHOOSETT ST. 66 EAST WADSWORTH PK DR. P.O. BOX 2365 PO BOX 26340

GREEN BAY FLUSHING EXTON CLEVELAND EDINA NEW YORK JAMESTOWN WILTON RICHMOND DUBLIN BILLINGS PEMBROKE DRAPER FARMINGTON HILLS MINNEAPOLIS

WI NY PA OH MN NY NY CT VA OH MT MA UT MI MN

54344 11365 19341 44147 55439 10084 14701 06897 23285 43017 59104 02359 84020 48333 55426

EMPLOYEE BENEFIT PLAN

PO BOX 945480

MAITLAND

FL

32794

EMPLOYEE BENEFIT PLAN EMPLOYEE BENEFIT SERV. EMPLOYEE BENEFIT SERVICES EMPLOYEE BENEFIT SOL. LLC EMPLOYEE BENEFITS CORP EMPLOYEE BENEFITS INS EMPLOYEE HEALTH & WELLNESS PLAN EMPLOYEE HEALTH INS. MGMNT RX EMPLOYEE PLANS LLC EMPLOYER DENTAL TRUST EMPLOYER PLAN SVCS. EMPLOYER RESOURCE NETWORK EMPLOYERS CASUALTY CO EMPLOYERS FIRE INS CO EMPLOYERS INS /WAUSAU EMPLOYERS MUTUAL EMPLOYERS NATL INS CO

P.O. BOX 15230 P.O. BOX 8160 534 RIVER CROSSING DR. 47 OLD RIDGEFIELD RD 1200 EAST GLEN AVE 233 WILSHIRE BLVD P.O. BOX 26800 26711 NORTHWESTERN HIGHWAY P.O. BOX 2362 79 BRIDGPORT AVE. 3180 NORTH LOOP W. STE400 6000 WESTERN PL. STE.118 512 E. RIVERSIDE DR. 1 BEACON ST 2000 WESTWOOD DR 2000 WESTWOOD DR PO BOX 2749

DALLAS SOUTH CHARLESTON FT. MILL WILTON PEORIA HEIGHTS SANTA MONICA CLEVELAND SOUTHFIELD FORT WAYNE SHELTON HOUSTON FORT WORTH AUSTIN BOSTON WAUSAU WAUSAU DALLAS

TX WV SC CT IL CA OH MI IN CT TX TX TX MA WI WI TX

75201 25303 29715 06897 61616 90401 44126 48033 46801 06484 77018 76107 78704 02108 54401 54401 75221

EMPLOYERS NATL INS CO

PO BOX 2749

DALLAS

TX

75221

8006333480

EMS INSURANCE COMPANIES ENTHONE CORPORATION ENTHONE INC.ASARCO HLTH ENVISION RX OPTIONS EPITOME INC. EQUIFAX EQUITABLE LIFE ASSUR EQUITABLE LIFE/CAS INS

P.O. BOX 7911 350 FRONTAGE RD 21441 HOOVER ROAD 2181 E. AURORA RD P. O. BOX 5406 P.O.BOX 4081 P.O. BOX 3000 P.O. BOX 2460

WARWICK WEST HAVEN WARREN TWINSBURG LANCASTER ATLANTA LANCASTER SALT LAKE CITY

RI CT MI OH PA GA SC UT

02887 06516 48089 44087 17606 30302 29721 84110

4012441834

3095

0846 1407

5585 1599

5480

8005584444 7185911100 8002237034 8006348816 8007866526 8002615962 8882749993 8042812138 8005520455 8007159414 8002242522 8007159414 8003558040 8006487593 4077085000

8008802489 8666784726 8002421510 2033561691 3096790335 8006340173 8003113446 8005450589 2039248436 8004476588 8002524698 1356 8003435660 7158477111 8006333480

2460

8104978647 8003614542 7173917700 4048858718 8008323211 8003525150

8/1/2014

Code Name J55 A82 198 199 H30 D80 849 N48 J08 L94 K35 K85 H75 797 M80 M78 M79 800 200 E93 E55 A12 J93 N73 K18 H92 D61 679 J35 680 A24 201 919 M81 202 203 E97 206 205 204 K25 K26

EQUITABLE PLAN SVCS INC EQUITY LEAGUE HLTH TRUST EQUITY LIFE & ANNUITY EQUITY NTAL LIFE INS ERIN GRP ADMIN ERISA DESIGN SYST.ADM. ERM HEALTH INS. ESI/MEDCO ESSENTIAL CARE PLAN ESSENTIAL STAFFCARE EVERCARE EVEREST EVOLUTION HEALTH CARE EXCELLO CORP EXCELLUS BCBS NEW YORK UTICA EXCELLUS BCBS NY ROCHESTER EXCELLUS BCBS NY SYRACUSE EXCESS ASSETS EXECUTIVE FUND LIFE IN EXPERIENCE HLTH PLN EXPRESS PHARMACY EXPRESS SCRIPT EXPRESS SCRIPTS EXPRESS SCRIPTS (MEDCO) EXPRESS SCRIPTS/TRICARE EYE MED EYECARE PLAN OF AMERICA EYELEMATIC MFG EYEMED CARE PLAN OF AMER. FAIRFIELD PROCESSING CORP FALLON COMMUNITY FAMILY LIFE INS CO FAN STEEL-VR WESSON FARA BENEFITS FARM BUREAU LIFE INS FARM FAMILY LIFE INS FARMA CARE MNGMT SERV. FARMERS NEW WORLD LIFE FARMERS/TRADERS LIFE FARMLAND LIFE INS CO FCE BENEFIT FCI USA INC

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State Zip

Plus 4 Phone

P.O. BOX 720460 165 WEST 46TH ST 14TH FL 200 S MAIN ST 1020 W 4TH ST/P.O.BX 8063 P.O. BOX 7777 204 E. LOMBARD ST 4TH FL. 100 CLINTON ST. 399 JEFFERSON ROAD P.O. BOX 105738 250 COMMONWEALTH DR. P.O.BOX 659754 P.O. BOX 19002 P.O. BOX 5001 215 SO MAIN ST P.O. BOX 22999 P.O. BOX 22999 P.O. BOX 22999

OKLAHOMA CITY NEW YORK GREENVILLE LITTLE ROCK LANCASTER BALTIMORE BROOKLYN PARSIPPANY ATLANTA GREENVILLE SAN ANTONIO PROVO NEW PORT RICHY E WINDSOR ROCHESTER ROCHESTER ROCHESTER

OK NY SC AR PA MD NY NJ GA SC TX UT FL CT NY NY NY

73172 10036 29601 72203 17604 21202 11201 07054 30348 29615 78265 84605 34656 06088 14692 14692 14692

0460 2582

3130 WISHIRE BLVD 1979 MARCUS AVE S/C 101 PO BOX 830280 P.O. BOX 66583 P.O. BOX 41366 P.O. BOX 747050 P.O. BOX 66518/SA TEAM P.O. BOX 498488 P.O. BOX 498488 SEEMAR RD 4000 LUXOTTICA PLACE 88 ROSE HILL AVE P.O. BOX 15121 122 SIXTH AVE 398 MARION AVE P.O. BOX 1910 5400 UNIVERSITY AVE PO BOX 656 P.O. BOX 519 9611 SUNSET HWY. SE 960 JAMES ST 1963 BELL AVE 445 RAKOLETA RD 825 OLD TRAIL RD

SANTA MONICA LAKE SUCCESS BIRMINGHAM ST LOUIS PLYMOUTH CINCINNATI ST. LOUIS CINCINNATI CINCINNATI WATERTOWN MASON DANBURY WORCESTER SEATTLE PLANTSVILLE MANDEVILLE W DES MOINES ALBANY LINCOLN MERCER ISL SYRACUSE DES MOINES SAN ANTONIA ETTERS

CA NY AL MO MN OH MO OH OH CT OH CT MA WA CT LA IA NY RI WA NY IA TX PA

90404 11042 35282 63166 55441 45274 63166 45249 45249 06795 45040 06810 01615 98101 06479 70470 50265 12201 02865 98040 13201 50315 78216 17319

7777

3707

9754 9002

9007 0366 5518 8488

8007492631 2128699380 5013725550 7175811300 8009524442 7188553960 8002727243 8006808728 8662980803 8003930993 8002864160 8003643865 2036232411 8006716081 8006716081 8006716081

8008317783 8002223383 8004516245 8003052179 8008413045 8009554879 8772261115 8002213272 8669393633

0121

8002832556 8606284705 8002243272 5184315000 8007771023

8008999355 7179387317

8/1/2014

Code Name A86 B12 469 BLG 941 867 207 208 210 209 681 K29 211 212 E54 682 D45 D44 M16 213 215 216 217 214 218 219 220 221 222 223 C21 B37 M18 224 225 226 B96 E05 E06 E90 F21 F38

FED CONTRACT EMP HLTH FED HOME LIFE INS FED. HM LIFE INS FEDERAL BLACK LUNG PROG FEDERAL EXPRESS FEDERAL HEALTH CARE FEDERAL INS CO FEDERAL KEMPER INS FEDERAL LIFE INS CO FEDERAL LIFE/CAS INS FEDERAL PAPER BOARD FEDERATED HR SERVICES FEDERATED LIFE INS CO FEDERATED MUTUAL INS FEDERATED-ALLIES RET ASSO FENN MANUFACTURING FHP ADM. FHP HEALTH CARE FIDELIS CARE NEW YORK FIDELITY BANKERS LIFE FIDELITY INTERSTATE LIFE FIDELITY MUT LIFE INS FIDELITY SECUR LIFE FIDELITY/CAS CO OF NY FIRE & CAS INS CO/CT FIREMAN'S FUND AMER FIREMAN'S FUND AMER FIREMAN'S FUND INS CO FIREMAN'S FUND INS CO FIREMEN'S INS CO/NJ FIRST ADM. FIRST BENEFIT CORP FIRST CHOICE HEALTH FIRST COLONY LIFE INS FIRST CONT LIFE/ACCDT FIRST FARWEST LIFE FIRST HEALTH FIRST HEALTH FIRST HEALTH FIRST HEALTH FIRST HEALTH FIRST HEALTH

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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PO BOX 791405 6277 SEA HARBOR DR 78 W MICHIGAN AVE P.O.BOX 740 P.O.BOX 727 21520 S.PIONEER BLVD 111 PROSPECT ST RT 2 3703 LAKE AT PHINGSTEN 78 W MICHIGAN AVE INLAND RD P.O. BOX 850958 129 E BROADWAY 129 E BROADWAY PO BOX 9367 FENN RD P.O. BOX 5049 P.O. BOX 52078 95-25 QUEENS BLVD 830 E MAIN ST PO BOX 54493 250 KING OF PRUSSIA RD 3130 BROADWAY 80 MAIDEN LANE 9 FARMSPRINGS DR 110 WILLIAM ST 110 WILLIAM ST 110 WILLIAM ST 110 WILLIAM ST 80 MAIDEN LANE P.O. BOX 8150 PO BOX 879 P.O. BOX 12659 P.O. BOX 1280 2302 SMITH ST 400 S W SIXTH AVE P.O. BOX 17 PO BOX 8091 PO BOX 30084 P.O.BOX 671088 P.O. BOX 340725 P.O. BOX 488

SAN ANTONIO ORLANDO BATTLE CRK LANHAM MEMPHIS HAWAIIAN GARDENS EAST ORANGE LONG GROVE GLENVIEW BATTLE CRK VERSAILLES RICHARDSON OWATONNA OWATONNA GARDEN CITY NEWINGTON COSTA MESA PHOENIX REGO PARK RICHMOND LOS ANGELES RADOR KANSAS CITY NEW YORK FARMINGTON NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK RAPID CITY ANDERSON SEATTLE LYNCHBURG HOUSTON PORTLAND BOISE LONDON SALT LAKE CITY HOUSTON HARTFORD PROVIDENCE

TX FL MI MD TN CA NJ IL IL MI CT TX MN MN NY CT CA AZ NY VA CA PA MO NY CT NY NY NY NY NY SD IN WA VA TX OR ID KY UT TX CT RI

1405

78279 32887 49016 20706 38194 90716 07019 60049 60025 49016 06383 75085 55060 55060 11530 06111 92628 85072 11374 23219 90054 19087 64111 10038 06032 10038 10038 10038 10038 10038 57709 46015 98111 24505 77006 97205 83707 40742 84130 77267 06134 02901

9320

8008999355 8002530856 8002530856 8006387072 9013693600 2138330114

8002530856 0958

8003372363

9367

8008283605

2078

7145136126 8006474347 8883433547

21596470000

6053432509 3177788555 8888891112 8883255433

1088

8005270772 8006066463 8005722089 8008335914 8002747526 8006066463

8/1/2014

Code Name F45 F46 H56 H68 I16 809 227 K27 M82 228 229 230 L92 E53 E20 E15 M29 K44 A61 857 J59 K07 L01 J71 G50 683 231 K63 232 233 946 J68 234 M83 L93 I10 L02 M84 F44 E22 873 E46

FIRST HEALTH FIRST HEALTH FIRST HEALTH FIRST HEALTH FIRST HEALTH FIRST HEALTH/EBP FIRST INS CO /HAWAII FIRST MEDICAL CARD INC. FIRST PRIORITY HEALTH FIRST PROTECTION LIFE FIRST PYRAMID LIFE FIRST REPUBLIC LIFE FIRST SERVICE ADMIN FIRST UNITED AMER. LIFE FIRST UNITED AMERICAN LF. FISERV HEALTH FISERV SAN ANTONIO (UMR) FLA COMBINE LIFE DENTAL FLEET RESERVE ADM. FLEX PLUS FLORIDA BEN. ADMIN FLORIDA HEALTHCARE PLANS FLORIDA HSP HLTHCARE SYS FLRX FMH BENEFIT SERVICES FOODWAY NATIONAL FOREMOST LIFE INS CO FOUNDATION BENEFITS ADMIN FOUNDATION LIFE INS FOUNDERS LIFE ASSUR FOX EVERETT FQHC WRAP AROUND (7990) FRANKLIN LIFE INS CO FRINGE BENEFITS SERV. FT. DEARBORN DENTAL GROUP FUNDAMENTAL CARE FUTURE SCRIPTS G.E. CAPITAL LTC G.E. CAPITOL ASSURANCE G.E. VISION CARE BENEFITS G.O.D. INC. GAINEY INSURANCE SVCS.

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P.O. BOX 6500 P.O. BOX 3086 P.O. BOX 22860 P.O. BOX 23070 4789 RINGS ROAD 740 EAST LANCASTER PIKE 1100 WARD AVE P.O. BOX 9950 19 NORTH MAIN ST 3203 WOMAN'S CLUB DR PYRAMID LIFE BLDG PO BOX F 3035 LAKELAND HILLS BLVD. PO BOX 299 SCOTTS CORNER P.O. BOX 3125 PO BOX 690450 12668 SILICON DR. P.O. BOX 100135 400 LOCUST ST 8TH FL. P.O.BOX 6000 13080 SOUTH BELCHER RD 1340 RIDGEWOOD AVE. P.O. BOX 536847 P.O. BOX 41965 P.O. BOX 25946 1000 SILAS DEANE HGWY 5800 FOREMOST DR P.O. BOX 559017 330 MAIN ST 100 TWIGGS ST P.O.BOX 188 PO BOX 2920 FRANKLIN SQUARE P.O. BOX 21240 P.O. BOX 23060 2036 E.CAMELBACK RD. P.O. BOX 13673 11000 PRAIRIE LAKES DRIVE 1650 LOS GAMA DRIVE P.O. BOX 2243 P.O.BOX 100 CLAY AVENUE

CORAPOLIS MILWAUKEE TUCSON TUSCON COLUMBUS EXTON HONOLULU ARECIBO WILKES BARRE RALEIGH LITTLE ROCK BATON ROUGE LAKELAND POUND RIDGE SYRACUSE SAN ANTONIO SAN ANTONIO COLUMBIA DES MOINES HAMPTON LARGO HOLLY HILL ORLANDO ROCHESTER OVERLAND PARK WETHERSFIELD GRAND RAPIDS AUSTIN CHATHAM TAMPA JACKSON HARTFORD SPRINGFIELD DENVER BELLEVILLE PHOENIX PHILADELPHIA EDEN PRAIRIE SAN RAFAEL SCHENECTADY KEARNEY GRAND RAPIDS

PA WI AZ AZ OH PA HI PR PA NC AR LA FL NY NY TX TX SC IA NH FL FL FL NY KS CT MI TX NJ FL MS CT IL CO IL AZ PA MN CA NY NJ MI

15108 53201 85734 85734 43017 19341 96814 00613 18711 27612 72201 70893 33805 10576 13220 78269 78249 29202 50398 03842 33773 32117 32853 14604 66225 06109 49506 78755 07938 33062 39205 06104 62713 80221 62223 85020 19101 55344 94903 12301 07032 49548

Plus 4 Phone 8004510929 8006905058 8003237676 8002806658 9163744600 8002237034 9950

7878152000 8008228753

2225

8036152225 9147644016 3154512544 8003683653 8002181004 8772039921 8004241120 6039291140 7275304144 3866767110 8007414810 8005520053 8009909058

3125

8668689449

0188

0060 3675 1899

6019816000 2175282011 3034266755 8007217987 8003085948 8886787012 9525166257 8004568329 8004339375 2013443013 8003470064

8/1/2014

Code Name B97 E88 G99 235 J02 I31 I47 I40 K36 I95 236 237 D46 961 J25 D82 L91 L90 684 976 L86 B39 798 H16 A21 K73 K53 238 D83 239 240 241 242 M09 L13 985 I82 243 244 246 245 I85

GALLAGHER BASSETT SERV. GALLAGHER WOODSMALL GALLEGHER BENEFITS ADMIN GAMBLE-ALDEN LIFE GARDEN STATE HEALTH CARE GE FINANCIAL ASSURANCE GE FINANCIAL ASSURANCE GE GRP LIFE ASS. CO GE LIFE/ANNUITY ASSUR CO. GEISINGER GEN AMER LIFE INS CO GEN UNITED LIFE INS GENERAL ACCIDENTAL LIFE GENERAL ADMINISTRATORS GENERAL CASUALTY GENERAL ELEC/GE PENSION GENERAL ELECTRIC CO. GENERAL ELECTRIC CO. GE VISION GENERAL ELECTRIC CO/MASS GENERAL MILLS INC. GENERAL MOTOTS CORP GENERAL PRESCRIPTIONS GENERAL SIGNAL CORP GENERAL VISION GENES HLTH VEN NATL BENE GENWORTH FINANCIAL GENWORTH LIFE/ANNUITY GEO WASHINGTON LIFE GEORGE WA. UNIV.HLTH.PLAN GEORGIA INTERNATIONAL GEORGIA LIFE/HEALTH GERBER LIFE INS CO GERMANTOWN INS CO GHI GHI HMO GILBERT/MAGILL CO. GILSBAR GLENS FALLS INS CO GLOBAL SURETY & INS GLOBE LIFE INS GLOBE LIFE/ACCDT INS GMP EMPL. RETIREE TRUST

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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P.O. BOX 23812 2345 GRAND SUITE 800 P.O. BOX 34297 5100 GAMBLE DR P.O. BOX 190349 100 BRIGHT MEADOW BLVD P.O. BOX 1477 100 BRIGHT MEADOW BLVD P.O. BOX 10821 P.O. BOX 8200 P. O. BOX 1805 1400 50TH ST P. O. BOX 363786 P.O.BOX 5430 P.O. BOX 519 PO BOX 6024 INSURANCE CONTINUATION P.O. BOX 1501 100 WOODLAWN AVE GENERAL MILLS BLVD. INDEPENDENT HELTHCARE TRUST 61 FREEMAN ST. P O BOX 10010 P.O. BOX 11138 148 W STATE ST SUITE 100 175 ADDISON RD P.O. BOX 40011 P. O. BOX 8700 4550 MONTGOMERY AV STE800 PO BOX 7325 PO BOX 1676 P.O. BOX 7005 GERMANTOWN MARKET SQ P.O. BOX 3000 P.O. BOX 4141 P.O.BOX 410249 P.O. BOX 1946 80 MAIDEN LANE 135 KIEWIT PLAZA GLOBE LIFE CENTER GLOBE LIFE CENTER 5245 BIG PINE WAY S.E.

TUSCAN KANSAS CITY SAN ANTONIO ST LOUIS PK BROOKLYN ENFIELD GREENFIELD ENFIELD CLEARWATER DANVILLE DUBLIN W DES MOINES SAN JUAN GREENVILLE SIMSBURY SCHENECTADY CHICAGO LATHAM PITTSFIELD MINNEAPOLIS CINCINNATI NEWARK STAMFORD CHICAGO KENNETT SQUARE WINDSOR LYNCHBURG JACKSONVILLE BETHESDA ATLANTA ATLANTA PARKERSBURG PHILADEL NEW YORK KINGSTON KANSAS CITY CONINGTON NEW YORK OMAHA OKLAHOMA CITY OKLAHOMA CY FORT MYERS

AZ MO TX MN NY CT MA CT FL PA OH IA PR SC CT NY IL NY MA MN OH NJ CT IL PA CT VA FL MD GA GA WV PA NY NY MO LA NY NE OK OK FL

85734 64108 78265 55416 11219 06082 01302 06083 33757 17821 43017 50265 00936 29606 06070 12301 60693 12110 01201 55426 45201 07105 06904 60611 19348 06095 24506 32211 20184 30357 30301 26102 19144 10116 12402 64141 70434 10038 68131 73184 73184 33907

Plus 4 Phone 8003545112 8009348923 8882210339

1477 1955 8821 8200

6024

0725

7186867272 8607371000 8004512513 8607371000 8778259337 8005040443 8004457119 8097584888 8032711391 8604083279 8004323450 8002427419 8884339370 8002525259 6125402311 8004894646 8003412234 8004321449 8004446353 8607371000 8008141898 2024160400

8006280011 3000

5998

2125014444 8772444466 8164743535 9858923520

4052701400 8006545433 9419366242

8/1/2014

Code Name C80 247 248 H11 C94 987 924 249 250 251 685 N79

252 253 254 255 256 257 258 E75 178 E23 F90 F91 259 H08 B69 A40 B98 E76 E24 686 K90 K47 B13 E56 I30 E07 B70 B14 260 261

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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GODWINS BOOKE & DICKENSON GOLDEN RULE LIFE INS GOLDEN STATE MUT LIFE GOOD SAMARITAN GOODWAY TRANSPORT INC. GOODYEAR TIRE GORDON FOOD SERVICES GOTHAM LIFE INS OF NY GOVERNMENT EMPLOYEES GOVERNMENT PERSONNEL GOVT EMPLOYEES HOSP ASSOC

P.O. BOX 15 7440 WOODLAND DR/J BUTLER 1999 W ADAMS BLVD P.O. BOX 279 PO BOX 2283 P.O.BOX 677 P.O.BOX 1787 126 N FRANKLIN ST GEICO PLAZA PO BOX 32266 P O BOX 4665

WINSTON SALEM INDIANAPOLIS LOS ANGELES BEACH GROVE YORK AKRON GRAND RAPIDS HAMPSTEAD WASHINGTON SAN ANTONIO INDEPENDENT

NC IN CA IN PA OH MI NY DC TX MO

27102 46278 90018 46107 17405 44309 49501 11551 20076 78284 64051

GPA

P.O. BOX 749075

DALLAS

TX

75244

GRANGE MUT LIFE INS GREAT AMER INS CO GREAT AMER LIFE INS GREAT AMER RESERVE IN GREAT COMMONWEALTH GREAT LAKES INS CO GREAT SOUTHERN LIFE GREAT WEST HEALTH INS. GREAT WEST LF/ANTHEM HLT. GREAT WEST LIFE GREAT WEST LIFE GREAT WEST LIFE GREAT WEST LIFE ASSUR GREAT WEST LIFE INS. GREAT WEST LIFE/GEN AMER GREATER ATLANTIC HLTH SER GRIFFIN HOSP. HLTH PLAN GROUP ADMINISTRATORS GROUP BENEFIT SERVICES GROUP HEALTH INS GROUP HEALTH OPTIONS GROUP HEALTH PLAN GROUP INS SERV CENTER GROUP INSURANCE CO. GROUP LINK GROUP PLAN ADMINISTRATORS GROUP RESOURCES GROUP SERVICES ADMIN GUARANTEE MUTUAL LIFE GUARANTEE RESERVE

PO BOX 48 680 WALNUT ST 6310 SAN VICENTE BLVD 2020 LIFE OAK 1420 VICEROY DR 1015 EUCLID AVE 3121 BUFFALO SPEEDWAY P.O. BOX 88260 1000 GREAT WEST DR. 10000 N. CENTRAL EXPWY. P.O. BOX 8020 200 RENAISSANCE CTR 1000 GREAT WEST DR. P.O. BOX 11111 1000 GREAT WEST DR 3550 MARKET STREET 680 BRIDGEPORT AVE. 1880 N. ROSELLE RD. P.O. BOX 4368 441 NINTH AVE. P.O. BOX 34585 P.O. BOX 61943 1020 PLAIN ST/BOX 9120 PO BOX 9016 6612 E. 75TH ST STE200 PO BOX 691930 3080 PREMIERE PARKWAY N.W 30 MONTGOMERY ST STE 506 8721 INDIAN HILLS DR 128 STATE ST

NAMPA CINCINNATI LOS ANGELES DALLAS DALLAS CLEAVELAND HOUSTON ATLANTA KENNETT DALLAS NORTH OLMSTEAD DETROIT KENNETT FORT SCOTT KENNETT PHILADELPHIA SHELTON SCHAUMBERG LUTHERVILLE NEW YORK SEATTLE HARRISBURG MARSHFIELD ANDOVER INDIANAPOLIS SAN ANTONIO DULUTH JERSEY CITY OMAHA HAMMOND

ID OH CA TX TX OH TX GA MO TX OH MI MO KS MO PA CT IL MD NY WA PA MA MA IN TX GA NJ NE IN

83651 45202 90048 75201 75235 44115 77006 30356 63857 75231 44070 48243 63857 66701 63857 19104 06484 60195 21094 10001 98124 17106 02050 01810 46250 78269 30071 07302 68114 46320

Plus 4 Phone 1719

2283

8003683804 3172974123 8009539150 7177676565 2167966531 6165307000 2029860733

4665

8008216136 8008277223

2166967500 8260

3749

1943

2876 3652

8007236991 8006638081 8006853020 8006638081 8006638081 8006638081 8006638081 8005756533 2158238610 8609268862 8475191880 4108321333 2125014444 8889014636 8007276754 7818298559 8004429300 8003597408 2106910500 7706238383 2123492699

8/1/2014

Code Name 262 H60 J83 263 I41 F87 264 687 265 266 H87 267 268 G88 J09 F30 F85 I07 D47 269 799 270 I27 N56 B81 J86 C40 K87 G46 N65 E77 I76 D62 E25 HCI B40 K83 E08 G89 F65 A75 D07

GUARANTEE TRUST LIFE GUARDIAN GUARDIAN GUARDIAN LIFE INS CO GUARDIAN PHS HEALTNET GUARDIAN RESOURCES HEALTH GUARDSMAN LIFE INS CO GUILFORD INDUSTRIES GULF ATLANTIC LIFE IN GULF LIFE INS CO GULF SOUTH RISK SERVICES HANOVER INS CO HANOVER LIFE INS CO HARBORSIDE HEALTHCARE HARRINGTON BENEFIT SERV. HARRINGTON BENEFITS HARRINGTON BENEFITS HARRINGTON BENEFITS HARRINGTON BENEFITS SVCS. HARTFORD ACCDT/IMDEM HARTFORD EAST CORP HARTFORD LIFE/ACCDT HARTFORD RETIREE MEDICAL HARTLAND EMPLOYEE BENEFITS HARVARD PILGRIM HAWAII BC/BS HEALTH ADVANTAGE HEALTH ALLIANCE PLAN HEALTH AMERICA HEALTH AMERICA HEALTH ASSURANCE HEALTH BENEFIT CLAIM DEPT HEALTH BENEFIT PROGRAM HEALTH CARD SERVICES HEALTH CARE INC. HEALTH CARE PLAN HEALTH CARE SOLUTIONS GRP HEALTH CHOICE HEALTH CHOICE OF CT HEALTH CLAIM SERVICES HEALTH CLAIMS SERVICES HEALTH CLAIMS SERVICES

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P.O. BOX 1144 P.O. BOX 423 P.O. BOX 8007 P.O. BOX 8024 1 LAKESHORE DR. P.O. BOX 3767 1025 W ASHWORTH PO BOX 168 PO BOX 27246 1301 GULF LIFE DR P.O. BOX 3857 3185 MONTROSE BLVD 3185 MONTROSE BLVD P.O. BOX 4925 P.O. BOX 720 P.O. BOX 70100 P.O. BOX 16789 P.O. BOX 197347 P.O. BOX 909772 P.O. BOX 4925 122 PARK AVE HARTFORD PLAZA P.O. BOX 10432 P.O. BOX 400 P.O. BOX 699183 P.O. BOX 860 P.O. BOX 48 2850 WEST GRAND BLVD 2575 INTERSTAE DRIVE P.O. BOX 7089 5 GATEWAY CENTER STE511 P.O. BOX 5007 1600 CLIFTON RD. (E07) P.O. BOX 1170 370 BASSETT ROAD 900 GUARANTY BUILDING P.O. BOX 1309 PO BOX 419726 P.O. BOX 382497 P.O. BOX 9615 P.O. BOX 273940 P.O. BOX 30367

GLENVIEW EAST BRIDGEWATER APPLETON APPLETON BRIDGEWATER HOLIDAY DES MOINES GUILFORD HOUSTON JACKSONVILLE HOUMA HOUSTON HOUSTON LANCASTER PUEBLO SHREVETORT COLUMBUS LOUISVILLE CHICAGO SYRACUSE E HARTFORD HARTFORD DES MOINES KINSTON QUINCY HONOLULU PROVIDENCE DETROIT HARRISBURG LONDON PITTSBURGH HARRISON ATLANTA PORT WASHINGTON NORTH HAVEN BUFFALO MUSKOGEE KANSAS CITY BIRMINGHAM DEERFIELD BEACH BOCA RATON TAMPA

IL MA WI WI MA FL IA ME TX FL LA TX TX PA CO LA OH KY IL NY CT CT IA NC MA HI RI MI PA KY PA AR GA NY CT NY OK MO AL FL FL FL

60025 02333 54912 54912 02324 34690 50265 04443 77027 32207 70361 77006 77006 17604 81002 71137 43216 40259 60690 13221 06108 06115 50306 28502 02269 96814 02901 48202 17710 40742 15222 72602 30333 11050 06473 14202 74402 64173 35238 33442 33427 33630

Plus 4 Phone 0423

8476990600 8882780454 8008734542 8882784542 8882784542 8005520455

9856321717

0720 6789

0432 9183 2365

5007

6726

3940 3367

8002359562 8004468182 8002562657 8008482664 8005912860 8005336654 8004485813 2035289406 8004485813 8006268609 8006826881 8883334742 8089455110 8006886965 8004224641 8007887895 8007888445 8007351022 8005461900 4046398012 8006453332 2032342011 7168471480 8007491422 8004446254 8887812707 9544802744 4079942202 8004468182

8/1/2014

Code Name G07 863 947 M85 G54 C57 689 M86 I02 I09 F79 I32 PHS

928 F03 L25 J16 H26 H24 965 G82 G90 M87 D84 E74 877 G91 M43 D27 M31 D06 E47

E58 L52 688 H04 K11 G63 K61 L63 I22 M30

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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HEALTH CONNECTICUT PPO HEALTH CORP OF AMERICA HEALTH ECONOMICS CORP. HEALTH ECONOMICS GROUP HEALTH FIRST/HEALTH PLANS HEALTH GUARD OF LANCASTER HEALTH INSURANCE PLAN HEALTH INSURANCE PLAN RX HEALTH MANAGEMENT CTR HEALTH MANAGMENT SYSTEM HEALTH NET HEALTH NET HMO

P.O. BOX 5006 1160 W SWEDESFORD RD P.O.BOX 92201 1050 UNIVERSITY AVE 8247 DEVEREUX DRIVE 280 GRANITE RUN DR STE105 55 WATER STREET 80 WOLF RD P.O. BOX 518 100 CUMMINGS CTR. STE3251 P.O. BOX 9103 21650 OXNARD ST

WALLINGFORD BERWLYN HOUSTON ROCHESTER MELBOURNE LANCASTER NEW YORK ALBANY SPRINGFIELD BEVERLY VAN NUYS WOODLAND HILLS

CT PA TX NY FL PA NY NY MA MA CA CA

06492 19312 77292 14607 32940 17601 10041 12205 01101 01915 91409 91367

6810 8190

HEALTH NET/PHS

1 FAR MILL XING BX 904

SHELTON

CT

06484

0944

8004387886

HEALTH NEW ENGLAND HEALTH OPTIONS INC HEALTH OPTIONS PROGRAM HEALTH PARTNERS HEALTH PARTNERS-PASSPORT HEALTH PLAN ADM. INC HEALTH PLAN ADMIN. HEALTH PLAN OF FLA HEALTH PLAN OF FLA HEALTH PLAN OF OHIO VALLEY HEALTH PLAN SERVICES HEALTH PLAN SVCS/CONS.GRP HEALTH PLANS HEALTH PLANS INC HEALTH PLUS OF MICHIGAN HEALTH RISK MANAGEMENT HEALTH SERVICE REVIEW OF OHIO HEALTH SERVICES ASSOC.

1 MONARCH PL 8500 NORTH WEST 33 ST P.O. BOX 2921 8100 34TH AV. SO. 2 PERIMETER PARK SOUTH P.O. BOX 2638 P.O.BOX 5817 P.O. BOX 819006 3251 HOLLYWOOD STE 401 52160 NATIONAL RD EAST ST. P.O. BOX 30102 P.O. BOX 9191 3501 EAST FRONTAGE RD P.O. BOX 5199 P.O. BOX 1700 P.O. BOX 9410 6730 ROOSEVELT AVE. P.O. BOX 64099

SPRINGFIELD MIAMI CLINTION MINNEAPOLIS BIRMINGHAM ROCKFORD WALLINGFORD HOLLYWOOD HOLLYWOOD CLAIRSVILLE TAMPA FRAMINGHAM TAMPA WESTBORO FLINT MINNEAPOLIS FRANKLIN ST. PAUL

MA FL IA MN AL IL CT FL FL OH FL MA FL MA MI MN OH MN

01144 33122 52733 55440 35243 61132 06492 33081 33021 43950 33630 01701 33630 01581 48501 55440 45005 55164

1006 1932 2921

8008424464 8009553589 8007737725 8008832177 2059681400 8156335800 2037941703 8004478255 8003855116 8886138385 8002377767 8008328333 8002953859 8883359400 8003329161 8008666730 5134220063 6126455719

HEALTH SOURCE PROVIDENT

25 MERCHANT ST. STE.100

CINCINNATI

OH

45246

HEALTH SRCE OF CT/CIGNA HEALTH TRANS HEALTH/WELFARE FUND HEALTHCARE MANAGMENT HEALTHCARE SAVINGS HEALTHCARE VALUE MGMT HEALTHCOMP ADMINISTRATORS HEALTHEASE HEALTHKEEPERS HEALTHMARKETS

P.O. BOX 2099 6060 S. WILLOW DR. 1981 MARCUS AVE/STE.C108 P.O. BOX 85016 4530 PARK RD. STE.110 100 RIVER RIDGE DR. P.O. BOX 45018 P.O. BOX 31372 P.O. BOX 26623 P.O. BOX 981606

CONCORD GREENWOOD VILLAGE NEW HYDE PARK BELLEVUE CHARLOTTE NORWOOD FRESNO TAMPA RICHMOND EL PASO

NH CO NY WA NC MA CA FL VA TX

03302 80111 11042 98015 28209 02062 93718 33631 23261 79998

8002274744 1096

7617

9191

9410 5737 0099

8002284912 5852419500 8007167737 7175609049 8004478255 5184468002 8006427694 9788672111 8005220088 8002916911

8005377100

2099 1038

8606749922 8003137667 6313245000 8884867927 8008338464 8009224286 8004427247 8002780656 8046429808 8172555200

8/1/2014

Code Name I20 I57 B71 L44 L11 163 I11 J27 F10 M53 A62 C41 272 H44 I68 B72 L23 F35 B49 M88 H82 A63 B41 691 F82 940 690 C58 D94 L04 J95 273 274 275 278 279 280 N72 F99 C81 M56 J67

HEALTHNET HEALTHNET HEALTHPASS HEALTHPLAN OF NY HEALTHPLEX - DENTAL HEALTHSCAPE HEALTHSCOPE BENEFITS HEALTHSMART HEALTHSOURCE PROVIDENT HEALTHY CHOICE BENEFITS HELIKON HEALTH PLAN HELLER ASSOC. HERALD LIFE INS CO HERE WELFARE FUND HERITAGE CONSULTANTS HERTZ PLAN MANAGEMENT HEWITT COLEMAN & ASSOCIATES HHS ADMINISTRATORS HIGHMARK GENERAL HIGHMARK SECURITY 65 PLAN HIGHMARK SERVICES HILL HAVEN CORP HILLHOUSE ASSOC HITCHNER MFG HLTH S. FOUNDATION ADMIN. HLTH. CHOICE/N.E. HLTHL HLTH. REINS. /TRAVELERS HLTH. RISK MANAGEMENT HLTH. SOURCE CT./CIGNA HM BENEFITS ADMINISTRATOR HMC PPO HOLIDAY LIFE INS CO HOME BENEFICIAL LIFE HOME INS CO HOME OWNERS LIFE INS HOME SECURITY LIFE HORACE MANN LIFE INS HORIZON HORIZON BC/BS HORIZON HLT.CARE S.W. EMP HOSPITALITY CARE HOTEL EMP&REST. EMP.INTL

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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405 LEXINGTON AVE P.O. BOX 14700 P.O. BOX 41566 HIP CONTINUUM HEALTH PART 333 EARLE OVINGTON BLVD. P.O. BOX 305059 P.O. BOX 612988 P.O. BOX 53010 BOX 6185 STATION B P.O. BOX 2164 P.O. BOX 1187 2787 BRISTOL ST. 1 INDEPENDENT DR 1921 LAS VEGAS BLVD.S.106 P.O. BOX 1730 P.O. BOX 726 P.O. BOX 6708 2716 ALBANY ST. P.O. BOX 535061 120 FIFTH AVE. PLACE P.O. BOX 535078 P.O. BOX 2995 98 SAN JACINTO BLV.STE800 ELM ST P.O. BOX 13188 3 FOREST PARK DR. P.O. BOX 740800 P.O. BOX 4022 P.O. BOX 2099 600 GRANT ST RM 2618 P.O. BOX 488 1500 JACKSON 3901 W BROAD ST 3050 HOLCOMB BRGD RD 307 N MICHIGAN AVE 505 W CHAPEL HILL ST 1 HORACE MANN PLAZA P.O. BOX 1219 3 PENN PLAZA E.PPO25 P.O. BOX 10811 P.O. BOX 6702 321 WEST 44TH ST.

NEW YORK LEXINGTON PHILADELPHIA NEW YORK UNIONVILLE NASHVILLE DALLAS LUBBOCK GREENVILLE NOBLESVILLE UNIONTOWN COSTA MESA JACKSONVILLE LAS VEGAS AUBURNDALE PARK RIDGE GREENVILLE SCHENECTADY PITTSBURGH PITTSBURGH PITTSBURG TACOMA AUSTIN MILFORD BIRMINGHAM FARMINGTON ATLANTA KALAMAZOO CONCORD PITTSBURGH FARMINGTON DALLAS RICHMOND SUITE D NORCROSS CHICAGO DURHAM SPRINGFIELD NEWARK NEWARK ALBERQUERQUE COLUMBIA NEW YORK

NY KY PA NY NY TN TX TX SC IN PA CA FL NV FL NJ SC NY PA PA PA WA TX CT AL CT GA MI NH PA CT TX VA GA IL NC IL NJ NJ NM SC NY

10174 40512 19101 10116 11553 37230 75261 79453 29606 46061 15401 92626 32276 89104 33823 07656 29606 12303 15253 15222 15253 98401 78720 03055 35202 06032 30374 49003 03302 75219 06034 75080 23230 30071 60601 27701 62715 07101 07105 87184 29260 10036

Plus 4 Phone

1566 2845 5059 3010

2995

3188 0800 4022 2099

8002050095 8002050095 2154737511 8004478255 8884685184 8009990972 5012251551 8006870500 8003543042 3177763703 4124380536 7145497052 8004578512 8002822460 8003544225 8882986828 8008333650 8002415704 4125447000 8664013762 2065724901 8007235555 2059913875 8606787450 8008420004 8002530966 8005314005 8002792624 8009224966 8043588431

0811

2177892500 8883405001 8003552583 8007266547 8032648739 8662615676

8/1/2014

Code Name J41 281 N78 868 A45 H48 M32 G55 H36 H34 915 H89 E98 H46 J91 692 C43 693 L98 K16 283 G92 284 285 286 287 F19 K10 L19 C42 288 932 I80 289 290 291 292 293 294 M89 E09 295

HOTEL EMP/REST.INT'L UNIO HOUSEHOLD INS CO HRI HUDSON GRP ADMIN INC HUGHES AIRCRAFT CO HUMANA HUMANA DENTAL PLANS HUMANA EMP. HEALTH HUMANA HEALTH CARE HUMANA INS OF PUERTO RICO HUMANA MED. PLAN HUMANA/CHOICECARE HUMANA-VENCOR MED. I.C.H.A IAB IBEW LOCAL 325 JOINT FUND ICH HEALTH PLAN IDEAL MFG CO IDEALIFE INS. CO. IDS ILL MUT LIFE/CAS CO. IMMEDIATE PHARMECEUTICAL IMPERIAL CAS & INDEM IMPERIAL LIFE ASSUR INA LIFE INS CO/CALIF INA LIFE INS CO/N. Y. INDECS CORPORATION INDEMNITY PLAN INDEPENDENCE ADMINISTRATORS INDEPENDENCE B/C INDEPENDENCE LIFE/ACCD INDEPENDENT ADMIN CO INDEPENDENT HEALTH ASSOC INDEPENDENT LIBERTY INDEPENDENT LIFE/ACCD INDEPNT ORD/FORESTERS INDIANAPOLIS LIFE INS INDUSTRIAL CAS INS CO INDUSTRIAL LIFE INS INFORMED RX INGLES MARKETS INC. INLAND LIFE INS CO

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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711 NIRTH DR. PO BOX10020 130 E RANDOLPH ST P.O. BOX 58 P.O.BOX 1403 PO BOX 2947 LOOP STATION P.O. BOX 14601 P.O. BOX 14611 1100 EMPLOYERS BLVD. P.O. BOX 29425 383 AVE FD ROOSEVELT P.O.BOX 19058 P.O. BOX 3188 P.O.BOX 14601 2024 HICKORY RD. P.O. BOX 224767 24 EMMA ST P.O. BOX 11670 PO BOX 157 P.O. BOX 10859 P.O. BOX 40007 411 LIBERTY ST 5540 WALLINGS RD. S. 15TH STREET 95 ST CLAIR AVE W/TORONTO 737 DELAWARE AVE/PO 39 737 DELAWARE AVE/PO 39 1099 WALL ST W.SUITE 317 P.O. BOX 678 P.O. BOX 1010 1901 MARKET ST. ONE INDEPENDENT DR. 10404 6TH AVE NORTH P.O. BOX 9066 126 OTTAWA AVE. NW 1 INDEPENDENT DR 789 DON MILLS RD 2960 N MERIDIAN ST 10 S RIVERSIDE PLAZA 2808 FAIRMOUNT ST 26 HARBOR PARK DR. PO BOX 15174 223 W JACKSON BLVD

AURORA CHICAGO EVANSVILLE FINDLAY MINNEAPOLIS LEXINGTON LEXINGTON GREENBAY SAN ANTONIO SAN JUAN JACKSONVILLE CINCINNATI LEXINGTON HOMEWOOD DALLAS BINGHAMTON SALT LAKE CITY BEACON FALLS CLEARWATER LYNCHBURG PEORIA NORTH ROYALTON OMAHA ONTARIO CAN M4 V1 BUFFALO BUFFALO LYNDHURST LIVERPOOL HORSHAM PHILADELPHIA JACKSONVILLE PLYMOUTH BUFFALO GRAND RAPIDS JACKSONVILLE ONTARION CAN C1T9 INDIANAPOLIS CHICAGO DALLAS PORT WASHINGTON ASHEVILLE CHICAGO

IL IL IN OH MN KY KY WI TX PR FL OH KY IL TX NY UT CT FL VA IL OH NE N7 NY NY NJ NY PA PA FL MN NY MI FL M3 IN IL TX NY NC IL

60598 60601 47701 45839 55402 40512 40512 54344 78229 00918 32245 45201 40512 60430 75222 13905 84111 06403 33757 24506 61634 44133 68102 00000 14240 14240 07071 13088 19044 19103 32276 55441 14231 49502 32276 00000 46208 60606 75201 11050 28813 60606

Plus 4 Phone 8006870500

4611

2131 9058 4601

8007271444 8003426454 8006484437 8004486262 8003331455 8005584444 8004486262 7872827900 8002233713 8005557997 8003331009 8005385099 8002751171 8005385099

9939

8663989310 8883208741 8002333872

0678 1480

0174

8008736364 2157844303 8883567899 8003581901 9043585100 8003280927 8005013439

5166056625 7046692941

8/1/2014

Code Name K30 297 J88 B99 694 C45 296 D49 L22 695 696 298 D86 905 299 300 M33 N64 302 301 303 304 305 G93 697 699 698 D48 306 307 308 I37 G32 832 L16 700 309 310 311 313 A92 F12

INNOVIANT INS CO STATE OF PA INS. ADMIN. OF AMER. INS. DESIGN ADM. INS. PROGRAMMERS INSURANCE ADM. CORP INSURANCE CO/N. AMER. INSURANCE FUND INSURANCE MANAGEMENT SERV. INSURANCE SERVICE CTR INSURED PLANS INC INTEGON LIFE INS CO INTEGRATED BENF.SOLUTIONS INTERACTIVE BENEFITS CORP INTERCOAST LIFE INS INTERCONTINENTAL LIFE INTERNATIONAL PAPER INTERNATIONAL UNION PAINTERS INTERNATL LIFE INTERNATL LIFE INS INTER-OCEAN INS CO INTERSTATE ASSURANCE INTERSTATE LIFE/ACCDT INT'L BEN. ADMIN. LLC INTL GROUP TRUST INTL TERM OPER CO INC INTL UNION OPER ENG 478 INTN'L UNION /OPER.ENG#98 INVESTORS HERITAGE INS INVESTORS INS CORP IOWA STATE TRAVELERS IRON WORKERS DIST. COUNS. ISLAND GROUP ADM. ITPE-NMU ITRON INC. ADMIN BY MERCER ITT HFTD/BEN PLANNERS ITT LIFE INS CORP J C PENNEY INS CO 311 J C PENNEY LIFE INS J HANCOCK MUT LIFE J J NEWMAN & CO J.F.MOLLOY ASSOCIATES

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P.O. BOX 8082 102 MAIDEN LANE P.O. BOX 5082 P.O. BOX 875 PO BOX 5817 P.O. BOX39119 737 DELAWARE AVE/PO 39 305 WEST 44TH ST 8TH AVE. P.O. BOX 15688 PO BOX 377 759 WEST MARKET ST 420 N SPRUCE ST P.O. BOX 83655 P.O.BOX 567 PO BOX 1796 30 CLINTON ST P.O. BOX 30541 ALLIED TRADERS 666 5TH AVE. FL. 25 9116 LEESGATE RD/PO 7805 CINCINNATI FINANCIAL CTR 420 KEOSAUQUA WAY/PO 1907 540 MCCALLIE AVE 100 GARDEN CITY PLAZA PO BOX 8287 17 BATTERY PLAZA 1965 DIXWELL AVE. TWO CENTER SQ. BOX 217 200 CAPITOL AVE/PO 717 PO BOX 23035 206 SIXTH AVE 3445 WINTON PLACE STE 110 P.O. BOX 1250 P O BOX 23679 P.O. BOX 4542 P.O. BOX 690450 418 E STANLEY ST/PO BX E 2020 LIVE OAK/PO BX 179 2700 WEST PLANO PKWY 200 BERKELEY ST/PO 111 825 EAST GATE BLVD P.O.BOX 68947

WAUSSAU NEW YORK MT. LAUREL OAKLAND WALLINGFORD PHOENIX BUFFALO NEW YORK AMARILLO ST LOUIS AKRON WINSTON SALEM LANCASTER FARMINGTON SACRAMENTO NEWARK SALT LAKE CITY BERLIN NEW YORK LOUISVILLE CINCINNATI DES MOINES CHATTANOOGA GARDEN CITY RICHMOND NEW YORK HAMDEN LONGMEADOW FRANKFORT PORTLAND DES MOINES ROCHESTER EAST HAMPTON SAVANNAH IOWA CITY SAN ANTONIO THORP DALLAS PLANOS BOSTON GARDEN CITY INDIANAPOLIS

WI NY NJ NJ CT AZ NY NY TX MO OH NC PA CT CA NJ UT CT NY KY OH IA TN NY VA NY CT MA KY OR IA NY NY GA IA TX WI TX TX MA NY IN

54402 10038 08054 07434 06492 85069 14240 10036 79101 63166 44303 27102 17608 06034 95808 07102 84130 06037 10103 40207 45206 50306 37402 11530 23226 10004 06514 01028 40601 97223 50309 14623 11937 31403 52244 78269 54771 75221 75075 02117 11530 46268

Plus 4 Phone 8775592955 8885991515 8002251345 2032697741 6028701400 2125866400 8006875944 8003463017 3656

0001

7173979714 2036760383

8003432737 8608289222 2128084380

5167391060

0217

2032889261 4135254221

4542 0450

5854243510 8009262306 9122325982 8668816645 8003683653

8006925246 8003430034 8002536995 8003313287

8/1/2014

Code Name 701 702 D87 A20 312 E11 J28 B73 F16 897 926 F11 F71 703 790

G06 G66 M90 314 315 A64 316 317 L09 D34 319 J74 320 C59 C44 E94 F47 704 321 C01 F66 C46 J65 M91 705 318 E57

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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JA ARCHAMBAULT JACKSON CORRUGATED JARDINE GRP.SRVCS.CORP JASON INC HEALTH & WELFAR JEFFERSON NATL LIFE JEFFERSON PILOT JEFFERSON PILOT JEFFERSON PILOT LIFE JOHN ALDEN HEALTH CARE JOHN ALDEN/FORTIS JOHN DEERE HEALTH JOHN HANCOCK JOHN T. RILEY INS. AGENCY JOHNSON ADMINISTRATORS

ROUTE 12 PO BOX 210 48 CORNELL RD. 75 PROGRESS LANE 1 VIRGINIA AVE 10101 S.W. FRWY.STE.204 P.O. BOX 51487 P.O. BOX 1561 P.O. BOX 829508 PO BOX 9398 3800 AVE OF THE CITIES 1585 PAOLI PIKE C22680 P.O. BOX 356 PO BOX 248

GROSVENORDALE MIDDLETOWN LATHAM WATERBURY INDIANAPOLIS HOUSTON ONTARIO LAKE CITY SOUTH FLORIDA MINNEAPOLIS MOLINE WESTCHESTER WEST BOYLSTON NEWTOWN

CT CT NY CT IN TX CA FL FL MN IL PA MA PA

06246 06457 12110 06720 46204 77074 91761 32056 33082 55440 61265 19380 01583 18940

KAISER FUND HEALTH PLAN

36 BRITISH AMERICAN BLVD.

LATHAM

NY

12110

1415

5188220546

KAISER PERMANENTE KAISER PERMANENTE KAISER PERMANENTE OF COLORADO KANAWHA INS CO KANSAS CITY LIFE INS KAY WREN ASSOC. KEMPER INS CO KENNESAW LIFE/ACCDT KEY BENEFIT ADMIN KEY BENEFITS KEY LIFE INS CO/S.C. KEYSTONE HEALTH PLAN EAST KEYSTONE LIFE OF TX KINDERCARE KING COUNTY MED. B/S KIRKE-VAN ORSDEL BEN.TRUS KLAIS & CO. KLOCK COMPANY KNICKERBOCKER LIFE IN KNIGHTS OF COLUMBUS KOHLER EMPOYEES BENEFIT KONICA QUALITY PHOTO E. KROGER CO KROGER RX KURT H VOLK INC KY CENTRAL LIFE INS L&H ADMINISTRATORS

P.O. BOX 23517 1001 LAKESIDE AVE P.O. BOX 373150 210 S WHITE ST/PO BX 610 PO BOX 139 P.O. BOX 668 1 KEMPER DR. 1447 PEACHTREE ST NE P.O. BOX 1279 P.O. BOX55210 3101 CARLISLE ST 1901 MARKET STREET #1000 P.O. BOX 809027 P.O. BOX 20961 P.O. BOX 21267 P.O. BOX 1047 1867 WEST MARKET ST. 1366 TOLLAND TNPK 2727 ALLEN PARKWAY 3316 FARNUM ST. MAIL STOP 014 221 PRESTIGE PK. RD. 10680 TREENA ST 5TH FL 1014 VINE STREET 1755 BOSTON POST RD 200 E MAIN ST 340 QUARDANGLE DR.

SAN DIEGO CLEVELAND DENVER LANCASTER KANSAS CITY AVON LONG GROVE ATALNTA FORT MILL INDIANAPOLIS COLUMBIA PHILADELPHIA DALLAS MONTGOMERY SEATTLE ST.LOUIS AKRON MANCHESTER HOUSTON OMAHA KOHLER EAST HARTFORD SAN DIEGO CINCINNATI MILFORD LEXINGTON BOLINGBROOK

CA OH CO SC MO CT IL GA SC IN SC PA TX AL WA MO OH CT TX NE WI CT CA OH CT KY IL

92123 44101 80237 29720 64141 06001 60049 30357 29716 46205 29250 19103 75380 36102 98111 63188 44313 06040 77019 68175 53044 06108 92131 45202 06460 40507 60440

0517

8004644000 2166215600 3033833600 8002872434 8167537000 8606519785 8009223185 4048928600 8668676883 3172847100

1203

0961 3065 1047

2033469671 8003665273 2037535116 3172678089 7137761761 8008423729 3867557511 8003284316 8003284316 8007471446 2153447780 8005411101 2159687700

2152412273 2143800505 8003349222 2064643600 8003828216 8003311096

8002322360 5022225784 2035281655 8669576437 8009174926 8004329536 8007597422

8/1/2014

Code Name 347 N43 L61 K33 D50 A65 322 D63 L15 M34 F59 323 A32 D09 A93 324 833 325 326 327 328 329 330 333

331 332 336 334 335 H83 337 036 959 J01 M35 706 338 339 340 341 342 H66

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LA & SOUTHERN LIFE LABORERS & OPER. ENG. UTL. AGRMNT LABORERS HEAVY & HIGHWAY LOCAL 60 LABORER'S HLTH WEL LABORERS NAT'L HLTH/WEL. LAHOOD & ASSOC. LAMAR LIFE INS CO LATVIAN RELIEF FUND OF AM LAUNDRY DRY CLEANING WORKERS LDI PRESCRIPTION SERVICES LEAHY&ASSOCIATES INC. LEGAL SECURITY LIFE LEGGETT & PLATT LEGIONNAIRE INS. TRUST LEWER AGENCY LEXINGTON INS CO LIBERTY HEALTH MERGED/PHS LIBERTY LIFE ASSUR LIBERTY LIFE INS CO LIBERTY MUTUAL INS CO LIBERTY NATL LIFE INS LIFE ASSUR OF PENNA LIFE GEN SECURITY INS

PO BOX 41310 2400 W DUNLAP AVE. 140 BROADWAY 220 CAMPUS LN P.O. BOX 1100 P.O. BOX 12170 317 E CAPITOL ST/PO 880 P.O. BOX 8857 275 SEVENTH AVE. 680 CRAIG ROAD 310 SOUTH RACINE SUITE700 2311 CEDAR SPRINGS 439 MAIN STREET P.O. BOX 1146 4534 WORNALL RD 102 MAIDEN LANE 1183 NEW HAVEN RD 175 BERKELEY ST PO BOX 789 PO BOX 7500 301 S 20TH ST 230 S 15TH ST 1233 WESTBANK EXPRESSWAY

JACKSONVILLE PHOENIX HAWTHORNE FAIRFIELD COLUMBIA OVERLAND PARK JACKSON ELKINS PARK NEW YORK CREVE COEUR CHICAGO DALLAS OXFORD SANTA BARBARA KANSAS CITY NEW YORK NAUGATUCK BOSTON GREENVILLE BRATTLEBORO BIRMINGHAM PHILADELPHIA METAIRIE

FL AZ NY CA MD KS MS PA NY MO IL TX MA CA MO NY CT MA SC VT AL PA LA

32203 85021 10532 94534 21044 66282 39205 19027 10001 63141 60607 75201 01540 93102 64111 10005 06770 02117 29502 05302 35202 19102 70004

LIFE IN CO OF NH

102 MAIDEN LANE

NEW YORK

NY

10005

LIFE INS CO OF ALA LIFE INS CO OF GA LIFE INS CO OF VA LIFE INS CO/NO. AMER LIFE INS CO/SOUTHWEST LIFE INSURANCE OF GA. LIFE INVESTORS/AMER LIFE OF AMERICA INS. CO. LIFE OF GEORGIA LIFEWISE LIFEWISE PLAN OF ARIZONA LIGHT METALS COLORING LINCOLN AMER LIFE INS LINCOLN BENEFIT LIFE LINCOLN INCOME LIFE LINCOLN LIBERTY LIFE LINCOLN NATL LIFE INS LINE CONST. BENE FUND

LIFE OF ALABAMA BLDG LIFE OF GEORGIA TOWER 6610 W BROAD ST 25 FRANKLIN ST. PO BOX 47421 P.O. BOX 8119 4333 EDGEWOOD RD NE 2727 ALLEN PARKWAY 6TH FL P.O.BOX 1510 P.O. BOX 7709 P.O. BOX 91134 270 SPRING ST PO BOX 3250 LINCOLN BENEFIT BLDG/8046 6100 DUTCHMANS LANE PO BOX 82449 1300 S CLINTON ST 2000 SPRINGER DR.

GADSDEN ATLANTA RICHMOND ROCHESTER DALLAS FORT WASHINGTON CEDAR RAPIDS HOUSTON DALLAS BEND SEATTLE SOUTHINGTON MEMPHIS LINCOLN LOUISVILLE LINCOLN FORT WAYNE LOMBARD

AL GA VA NY TX PA IA TX TX OR WA CT TN NE KY NE IN IL

35902 30308 23219 14604 75247 19134 52406 77019 75221 97708 98111 06489 38103 68501 40205 68501 46801 60148

Plus 4 Phone

1498 2170 0857

1146

7500

8119

7709

7019

8004743485 9147692440 7078642800 8002355805 9133620040 6019493110 2156354137 2122068900 8006529550 3122431265 2146818121 5089878706 8002356943 8008217715 8607234451 8008421509 8032688391 8022547669 2053252575

2055432022 4049805471 8042816452 7162581744 2146389223 8008777703 3193988511 8006699030 8003456507 8005479515 8005926804

4024743227 5024595650 4024743227 2194552000 8003237268

8/1/2014

Code Name 707 F04 870 853 923 J60 839 H90 C83 K13 F67 820 914 A67

834 C82 D10 837 B74 J82 J98 C02 F48 H61 835 C37 H55 862 L56 I01 H81 B15 H67 G95 I93 F83 836 819 I75 D11 E99 D65

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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LITTON OFFICE PRODUCTS LOAN CLAIM SERVICES LOCAL #155 LOCAL #174 LOCAL #840 LOCAL #9 LOCAL 105 UN FURNITURE WK LOCAL 137 INT'L UNION LOCAL 1430 WELFARE FUND LOCAL 1500 WFCW LOCAL 169 LOCAL 173 (INS.PROG) LOCAL 192

184 WINDSOR AVE 4747 LINCOLN MALL DR 10401 CT AVE. 540 W 48TH ST 345 WEST 44TH STREET PO BOX 61593 P O BOX 100037 1360 PLEASANTVILLERD 170 HAMILTON AVE. 221-10 JAMAICA AVE. 33 WEST 14TH ST. 60 N MAIN ST 141 SO CTR-SUITE 200

WINDSOR MADISON KENSINGTON NEW YORK NEW YORK KING PRUSSIA NASHVILLE BRIARCLIFF MANOR WHITE PLAINS QUEENS VILLAGE NEW YORK WALLINGFORD CASPER

CT IL MD NY NY PA TN NY NY NY NY CT WY

06095 60443 20895 10036 10036 19406 37210 10510 10601 11428 10011 06492 82601

LOCAL 1964

158 VERGEN TPK.

RIDGEFIELD PARK

NJ

07660

2014406523

LOCAL 1J-JEWELRY LOCAL 202 WELFARE FUND LOCAL 235 LOCAL 25 TEAMSTERS LOCAL 259 UAW LOCAL 274 PIPEFITTERS LOCAL 281 WELFARE FUND LOCAL 282 LOCAL 295/851 LOCAL 298 LOCAL 3 IBEU LOCAL 32 E AFL-CIO LOCAL 32B-J LOCAL 32BJ HEALTH/WF LOCAL 342-50 SEAFOOD DIVISION LOCAL 348 LOCAL 35 PAINTERS COUNCIL LOCAL 365-CEM WKRS WELFR LOCAL 371 (UFCW) LOCAL 376 UAW LOCAL 381 DISPLAY UNION LOCAL 399 I.U.O.E LOCAL 4 IUOE LOCAL 40 SHEET METAL LOCAL 413 LOCAL 445 LOCAL 46 PSEW LOCAL 464A UFCW

133 WEST 44TH STREET HUNTS PT. MARKET ROOM 12A 41 KNOWLLWOOD RD. 16 SEVER STREET 145 HUDSON STREET 3235 KENNEDY BLVD. 11900 SOUTH LARAMIE AVE 172-11 HILLSIDE AVE 1 DAG HAMMARSKJOLD PLAZA 201 W. VALLEY STREAM BLVD 158-11 JEWEL AVE 4234 BRONX BLVD. 101 AVE. OF AMERICAS P.O.BOX 231418 166E E JERICHO TPKE 108-36 QUEENS BLVD. 25 COLGATE RD. SUITE 204 67-05 FRESH POND RD 290 POST RD. WEST 30 ELMWOOD COURT 160 MINEOLA BLVD 763 WEST JACKSON BLVD. 177 BEDFORD ST PO BOX 345 100 OLD FORGE RD. 7001 BRUSH HOLLOW RD. P.O. BOX 2572 P.O.BOX 34203 245 PATERSON AVE.

NEW YORK BRONX ELMSFORD CHARLESTOWN NEW YORK JERSEY CITY ALSIP JAMAICA NEW YORK VALLEY STREAM FLUSHING BRONX NEW YORK HARTFORD MINEOLA FOREST HILLS BOSTON RIDGEWOOD WESTPORT NEWINGTON MINEOLA CHICAGO LEXINGTON ROCKY HILL WESTBURY NEW BURGH SEATTLE LITTLE FALLS

NY NY NY MA NY NJ IL NY NY NY NY NY NY CT NY NY MA NY CT CT NY IL MA CT NY NY WA NJ

10036 10474 10523 02129 10013 07306 60803 11432 10017 11580 11365 10466 10013 06123 11501 11375 02131 11385 06881 06111 11501 60661 02173 06067 11590 12550 98125 07424

2122462143 7188421212 9145923331 6172419220 2129661920 2019639600 7085971832 8602693632 2123084200 5168726690 7185912000 7183246556 2123883300 8003463017 5167475980 7187935715 6175241240 7184566230 2032264217 8609531346 5162482662 3122362157 6178611600 8002015840 5163388700 9145644076 2064417574 2012565803

3960 1130

1906 1418

3758

7087477206 3014683731 2123077007 2125812784 8008772956 6158898860 9147621268 9149493739 7184798700 2122559655 8004468646 3072662877

8/1/2014

Code Name F13 840 847 G94 838 D93 E14 H85 A66 D05 G27 G26 A94 G74 B16 A95 D25 I58 B17 343 344 345 346 M92 348 349 J99 350 821 801 C47 351 N36 708 352 J20 709 353 C60 B44 N39 A96

LOCAL 488 IBEW LOCAL 493 HLTH SER PLAN LOCAL 5/220 UN FD&COM WK LOCAL 54 WELFARE FUND LOCAL 66 N E LAUNDRY WK LOCAL 7 UFCW UNION LOCAL 707 RD.CARR.WELF.FD LOCAL 731 LOCAL 76B UNITED FURN WKS LOCAL 78 FIRST BEN. AGCY. LOCAL 804 LOCAL 810 LOCAL 875 LOCAL 88/MAGNA CARE LOCAL 888 LOCAL 917 LOCAL 958 WSTE MATL.UNION LOCKARD & WILLIAMS LONDON AGENCY LONDON ASSURANCE CO LONDON GUARANTEE/ACCDT LONDON LIFE INS CO LONE STAR LIFE INS LOVELACE HEALTH PLAN LOYAL AMER LIFE INS LUMBERMENS MUTUAL/CAS LUMENOS LUTHERAN BROTHERHOOD LYTLE ASSOC LYTLE ASSOCIATES M.D. IPA HEALTH PLAN MACCABEES MUT LIFE INS MACDERMID RETIREE MACRISTY INDUSTRIES MADISON LIFE INS CO MAGNACARE TPA DEPT MAIL HANDLER BENEFIT PLAN MAIN LIFE INS CO MAINE HEALTH PLAN MAINE MUNI EMPL HLTH TRST MAINE SENSE MAKSIN MGMT CORP

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60 NORTH MAIN ST. P O BOX 485 400 CHAPEL ROAD 1650 BROADWAY #402 697 BROADWAY 8700 TPK. DR.STE.200 14 FRONT STREET 229 EAST 58TH STREET 150-47 HILLSIDE AVE. P.O. BOX 4138 34-21 REVIEW AVENUE 10 EAST 15TH. ST. 7401 QUEENS BLVD 2366 FLATBUSH AVE 6 GRAMATEN AVE.REET 126 UNIVERSITY PLACE 225 LAFAYETTE ST.STE.801 P.O. BOX 1688 40 COMMERCIAL WAY 111 PROSPECT ST 80 MAIDEN LANE 255 DUFFERIN AVE/LONDON 200 TREADWAY PLAZA 5400 GIBSON BLVD. SE 2460 GOVERNMENT BLVD RT 2 1801 N. BEAUERGARD ST. 625 FOURTH AVE SOUTH PO BOX 2128 P O BOX 2128 4 TAFT COURT 25800 NORTHWESTERN HWY 1401 BLAKE ST. 206 NEWINGTON AVE 845 THIRD AVE 825 EAST GATE BLVD P O BOX 8402 1200 1ST NATL BANK BLDG 84 MIDDLE ST.PO BOX 3545 37 COMMUNITY DR P.O. BOX 9780 2500 MCCLELLAN AVE

WALLINGFORD UNCASVILLE SOUTH WINDSOR NY SOMMERVILLE WESTMINSTER HEMPSTEAD NEW YORK JAMAICA AKRON LONG ISLAND NEW YORK ELMHURST BROOKLYN MT VERNON NEW YORK NEW YORK PASCAGOULA E PROVIDENCE EAST ORANGE NEW YORK ONTARIO CAN A DALLAS ALBUQUERQUE MOBILE LONG GROVE ALEXANDRIA MINNEAPOLIS NIAGARA FALLS NIAGARA FALLS ROCKVILLE SOUTHFIELD DENVER NEW BRITAIN NEW YORK GARDEN CITY LONDON CINCINNATI PORTLAND AUGUSTA PORTLAND PENNSAUKEN

CT CT CT NY MA CO NY NY NY OH NY NY NY NY NY NY NY MS RI NJ NY K1 TX NM AL IL VA MN NY NY MD MI CO CT NY NY KY OH ME ME ME NJ

06492 06382 06074 10019 02144 80030 11550 10022 11432 44321 11101 10003 11373 11234 10550 10003 10012 39568 02914 07019 10038 00000 75235 87108 36606 60049 22311 55415 14302 14302 20850 48075 80202 06051 10022 11530 40742 45020 04104 04330 04104 08109

Plus 4 Phone

0157

2032654964 8608481259 2032893409 2122656556 6176288770 8005271647 5164867100 7184720820 7185268000 8008374097 7187865410 2126914100 7188982020 7182534669 8002231503 2126913560 2129259634 8005307222 4014354700

2147026400 5052627267 8006336752 8009223185 8778755981 6123407000 7162840468 7162840468 8003426141 7204793078

9486

8002254055 8004107778 5139213338 8002453529 2076238428 8664813103 8002576250

8/1/2014

Code Name B75 C03 E18 I06 K12 B45 F05 M36 E59 J31 354 K76 356 I66 K69 M93 357 A68 A42 L28 358 359 360 361 650 C23 887 B18 A26 E60 822

K79 B42 H05 G77 929 J46 850 G43 C24 H77 G62

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

34 of 57

Plus 4 Phone

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State Zip

MALONEY & ASSOCIATES MAMSI MANAGE MED MANAGED BEN. PLANS MANAGED CARE OF AMERICA MANAGED HEALTH FUNDING MANAGED HEALTH FUNDINGS MANAGED HEALTH NETWORK MANAGED PRESCRIPTION SVCS MANALAY RESORT GROUP MANCHESTER LIFE INS CO MAPRE LIFE MARK TWAIN LIFE INS CO MARSH ADVANTAGE AMERICA MARSH CLAIMS MARTIN'S POINT HEALTH CARE MARYLAND CAS CO MASHANTUCKET PEQUOT MASON TENDERS DC WELFARE MASS BRICKLAYERS MASS CAS INS CO MASS GEN LIFE MASS INDEMNITY/LIFE MASS MUTUAL LIFE/UNICARE MASS STAT CARPE/HELTH BEN MASSENA CNTR.SCHL.EMP.BEN MASTERS MATES & PILOTS MATTHEW THORNTON HLTH PLN MAURY/DONNELLY & PARR MAXICARE OF INDIANA

211 BROADWAY 4 TAFT COURT P.O. BOX 17264 P.O. BOX 7067 820 PARRISH ST. 5016 N PKWY CALABASAS P.O.BOX 11448 2019 AEROJET PO BOX 66922 PO BOX 17700 243 N LINDBERGH BLVD P.O. BOX 70297 4400 W LINCOLN BLVD P.O. BOX 2305 P.O. BOX 10439 P.O. BOX 9746 3910 KESWICK RD/PO 1228 PO BOX 3620/ BLDG 3 32 WEST 18TH ST 645 MORRISSEY BLVD. 50 CONGRESS ST 1 NEWTON EXECUTIVE PK 130 NORTH ST P.O. BOX 55130 250 EVERETT STREET 209 MAIN ST 5700 HAMMONDS FERRY RD P.O. BOX 9514 COMMERCE & WATER/BEN DEPT 9480 PRIORITY WAY W. DR

LYNBROOK ROCKVILLE GREENVILLE PRINCETON PITTSBURG CALABASAS JACKSONVILLE RANCHO CORDOVA ST. LOUIS LAS VEGAS ST. LOUIS SAN JUAN OKLAHOMA CY SPOKANE DES MOINES PORTLAND BALTIMORE MASHANTUCKET NEW YORK BOSTON BOSTON NEWTON HYANNIS SPRINGFIELD ALLSTON MASSENA LINTHICUM HEIGHTS MANCHESTER BALTIMORE INDIANAPOLIS

NY MD SC NJ PA CA FL CA MO NV MO PR OK WA IA ME MD CT NY MA MA MA MA MA MA NY MD NH MD IN

11563 20850 29606 08540 15220 91302 32239 95742 63166 89109 63141 00936 73105 99201 50306 04104 21203 06339 10011 02122 02109 02162 02601 01111 02134 13662 21090 03108 21202 46240

MAXON INS CO

70 N BROADWAY

IRVINGTON

NY

10533

9145917111

MAXOR PLUS MB VALUATION SERVICES MCCALL PATTERN HEALTH MCDONALDS LIC.HLT/WLF/BC MCDONOUGH CAPERTON SER. MCS LIFE INSURANCE MD HLTH PLAN/PHS MDNY MED BENEFIT SYSTEMS MED COST PREF/PIEDMONT MED PLUS HEALTH PLAN

320 S. POLK STE 200 1111 EMPIRE CENTRAL PLACE 615 MCCALL RD. P.O. BOX 4508 P.O.BOX 3262 P.O. BOX 90223547 ONE FAR MILL XING 1 HUNTINGTON QUAD P.O. BOX177 5605 ROANNE WAY P.O. BOX 607076

AMARILLO DALLAS MANHATTAN OAKBROOK CHARLESTOWN SAN JUAN SHELTON MELVILLE SOUTH BEND GREENSBORO BAYAMON

TX TX KS IL WV PR CT NY IN NC PR

79101 75247 66502 60522 25332 00902 06484 11747 46601 27409 00960

8063245400 2143737887 7857764041 8003234195 8006248605 8009810081 8004387886 8009091950 2192370560 3365442222 7877983101

1448 6922

7184798700 8004476267 8009928088 8663298745 8009224966 8008288360 9047275088 8003272133 8007596959 7028366570

8297

7872505214

0439 5040

8665837541 8004483436 8887327364 8887796872 2126336003 6174365500 6177288000

1996 9514 3899

5035 4508 3547

7076

8002888630 8005440796 3157641053 4108508500 8005448333 8006389202 8007525866

8/1/2014

Code Name K46 I61 F68 J57 896 I56 710 B54 H07 J85 711 MDD MPA RRB

MPB MDT 362 I81 C25 H41 958 712 A01 J40 363 L27 I89 L05 L08 N77 L33 J79 N71 M37 M94 364 365 355 I28 K15 366 367

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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MEDCO DIRECT CLAIMS RX MEDCO HEALTH MEDCO VALUE PLUS MEDEX MEDI PLAN MEDICA PREMIER MEDICAL CLAIMS SVC INC MEDICAL MUTUAL OF OHIO MEDICAL MUTUAL OF OHIO MEDICAL VALLEY PHYS. MEDICAL WEST COMM HEALTH MEDICARE D MEDICARE PART A

P.O. BOX 14711 P.O. BOX 2187 7083 GRAND NATIONAL DR. 2231 RUTHERFORD RD 502 VALLEY RD. 5601 SMETANA DRIVE P.O.BOX 160 P.O. BOX 6018 P.O. BOX 6018 P.O. BOX 2207 444 MONTGOMERY ST PO BOX 2920 P.O. BOX 2920

LEXINGTON LEE SUMMIT ORLANDO CARLSBAD WAYNE MINNETONKA RAVENWOOD CLEVELAND CLEVELAND SCHENECTADY CHICOPEE HARTFORD HARTFORD

KY MO FL CA NJ MN WV OH OH NY MA CT CT

40512 64063 32819 92008 07470 55343 26164 44101 44101 12301 01020 06104 06104

MEDICARE PART A AND B

P.O. BOX 10066

AUGUSTA

GA

30999

MEDICARE PART B MEDICARE TRANS ASST (TAP) MEDICO LIFE INS CO MEDIMPACT MEDI-PLUS MED-PAY MED-SPAN INC MEDTAC MEGA LIFE HEALTH MEGA LIFE&HEALTH INS MENNONITE MUTUAL AID MERCER ADM MERCK-MEDCO RX SERVICES MERCY HEALTH PLAN MERITAIN HEALTH MERITAIN-AETNA CO METLIFE METLIFE DENTAL METLIFE DENTAL METRO PLUS HEALTH PLAN METROPOLITAN LIFE LONG TERM METROPOLITAN/UNITED HLTH. MFA LIFE INS CO MFG'S LIFE INS CO MHF INS. ADMIN MICHIGAN CONF. TEAMSTERS MICHIGAN LIFE INS MID-AMERICA INS CO

P.O. BOX 2920 PO BOX 2920 3860 LEAVENWORTH ST 10680 TREENA ST. 1776W. LAKES PKWY 1650 E. BATTLEFIELD ST300 P.O.BOX 340725 P.O. BOX 9110 P.O.BOX 982009 P.O. BOX 30888 1110 N MAIN ST P.O. BOX 4542 P.O. BOX 67004 P.O. BOX 4568 P.O. BOX 853921 P.O. BOX 27267 P.O. BOX 40007 P.O. BOX 981282 P.O. BOX 14093 160 WATER STREET 3RD FLOOR 57 GREENFARMS RD P.O. BOX 740800 1817 W BROADWAY 200 BLOOR ST E/TORONTO P.O. BOX 48098 2700 TRUMBULL AVE 28333 TELEGRAPH RD W CAPITOL PO 2900

HARTFORD HARTFORD OMAHA SAN DIEGO DES MOINES SPRINGFIELD HARTFORD NEWTON NORTH RICHLAND HILLS PHOENIX GOSHEN IOWA CITY HARRISBURG SPRINGFIELD RICHARDSON MINNEAPOLIS LYNCHBURG EL PASO LEXINGTON NEW YORK WESTPORT ATLANTA COLUMBIA ONTARIO CAN W JACKSONVILLE DETROIT SOUTHFIELD LITTLE ROCK

CT CT NE CA IA MO CT MA TX AZ IN IA PA MO TX MN VA TX KY NY CT GA MO B4 FL MI MI AR

06104 06104 68105 92131 50398 65804 06134 02160 76180 85078 46526 52244 17106 65808 75085 55427 24506 79998 40512 10038 06880 30374 65201 00000 32247 48516 48076 72203

Plus 4 Phone 2187

5012 0160

7004 3921 9939 1282

0800

8009038645 8009882285 8009525277 7606024430 8006371225 8009523455 3042735384 8003621279 8004162583 8005865386 4135943111

4023916900 8007882949 8002472192 8007779087 8004446222 8003479355 8005275504 8003009409 8003487468 8668816645 8003558279 8003308454 8883066316 8005669311 8775827767 8009420854 8004486500 8003039626 8003080179 8005215505 3144458441 8774015730 3139642400

8/1/2014

Code Name 368 J29 C26 369 370 371 372 373 374 377 H94 378 D64 375 376 F23 379 380 381 802 N80

382 A84 I12 383 713 384 J32 385 M95 I65 885 C61 841 890 A35 H86 C84 K24 714 J14 G41

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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MID-AMERICA MUT LIFE MIDAS TRUST/HLTH SMART MID-ATLANTIC MED SVC VA. MIDLAND CASUALTY CO MIDLAND INS CO MIDLAND MUT LIFE INS MIDLAND NATIONAL LIFE MID-SOUTH INS CO MID-STATES LIFE/AMER. MIDWEST LIFE/LINCOLN MIDWEST NATIN'L LIFE INS MID-WEST NATL LIFE INS MIDWEST SECURITY MID-WESTERN LIFE INS MIDWESTERN NATL LIFE MILES HEALTH CARE MINISTERS LIFE/CAS MINNESOTA PROT LIFE MISSOURI NATL LIFE INS MOBIL CHEMICAL

2021 E HENNEPIN AVE P.O. BOX 16110 P.O. BOX75223 1 STATE STREET PLAZA 1 STATE STREET PLAZA 250 E BROAD ST 1 MIDLAND PLAZA DRAWER 2069 489 N ORANGE 500 S 16TH ST P.O. BOX 982017 P.0. BOX 982017 P.O. BOX 19035 PO BOX 1429 1501 EUCLID AVE BRISTOL ROAD 3100 W LAKE ST/PO 915 3800 WAYZATA BLVD 4646 ROANOKE 495 LORDSHIP BLVD

MINNEAPOLIS SALT LAKE CITY BALTIMORE NEW YORK NEW YORK COLUMBUS SIOUX FALLS FAYETTEVILLE ORLANDO LINCOLN NORTH RICHLAND HILLS NORTH RICHLAND HILLS GREENBAY ENID CLEVELAND DAMARISCOTTA MINNEAPOLIS MINNEAPOLIS KANSAS CITY STRATFORD

MN UT MD NY NY OH SD NC FL NE TX TX WI OK OH ME MN MN MO CT

55413 84116 21275 10004 10004 43215 57101 28302 32801 68501 75182 76182 54307 73701 44115 04543 55472 55405 64112 06497

MODA/ODS

P.O. BOX 40384

PORTLAND

OR

97240

MODERN LIFE/ACCDT INS MOHAWK VALLEY PHYS MOLINA HEALTHCARE OF WA MONARCH LIFE INS CO MONSATO MONTGOMERY WARD LIFE MONUMENTAL INS. MONUMENTAL LIFE INS MORGAN WHITE ADMIN MORRIS ASSOCIATES MORSE CARE HEALTH PLAN MOTEL 6 MOTION PICTURE HEALTH FD MOTOROLA MEDICAL PLAN SER MOUNMENT BUILDER/N AMERIC MOUNTAIN STATES ADM. MPI LABEL SYSTEMS MRCC EMP. BENE. PLAN MT VERNON GROUP MT.STATES ADMIN. SERV. MTAC GRP. INS. TRUST

175 W JACKSON BLVD 111 LIBERTY ST P.O. BOX 3387 1250 STATE ST 101 GRANBY ST 140 S STATE ST PO BOX 97 P.O. BOX 97 5722 I 55 N 9045 E. 59TH. STREET 555 TPK ST P.O. BOX 809092 P.O. BOX 1999 P O BOX 29005 1612 CENTRAL STREET 13901 E. EXPOSITION AVE. P.O. BOX 567 2075 WEST BIG BEAVER RD 50 CROSS ST P.O. BOX 32709 60 FOREST ST.

CHICAGO SCHENECTADY BELLEVUE SPRINGFIELD BLOOMFIELD CHICAGO SCRANTON SCRANTON JACKSON INDIANAPOLIS CANTON DALLAS STUDIO CITY PHOENIX EVANSTON AURORA KILLINGLY TROY WINCHESTER TUCSON HARTFORD

IL NY WA MA CT IL PA PA MS IN MA TX CA AZ IL CO CT MI MA AZ CT

60604 12305 98009 01101 06002 60603 18504 18504 69211 46250 02021 75380 91614 85038 60201 80012 06239 48084 01890 85751 06105

Plus 4 Phone 0110

8889181234 8003426141

6142282001 6053355700

8017

8007338880 8887563534 8002362515 4052348390 2075634555 6129277131 6129443900 8169317500 8004485791 8882172365

3387

0097 0097 2638

9092 9005

3446 2709

8007774793 8008697165 4137855811 8006210393 8002421991 8007529797 6019562028 8009506789 6178289300 2147025920 8187690007 8004213973 3128692031 8008288012 2037744926 2488224150 6177294899 8008664731 8605204455

8/1/2014

E78

L73 386 B77 A97 B78 387 I34 388 389 390 391 392 393 M44 I52 C31 E80 D12 D67 N58 716 933 934 J56 H84 717 F69 395 718 396 397 502 398 M17 912 A09 A74 J36

37 of 57

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Plus 4 Phone

MULTI INTEGRADED MANAG. MULTI NATL UNDERWRITERS MULTI-CIRCUITS

33 NORTH RD. P.O. BOX 863 PO BOX 110

WAKEFIELD INDIANAPOLIS MANCHESTER

RI IN CT

02879 46206 06040

2164

MUTUAL ASSOC. ADMIN. INC.

790 NEW YORK AVE

HUNTINGTON

NY

11743

5164242400

MUTUAL ASSURANCE ADMIN. MUTUAL BENEFIT LIFE MUTUAL EMP. BENEFITS MUTUAL HEALTH AGENCY MUTUAL HEALTH SERVICES MUTUAL LIFE INS/N. Y. MUTUAL OF OMAHA MUTUAL OF OMAHA INS CO MUTUAL PROTECTIVE INS MUTUAL SAVINGS LIFE MUTUAL SECURITY LIFE MUTUAL SERVICE CAS. MUTUAL SERVICE LIFE MVP ROCHESTER N. AMER. DENTAL BEN. NTWK N. J. AUTO DEALERS ASSOC. N.E. ELEC.WORKERS FUND N.Y. DIST.COUNCIL /CARPT. N.Y. STATE AUTO DEALERS NAHGA NALC HLTH BEN PLN LOC 321 NAT`L CAPITOL ADMIN SER NAT`L FED-FEDERAL EMPLOYE NATIONAL BEEF PKG. CO NATIONAL BENEFIT ADM. NATIONAL BENEFIT FUND NATIONAL BENEFIT FUND NATIONAL CASUALTY CO NATIONAL CHROMIUM NATIONAL FARMERS UNION NATIONAL FIDELITY LIFE NATIONAL FINANCIAL INS CO NATIONAL FIRE INS/HART NATIONAL HEALTH ADMINISTRATORS NATIONAL HEALTH CARD NATIONAL HEALTH INS CO NATIONAL HEALTH PLAN NATIONAL HEALTH SYSTEMS

P.O. BOX 42096 570 BROAD ST P.O. BOX 1572 PO BOX 70 P.O. BOX 94601 1740 BROADWAY 1716 "N" ST. N.W. DODGE AT 33RD ST P.O. BOX 3477 PO DRAWER 2222 3000 E SOLISEUM BLVD 1919 UNIVERSITY AVE 1919 UNIVERSITY AVE 220 ALEXANDER STREET P.O. BOX 94928 P. O. BOX 7510 379 WETHERELL ST. 395 HUDSON ST. P.O. BOX 7347 P.O. BOX 189 20547 WAVERLY COURT P.O.BOX 10114 P.O.BOX 6333 P.O. BOX 978 140 LITTLETON RD. 310 WEST 43RD ST 300 WEST 42ND ST. PO BOX 4110RAPH RD SENEXSET RD 12055 E 45TH AVE 1002 WALNUT ST 777 MAIN ST. STE.900 CNA PLAZA 204 EAGLE ROCK AVE P.O.BOX 1170 PO BOX 619999 #1 PENN PLAZA RM 735 155 INVERNESS DRIVE WEST

OKLAHOMA CITY NEWARK MELVILLE GREENE CLEVELAND NEW YORK WASHINGTON OMAHA OMAHA DECATUR FORT WAYNE ST. PAUL ST. PAUL ROCHESTER CLEVELAND TRENTON MANCHESTER NEW YORK ALBANY BRIDGTON ASHBURN FAIRFAX ROCKVILLE LIBERAL PARSIPPANY NEW YORK NEW YORK SCOTTSDALE PUTNAM DENVER KANSAS CITY FORT WORTH CHICAGO ROSELAND PORT WASHINGTON DALLAS NEW YORK INGELWOOD

OK NJ NY NY OH NY DC NE NE AL IN MN MN NY OH NJ CT NY NY ME VA VA MD KS NJ NY NY AZ CT CO MO TX IL NJ NY TX NY CO

73123 07101 11747 13778 44101 10019 20036 68131 68103 35601 46805 55104 55104 14607 44101 08628 06045 10014 12224 04009 20149 22030 20850 67905 07054 10036 10108 85261 06260 80239 64106 76102 60685 07083 11050 75261 10119 80112

8008253540 2014818000 5167777400 8008430683 2165228500 2127082000 2028334910 8007751000 4023916900 2055527300 2194840511 6126317000 6126317000 5853253113 8778011500 8003565232 8606468403 8005293863 5184631148 2076473108 8886366252 7039346227 8002625233 6026260636 8002580103 2123973852 6464739200

Code Name G37 K20 715

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

4601

4928

0189

0636

0933

8002135640 3172622132

3033375500 5313

5000

8007251407 3128225940 8883350133 8006453332 8002371900 2122793232 8002530636

8/1/2014

Code Name A70 C27 C95 D66 410 413 L12 414 415 886 394 M06 K52 B46 B47 C05 399 402 403 404 405 E79 A48 407 B79 409 408 A31 411 412 L58 H29 J73 G09 G38 899 M96 851 F50 D88 F96 C86

NATIONAL MANUFACTURING CO NATIONAL PHARMACY NATIONAL RX SERVICE NATIONAL RX SVCS. NATIONAL SURETY CORP NATIONWIDE CAS INS NATIONWIDE HEALTH PLAN NATIONWIDE LIFE INS NATIONWIDE MUTUAL INS NATL AUTOM SPRINKLER IND NATL BEN FRANKLIN LIFE NAT'L BETTER LIVING ASSO.(NBLA) NATL CLAIM ADM SERVICE NATL CLAIM ADM SVC OF PA NATL CLAIM ADM SVC OF RI NAT'L ELEVATOR IND. NATL FOUNDATION LIFE NATL INDEPENDENCE INS NATL LIBERTY LIFE NATL LIFE & ACCDT INS NATL LIFE INS OF VT NAT'L ORG.IND.TRADE UNION NATL PRESCRIP ADMIN (NPA) NATL SAVINGS LIFE INS NAT'L STARCH & CHEMICAL NATL STATES INS CO NATL STD LIFE INS CO NAT'L STUDENT SERV NATL TRAVELERS LIFE NATL UNION FIRE/PITTS. NAVITUS NEAD INSURANCE TRUST NEBCO NECA-IBEW WLF. TRUST NEIGHBORHOOD HEALTH NEP ADMIN & CONSULTANTS NEPA SECURITY 65 HEALTH PLAN NESTLE FOOD COR/NESTLE CO NETWORK HEALTH PLAN NETWORKS NEW ENGLAND ELEC WORKERS NEW ENGLAND EMP. BENEFIT

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P.O. BOX 577 P.O. BOX1000 PO BOX 98500 P.O. BOX 1015 789 DON MILLS RD PO BOX 2399 P.O. BOX 420 PO BOX 2399 PO BOX 2399 8000 CORPORATE DR 360 W JACKSON BLVD 1300 VIRGINIA DR. P.O.BOX 221169 P.O. BOX 778974 PO BOX 279 P.O. BOX 475 777 MAIN ST. STE. 900 VALLEY FORGE VALLEY FORGE NATIONAL LIFE CTR NATIONAL LIFE DR 148-06 HILLSIDE AVE PO BOX 1981 PO BOX 1338 P.O. BOX 6500 1830 CRAIG PARK CT 311 E ROBINSON/PO 991 P.O. BOX 1500 820 KEOSAUQUA WAY 102 MAIDEN LANE P.O. BOX 999 40 WASHINGTON ST 144 METRO CTR BLVD.STE100 2120 HUBBARD AVE. 7600 CORPORATE CENTER DR. PO BOX 152 70 NORTH MAIN ST. BOARDMAN ROAD P.O. BOX 120 P.O. BOX 6978 379 WETHERELL ST. P.O. BOX 30466

STERLING ELMWOOD PARK LAS VEGAS SUMMIT ONTARIO CAN C COLUMBUS SPRINGFIELD COLUMBUS COLUMBUS LANDOVER CHICAGO FORT WASHINGTON CHARLOTTE HARRISBURG PROVIDENCE NEWTON SQUARE FORT WORTH VALLEY FORGE VALLEY FORGE NASHVILLE MONTPELIER JAMAICA EAST HANOVER MUFREESBORO BRIDGEPORT ST LOUIS ORLANDO DEVON DES MOINES NEW YORK APPLETON WELLESLEY WARWICK DECATUR MIAMI SYBERTSVILLE WILKES BARRE NEW MILFORD MENASHA LIBERTYVILLE MANCHESTER TAMPA

IL NJ NV NJ T9 OH MA OH OH MD IL PA NC PA RI PA TX PA PA TN VT NY NJ TN CT MO FL PA IA NY WI MA RI IL FL PA PA CT WI IL CT FL

61081 07407 89114 07902 00000 43216 01101 43216 43216 20785 60606 19034 28222 17177 02903 19073 76102 19481 19481 37250 05602 11435 07931 37130 08807 63146 32802 19333 50308 10005 54912 02481 02886 62526 33126 18251 18711 06776 54952 60048 06040 33630

Plus 4 Phone

1015

2239

8974 0279 5313

0906

0999

3466

8156251320 8002337840 8008420304 8006317780 8009723363 8006356585 8888031780 8008822822 8006382603 3128765000 8002223085 8662323646 8006358832 8002836227 8002524611 8007251407 8005237900 8005237900 6157491555 7182913434 8005267813 6158961502 9086855146 3148780101 3054234289 2156882277 5152830101 8775717500 7814311450 8888833757 8007654239 3057717294 8005826382 8008298599 2033550911 8008411513 8003457033 8606468403 8006541731

8/1/2014

Code Name I24 903 G59 416 842 719 C48 720 H42 M97 F81 M98 417 E36 418 H54 419 420 421 423 422 424 425 426 C06 A46 C85 F92 H78 D13 427 428 432 C07 A23 M99 E82 A19 C04 721 K77 429

NEW ENGLAND FINANCIAL NEW ENGLAND HEALTH CARE NEW ENGLAND JOINT BOARD NEW ENGLAND MUT LIFE NEW ENGLAND PLAN SERVICE NEW ENGLAND TEAMSTERS INS NEW ERA NEW LONDON MARINE NEW WORLD CLAIMS SVC. NEW YORK HOTEL UNION NEW YORK LIFE NEW YORK LIFE (LONG TERM CARE) NEW YORK LIFE INS NEXCALIBER NIAGRA FIRE INS CO NIPPON INSURANCE NN INVESTORS LIFE INS NO AMER ASSUR SOC/VA NO AMER CO LIFE/HEALTH NO AMER LIFE ASSUR CO NO AMER LIFE/CAS CO NO CAROLINA MUT LIFE NO CENTRAL LIFE INS NO RIVER INS CO NOBLES/LOWNDES ADM. NORTH AMERICAN ADMIN NORTHEAST DELTA DENTAL NORTHEAST DIRECT HEALTH NORTHEAST HMC PPO HEALTHC NORTHEAST SPEC.RISK INS NORTHERN ASSURANCE CO NORTHERN LIFE INS CO NORTHWESTERN SECURITY NORWALK BD. OF ED. NOVA HEALTH CARE NOVAYS HEALTH NPPN NRTH GRP SER AMER (NGS) NTDRA INS. TRUST NUTMEG BAKERS SUPPLY NVA/NAT. VIS. ADM NW MUT LIFE/SEE CC 431

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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P.O. BOX 578 77 HUYSHOPE AVE GARMENT WORKERS SQUARE 501 BOYLSTON ST P O BOX 4015 PO BOX 38 P. O. BOX 4884 56 LEWIS 2624 NORTH FIFTH ST ATTN CLAIMS DEPT 1333 NORTH CALIFORNIA BLV P.O. BOX 59005 51 MADISON AVE P.O. BOX 802422 80 MAIDEN LANE P.O. BOX 39710 731 N JACKSON ST 110 SOUTH SEVENTH ST 209 S LASALLE ST/PO 466 105 ADELAIDE W/TORONTO 1750 HENNEPIN AVE 411 W CHAPEL ST 275 E FOURTH ST MADISON AVE CANFIELD RD P.O. BOX 248 POBOX 9501 6 LOUDON RD. 21 AUSTIN DR.PO BOX 435 P.O. BOX 518 P.O. BOX 10723 1 BEACON ST PO BOX 12530 PO BOX 825 125 EAST AVE. 2680 GRAND ISLAND BLVD 10801 EXECUTIVE CENTER DR. 419 EAST MAIN STREET POBOX 7676 1250 I ST. N.W. STE 400 PO BOX 155 1200 RTE. 46 WEST 720 E WISCONSIN AVE

SPRINGFIELD HARTFORD FALL RIVER BOSTON ISELIN NORTH ANDOVER HOUSTON NEW LONDON NILES NEW YORK WALNUT CREEK AUSTIN NEW YORK DALLAS NEW YORK COLORADO SPRINGS MILWAUKEE RICHMOND CHICAGO ONTARIO CANADA MINNEAPOLIS DURHAM ST PAUL MORRISTOWN NEWTOWN AMHERST CONCORD MARLBOROUGH SPRINGFIELD ROCHESTER BOSTON SEATTLE WILKESBORO NORWALK GRAND ISLAND LITTLE ROCK MIDDLETOWN ST CLAIR SHORES WASHINGTON BEACON FALLS CLIFTON MILWAUKEE

MA CT MA MA NJ MA TX CT MI NY CA TX NY TX NY CO WI VA IL CA MN NC MN NJ PA NY NH CT MA NY MA WA NC CT NY AR NY MI DC CT NJ WI

01101 06106 02720 02117 08830 01845 77210 06320 49120 10129 94596 78755 10010 75380 10038 80949 53201 23220 60604 00000 55403 27702 55101 07960 18940 14226 03301 06447 01101 14610 01940 98111 28697 06852 14072 72211 10916 48081 20005 06403 07013 53202

Plus 4 Phone

4884

7812740808 8607281100 5086745762 8006638081 8002331427 9786827407 2813687200

2422

8006240698 2125866400 8006951352 8007235555 2125767000 8007410185 8009376542 3193988511 3129021080 2049491660 6123476500 9196829201 6122278000

0518

2159687700 8008286922 8008325700 8004236619 8006638081 7164820269 8003435660 2062921111 8608544021 8009995703 8002943557 8005262918 8773317275 2027892086 9735742400 4142711444

8/1/2014

Code Name F33 F22 E81 L57 I69 A18 K51 C08 435

436 437 438 439 N01 440 441 442 443 444 445 446 447 843 L99 722 G10 F70 448 F20 J39 L87 K74 G96 G68 L10 449 J72 510 B76 J43 975 J52

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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NYHART COMPANY NYL CARE NYL CARE HMO PLAN NYSHIP O'BRIEN & GERE HLTH OCEAN STATE PHYS HEALTH OFFICE OF GRP BENEFITS OFFICE OF THE ADMIN.

P.O. BOX 88187 4500 FULLER DR.SUITE 100 1 LIBERTY PLZ.MAILDROP111 EMPLOYEE BENEFITS DIVISION P.O. BOX 6329 POBOX 2002 P.O.BOX 44036 1255 23RD. ST.N.W. STE300

EVANSVILLE IRVING NEW YORK ALBANY SYRACUSE WARWICK BATON ROUGE WASHINGTON

IN TX NY NY NY RI LA DC

47714 75038 11518 12239 13217 02887 70804 20037

8124715870 9726505500 2124371000 8008334344 8663019922 8004221404 8002151093 8004249883

OHIO CASUALTY INS CO

136 N THIRD ST

HAMILTON

OH

45025

8008436464

OHIO LIFE INS CO. OHIO MED INDEM OF AMER OHIO NATL LIFE INS CO OHIO STATE LIFE INS OKLAHOMA STATE/EDU. EMP. OLD AMERICAN INS CO OLD EQUITY LIFE INS OLD LINE LIFE INS/AMER OLD REPUBLIC INS CO414 OLD REPUBLIC LIFE/ILL OLD REPUBLIC LIFE/N.Y. OLD SECURITY LIFE INS OLD SOUTHERN LIFE INS OLIN DIRECT CLAIMS OLIN RETIREE HEALTH PLAN OLIN SKI COMPANY OLYMPIC OLYMPIC HLTH MANAGEMENT OMAHA WOODMEN LIFE INS ON ASSIGNMENT INC. ONE SOURCE GROUP MEDICAL ONENET OPERATING ENG. TRUST FUND OPTICARE OPTIMA HEALTH INS. CO OPTIMED HEALTH PLANS ORANGE STATE LIFE INS OREGAN DENTAL SERVICES OREON GROUP OSCAR MEYER FOOD OSHKOSH B'GOSH HLTH CARE OXFORD HEALTH INSURANCE OXFORD HEALTH PLANS

136 N THIRD ST 6740 N HIGH ST PO BOX 237 6465 REFLECTIONS DRIVE 3545 NW 58TH ST. 4900 OAK ST 811 CHICAGO AVE 707 N 11TH ST W PITTSBURGH AVE 307 N MICHIGAN AVE 560 DELAWARE AVE 3430 BROADWAY 203 S HILL ST P.O. BOX 4500 12421 MEREDITH DRIVE 475 SOUTH ST P.O. BOX 5348 P.O. BOX 5348 MERCHANDISE MART 26651 WEST AGOURA RD. P.O. BOX 18802 P.O. BOX 934 100 EAST CORSON ST. P.O. BOX 7548 4417 CORPORATION LANE 4 TERRY DR. BLDG 1 302 S JUPITER AVE 601 S. WEST 2ND ST. 433 SOUTH MAIN ST P.O. BOX 7188 112 OTTER AVE. P.O.BOX 7082 P.O. BOX 1360

HAMILTON WORTHINGTON CINCINNATI DUBLIN OKLAHOMA CITY KANSAS CITY EVANSTON MILWAUKEE GREENSBURG CHICAGO BUFFALO KANSAS CY MONTGOMERY NORWALK URBANDALE MIDDLETOWN BELLINGHAM BELLINGHAM CHICAGO CALABASAS CHATTANOOGA FREDERICK PASADENA ROCKY MOUNT VIRGINIA BEACH NEWTON CLEARWATER PORTLAND WEST HARTFORD MADISON OSHKOSH BRIDGEPORT NEWARK

OH OH OH OH OK MO IL WI PA IL NY MO AL CT IA CT WA WA IL CA TN MD CA NC VA PA FL OR CT WI WI CT NJ

45025 48035 45201 43017 73112 64141 60202 53233 15601 60601 14202 64111 36102 06856 50398 06457 98227 98227 60654 91302 37422 52149 91103 27804 23462 18940 33515 97204 06110 53708 54901 06601 07101

8008436446 5138613600 6147644000 8005436044 8167534900 4142712820 3123468100 7168843422

4500

5348

8002377620 8007823604 8006880010 8006880010 4023421890 8188787900 8002446224 8003461229 6263561000 8003778751 8007419910 8004828770 8772777280

8975

1360

6082413311 9202324180 8004446222 8004446222

8/1/2014

Code Name I39 450 451 724 G53 F18 D35 F26 855 C09 I05 452 G12 454 E26 455 F49 K34 N03 N04 N02 F24 453 J49 874 456 950 K64 N84

457 893 E27 N05 K96 458 N60 L59 727 808 D36 F98 459

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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OXFORD LIFE INS OXFORD LIFE INS CO OZARK NATL LIFE INS CO P.T.W.A. P5 ELECTRONIC HLTH SVS. PA.EMPLOYEES BEN.TRUST PACIFIC BENEFIT ADM. PACIFIC CARE OF UTAH PACIFIC FIDELITY PACIFIC GAS & ELEC. PACIFIC HERITAGE ADMIN. PACIFIC INDEMNITY CO PACIFIC LIFE AND ANNUITY PACIFIC MUT LIFE INS PACIFIC MUTUAL PACIFIC STD LIFE INS PACIFICARE PACIFICARE PACIFICARE PACIFICARE BEHAVIORAL HEALTH PACIFICARE COLORADO PACIFICARE MERCY MED FOND PACIFIE INS OF CALIF PAID DENTAL PAID RX/MEDCO HLTH SYS PAN AMER LIFE INS PANHANDLE EASTERN CORP. PARAGON BENEFITS INC

P.O. BOX 46518 2721 N CENTRAL AVE 906 GRAND/PO BX 2059 PO BOX 1808 P.O. BOX 247 150 S. 43RD. STREET 490 LAWN DALE DRIVE 35 WEST BROADWAY P.O. BOX 982009 P.O. BOX 5827 P.O. BOX 1020 111 PROSPECT ST P.O. BOX 33699 700 NEWPORT CTR DR 1717 DIXIE HWY. STE 700 PO BX 1796 P.O. BOX 6099 P.O. BOX 400046 PLO.O BOX 30975 P.O. BOX 3153 P.O. BOX 30975 P.O. BOX 60000 80 MAIDEN LANE P.O. BOX 9150 P.O. BOX 14711 2400 CANAL ST/PO 60219 P.O.BOX 1642 P.O. BOX 12288

MADISON PHOENIX KANSAS CY WEST HARTFORD ROY HARRISBURG SALT LAKE CITY SALT LAKE CITY NORTH RICHLAND HILLS SAN MATEO PORTLAND EAST ORANGE PHOENIX NEWPORT BCH FORT WRIGHT SACRAMENTO CYPRESS SAN ANTONIO SALT LAKE CITY LAGUNA HILLS SALT LAKE CITY SAN FRANCISCO NEW YORK AUSTIN LEXINGTON NEW ORLEANS HOUSTON COLUMBUS

WI AZ MO CT UT PA UT UT TX CA OR NJ AZ CA KY CA CA TX UT CA UT CA NY TX KY LA TX GA

53744 85004 64142 06144 84067 17111 84115 84165 76182 94402 97207 07019 85067 92663 41011 95808 90630 78229 84130 92654 84130 94160 10038 78766 40512 70160 77251 31917

PARAGON MEDICAL

AGA PLAIN ADMINISTRATOR

FT. WAYNE

IN

46825

PARAMOUNT MUT LIFE INS PARKSIDE MEDICAL SER PARTNERS HLTH PLAN OF N.C PARTNERS RX MANAGEMENT PATIENT ADVOCATES PAUL REVERE LIFE INS PBA HEALTH AND WELFARE FUND PBM PLUS INC PCG-CENTRAL TRUST BLDG PCS PCS OF PUERTO RICO PEAK ADM. SERVICES PEERLESS INS CO

30 CLINTON ST 1030 HIGGINS RDSUITE 200 P.O. BOX 24907 P.O. BOX 12119 P.O.BOX 1959 18 CHESTNUT ST 125 BROAD STREET 11TH FLOOR 300 TECHNECENTER DR 309 VINE ST P.O. BOX 52116 P. O. BOX #363689 P.O. BOX 59212 62 MAPLE AVE

NEWARK PARKRIDGE WINSTED-SALEM SCOTTSDALE GRAY WORCESTER NEW YORK MILFORD CINCINNATI PHOENIX SAN JUAN MINNEAPOLIS KEENE

NJ IL NC AZ ME MA NY OH OH AZ PR MN NH

07102 60058 27114 85260 04039 01608 10004 45150 45202 85072 00936 55459 03431

Plus 4 Phone 8774693073 8005280463

0648 8009

3699

0975 1053 0975 0058

8003973685 7175614750 8006483949 8013551234 8005272845 8009983242 8003673721 8007298545 7146403011 6063319300 9167563030 7149521121 8009509355 8009323004 8008882998 8008779777 8006248822 8003423279 8002727243 5045661300 7136276350 8002779218 8008886472

4907

3689 0212

7086927020 8009425695 8006594112 8002908559 5087994441 2123497560 8002632178 8009665772 8097531869 8009971750 6033523221

8/1/2014

Code Name 460 461 462 725 463 464 935 I33 465 A03 930 466 401 400 468 J03 467 H97 H57 K17 A17 726 B80 J17 D14 G30 E83 H03 N06 J70 C89 728 844 470 875 G64 471 G75 H64 H43 C10 472

PEKIN INS CO PEKIN LIFE INS CO PENISULAR LIFE INS CO PENN GENERAL SVC CORP PENN MUTUAL LIFE INS PENN SECURITY LIFE PENN TREATY LIFE INS PENN WESTERN BENEFITS PENNSYLVANIA LIFE INS PENSION ASSOC. INC. PENSION GRP SER PENSION LIFE OF AMER. PEOPLE BENEFIT LIFE INS. PEOPLES BENEFIT LIFE INS. PEOPLES LIFE INS/D.C. PEOPLES SECURITY LIFE INS PEOPLES-HOME LIFE/IND. PERFECT HEALTH INSURANCE PERFORMAX PERFORMAX PERFORMED COST MANG SERV PETER PAUL/CAD/SCHWEPPS PFM INC PHARM NETWK NATL CO (PNNC PHARMACARE PHARMACARE PHARMACY ACCESS PHARMACY ADV.SYSTEM PHARMACY DATA MANAGEMENT PHARMACY SERVICE CORP PHARMACY SERVICE CORP. PHELPS DODGE COPPER PROD PHILADELPHIA AM LIFE PHILADELPHIA LIFE INS PHILLIPS ADMIN.SER. PHN/PHS PHOENIX ASSURANCE CO PHOENIX DENTAL PHOENIX GROUP SERV. PHOENIX GROUP SERVICES PHOENIX HOME LIFE PHOENIX MUTUAL INS CO

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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2505 COURT ST 2505 COURT ST 645 RIVERSIDE AVE 1020 PLAIN ST PO BOX 9120 INDEPENDENCE SQUARE 7777 BONHOMME ST 3440 LEHIGH STREET P.O. BOX 7834 3130 WISHIRE BLVD 10795 WATSON RD P.O.BOX 4022 1 VALLY FORGE PLAZA P.O. BOX 484 P. O. BOX 484 601 NEW HAMPSHIRE AVE NW P.O. BOX 61 59 MAIDEN LANE P.O. BOX 140724 P.O. BOX 1065 P.O. BOX 60608 P.O. BOX 26000 NEW HAVEN RD P.O. BOX 2469 4020 WAKE FOREST RD 25 BLACKSPONE PL.BOX519 P.O. BOX 2860 P.O. BOX 3010 50 LENNOX PT. P.O. BOX 5300 2045 MIDWAY DRIVE 210 GREATER OAKS BLVD. 41 WAWECUS ST BOX 970 4625 WASHINGTON AVE PO BOX 2465 P.O.BOX 218 P.O. BOX 22669 80 MAIDEN LANE P.O. BOX 1477 701 HIGHLANDER PO 150809 P.O. BOX 150809 P.O. BOX 677 1 AMERICAN ROW

PEKIN PEKIN JACKSONVILLE MARSHFIELD PHILADELPHIA ST. LOUIS ALLENTOWN GREENSBORO SANTA MONICA ST LOUIS KALAMAZOO VALLEY FORGE VALLEY FORGE VALLEY FORGE WASHINGTON DURHAM NEW YORK STATEN ISLAND AMHERST KING OF PRUSSIA ALBUQUERQUE NAUGATUCK LIVONIA RALEIGH LINCOLN PITTSBURG ANDOVER ATLANTA POLAND TWINSBURG ALBANY NORWICH RACINE HOUSTON ALBANY LONG BEACH NEW YORK GREENFIELD ARLINGTON ARLINGTON GREENFIELD HARTFORD

IL IL FL MA PA MO PA NC CA MO MI PA PA PA DC NC NY NY NY PA NM CT MI NC RI PA MA GA OH OH NY CT WI TX OR CA NY MA TX TX MA CT

61554 61554 32203 02050 19172 63105 18103 27417 90404 63127 49003 19482 19493 19493 20048 27702 10038 10914 14226 19406 87125 06770 48151 27609 02865 15230 01810 30324 44514 44087 12203 06360 53405 77001 97321 90801 10038 01302 76015 76015 01302 06115

Plus 4 Phone 3093461161 3093461161 6178376171

0834

8003620700 3366659400 2138286411 8003659036 8002530966 2153371400 8005237900 8005237900 8004445431

0724 1065 6000

8774550294 8774421442 8885547629 8008544469

5386

3132614750 9198761593 8007771023 8886459303 8008224542 8887275560 8005490093 8008007153 8002277269

5669

4145544504 7138714990 8003569822 8772268045 8004512513 8003976241 8003976241 8004512513 8604035000

8/1/2014

Code Name E61 N07 K04 H51 H27 473 J12 C87 474 475 476 729 477 996 H21 479 480 C11 730 A71 I13 K42 803 N61 L77 D15 970 731 481 F31 H70 K32 C88 K43 E84 J05 482 483 D16 N38 I99 E12

PHOENIX MUTUAL INS.CO. PHP MID MICHIGAN PHYS.HLTH PLAN OF S. MICH PHYSCIAN OF CA. PHYSICIANS CARE NETWORK PHYSICIANS MUT LIFE PIEDMONT ADMINSTRATORS PIERCE COUNTY MEDICAL PILGRIM HEALTH/LIFE PILGRIM LIFE INS CO PILGRIM LIFE OF IND. PILLSBURY COMPANY PILOT LIFE INS CO PIONEER HLTH PIONEER LIFE PIONEER MUT LIFE INS PIONEER SECURITY LIFE PIPE FITTERS LOCAL 205 PITNEY BOWES PLAN PLAN DATA PLAN HANDLERS INC PLANNED ADMINISTRATOR INC PLASTIGLIDE MFG CORP PLUMBERS & PIPEFITTERS PMA MEDICAL GROUP BILL POE AND BROWN POMPCO POST MASTERS BENEFIT FUND PRAETORIUM MUT LIFE PRECISE BENEFIT ADM. PREF. GRP. PLANS PREFERRED ADMIN. SERV PREFERRED ASSURANCE PREFERRED CARE PREFERRED CARE INC. PREFERRED ONE ADMIN. SVC PREFERRED RISK LIFE PREFERRED RISK MUTUAL PREFERRED WORKS PREMERA BLUE CROSS PREMIER HEALTH PLUS PRESBYTERIAN HEALTH PLAN

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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PO BOX 3005 1400 EAST MICHIGAN AVE P.O. BOX 4055 1570 BROOKHOLLOW DRIVE P.O. BOX 101111 2600 DODGE STREET P.O. BOX 78030 P.O. BOX 2915 1143 LANNEY WALKER BLVD 1835 DEL MAR DR 2902 N MERIDIAN ST PO BOX 40 PO BOX 20727 P.O.BOX 6600 P.O. BOX 5151 203 NO TENTH ST 80 MAIDEN LANE 2908 N. HARVARD AVE PO BOX 1168 P.O. BOX 719 930 CANTERBURY PLACE P.O. BOX 6702 952 SOUTH MAIN ST LOCAL 520 P.O. BOX 2854 P.O. BOX 2480 P.O.BOX 6329 PO BOX 1019 N ROYAL ST 1607 MAIN ST/PO BX 419 P.O. BOX 9064 P.O. BOX 15136 259 MONROE AVE P.O. BOX 12370 P.O.BOX 22920 P.O. BOX 1538 P.O. BOX 59212 1111 ASHWORTH RD 1111 ASHWORTH RD 3 SKYLINE DR. DEPT.632 P.O. BOX 91059 9500 WEST DODGE RD. PO BOX 27489

AGAWAM LANSING JACKSON SANTA ANA COLUMBIA OMAHA GREENSBORO TACOMA AUGUSTA FOLCROFT INDIANAPOLIS MINNEAPOLIS GREENSBORO HOLYOKE JAMESVILLE FARGO NEW YORK TULSA LAWRENCE UNION ESCONDIDO COLUMBIA WATERBURY CINCINNATI CLINTON DAYTONA BEACH SYRACUSE ALEXANDRIA DALLAS JERICHO ALBANY ROCHESTER ALBANY ROCHESTER FORT WASHINGTON MINNEAPOLIS W DES MOINES W DES MOINES HAWTHORNE SEATTLE OMAHA ALBUQUERQUE

MA MI MI CA SC NE NC WA GA PA IN MN NC MA WI ND NY OK MA NJ CA SC CT OH IA FL NY VA TX NY NY NY NY NY PA MN IA IA NY WA NE NM

01001 48912 49204 92705 29201 68131 27427 98401 30901 19032 46208 55440 27420 01041 53547 59102 10038 74115 01842 07083 92025 29260 06721 45210 52733 32115 13217 22314 75221 11753 01112 14607 12212 14692 19034 55459 50265 50265 10532 98111 68114 87125

Plus 4 Phone 2107

1111 2671 2915

8882558961 5173648400 8003947569 8009907262 8002233943 8002289100 3365442222 2065976557 6046596250 2155348800

5151

9196913000 8004667600 8007597007

2404

9186226565

0212

9083523456 8005385512 8007684375 2037567487 5132410444 8884762669 9042395710 8002344393 7036835585 2145801898 5168906000 8005737474 8888682368 8007580574 8009993920 2156288108 8009971750

7489

5152256272 9143456000 8006761411 8003131757 5058230000

5136

8/1/2014

Code Name G13 D37 K45 D17 K50 K58 A72 938 F06 E13 J50 H14 I51 G20 E85 083 F75 N08 F93 999 D89 880 D18 D20 942 484 732 L70 L71 733 E89 I15 485 734 L31 M19 486 487 489 490 488 433

PRESBYTERIAN HLTH SVCS. PRESCRIPTION SOLUTIONS PRIMARY PHYSICIANCARE INC PRIME EXTRA PRIME THERAPEUTIC PRIME THERAPEUTIC PRIMESOUTH INC. PRINCIPAL FINANCIAL GRP PRINCIPAL HLTH C/DELAWARE PRINCIPAL INSURANCE GROUP PRINCIPAL LIFE INS PRINCIPAL LIFE INS. PRINCIPAL LIFE INS. CO PRINCIPAL LIFE INSURANCE PRINCIPAL MUTUAL PRINCIPAL MUTUAL LIFE PRINCIPAL MUTUAL LIFE PRIORITY HEALTH PRIVATE HLTH. CARE SYSTEM PRIVATE INSURANCE PRO VANTAGE PROF PENSIONS INC PROF. BENEFITS ADM. PROFESSIONAL ADM.SVCS. PROFESSIONAL CLAIMS MGMT PROFESSIONAL INS CORP PROGRAMMED BENEFITS PROGRESSIVE MEDICAL INC PROGRESSIVE MEDICAL INC PROJECTS INC PRO-SERVE PHARMACY PROTECTIVE DENTAL CARE PROTECTIVE LIFE INS PROTOTYPE & PLASTIC MOLD PROVIDENCE HEALTH PLANS-MED PROVIDENCE RI SCHOOL SYSTEM PROVIDENT ALLIANCE INS PROVIDENT INDEMNITY PROVIDENT LIFE/CIGNA PROVIDENT MUT LIF/PHIL PROVIDENT/HEALTHSOURCE PROVIDENT/OCCIDENTAL

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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P.O. BOX 13896 PO BOX 6037 MAIL ST07-290 P.O. BOX 11088 P.O. BOX 1088 P.O. BOX 64812 RD STE 100 P.O. BOX 64812 P.O. BOX 212129 211 N LOOP/1604E STE165 P.O.BOX 5670 1 INT'L PLAZA SUITE 100 1 INT'L PLZ STE 100 P.O. BOX 39710 P.O. BOX 781320 P.O. BOX 57700 10985 CODY STE. 200 711 HIGH ST 3435 STELZER RD.STE.300 1231 EAST BELTLINE P.O. BOX 20115 (NO ADDRESS) P.O. BOX 1662 444 FAXON ROAD P.O. BOX 4687 1 WHITEHOUSE PK.ROAD P.O.BOX 35276 135 RIVERSIDE AVE CORPORATE CENTER WEST PHARMACY CLAIMS DEPT 250 PROGRESSIVE HIGHWAY 65 SEQUIN DR P.O. BOX 9081 P.O. BOX 830626 PO BOX 2606 35 INDUSTRIAL PARK PL P.O. BOX 3125 797 WESTMINSTER ST. P.O.BOX 19702 2500 DEKALB PIKE P.O. BOX 188002 1600 MARKET ST FOUNTAIN SQUARE 14200 CHICAGO RD 215

PHILADELPHIA CYPRESS CHARLOTTE TWINSBURG ST. PAUL ST. PAUL COLUMBIA SAN ANTONIO WILLMINGTON PHILADELPHIA PHILADELPHIA COLORADO SPRINGS INDIANAPOLIS SALT LAKE CITY OVERLAND PARK DES MOINES COLUMBUS GRAND RAPIDS ARLINGTON

PA CA SC OH MN MN SC TX DE PA PA CO IN UT KS IA OH MI TX

19101 06300 28220 44087 55164 55164 29221 78232 19808 19113 19113 80949 46268 84157 66210 50307 43219 49525 76006

3896 0037 1088

WAUKESHA EAST HAVEN OAK BROOK HAMMONTON CANTON JACKSONVILLE WEST HARTFORD WESTERVILLE WESTERVILLE GLASTONBURY OXNARD BIRMINGHAM BIRMINGHAM MIDDLETOWN PORTLAND PROVIDENCE IRVINET NORRISTON CHATTANOOGA PHILADELPHIA CHATTANOOGA DOLTON

WI CT IL NJ OH FL CT OH OH CT CA AL AL CT OR RI CA PA TN PA TN IL

53187 06513 60522 08037 44735 32202 06110 43082 43082 06033 93031 35283 35202 06457 97208 02903 92713 19404 37422 19101 37402 60419

0812

3910

3035 4501

1662 4687

1670

9081 0626

8007737752 8007887871 8004465439 8004224201 8004231973 8773577463 8037508743 2103403122 8008337423 8005221279 8003294130 8008261820 8005335044 8009849084 3166367668 8004225002 8003234646 6164648235 8884113888 8007840881 2034687339 8004355694 8008731727 8003258424 9043547171 2035211161 8667647987 8667647987 8009627378 8004569194 8008663808 8008784445 4014659165 7145530700

1277

8008438942 8006885177 8003555967 3128499210

8/1/2014

Code Name 434 M21 N09 491 K21 L46 492 937 493 494 C50 D68 B82 495 N32 736 N53 737 J34 H25 990 497 496

498 738 499 G11 D90 H96 430 739 M22 500 501 D21 503 A76 740 C29 963 980 L79

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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PROVIDENT/OCCIDENTAL PRUDENTIAL INS. CO OF AMER. PRUDENTIAL LONG TERM CARE PRUDENTIAL/AETNA PSERS HLTH ADMIN UNIT PSI/TRIVERIS PUBLIC SAVINGS LIFE PUERTO RICO "SSS" PURITAN LIFE INS CO PYRAMID LIFE INS R&R CORRUGATED CONTAINER R.E. HARRINGTON R.L. LYONS CO RANGER NATL LIFE IINS REASSURE AMERICA LIFE INS. CO. REB INDUSTRIES RECKTENN REDINGTON COUNTER INC REGAL MARINE HEALTH PLAN REGENCE B/S PREF. PLAN C REGIONAL CLAIM PROCESSING RELIABLE LIFE INS CO

230 W MONROE ST/SUITE1520 P.O. BOX 89436 2101 WELSH RD P.O. BOX 14586 P.O. BOX 2921 P.O. BOX 547 304 MEETING ST P.O.BOX 3628 245 WATERMAN 6201 JOHNSON DR/PO 772 CONTAINER DR. P.O. BOX 182173 27576 COMM. CNTR DR ST111 PO BOX 2807 8545 126TH AVE. 35 NUTMEG LA BENEFITS SERVICE CENTER 130 ADDISON RD BOX 608 P.O. BOX 916188 P.O. BOX 21267 P.O.BOX 9062 231 W LOCKWOOD AVE

CHICAGO CLEVELAND DRESCHER LEXINGTON CLINTON EATONTOWN CHARLESTON SAN JUAN PROVIDENCE SHAWNEE MSN TERRYVILLE COLUMBUS TEMECULA HOUSTON LARGO GLASTONBURY ORLANDO WINDSOR LONGWOOD SEATTLE MELVILLE WEBSTER GRVS

IL OH PA KY IA NJ SC PR RI KS CT OH CA TX FL CT FL CT IL WA NY MO

60606 44101 19025 40512 52733 07724 29401 00936 20818 66202 06786 43218 92590 77001 33776 06033 32878 06095 32791 98111 11747 63119

RELIABLE LIFE/CAS INS

P.O.BOX 4160

MADISON

WI

53711

RELIANCE INS CO RELIANCE INSURANCE RELIANCE STD LIFE INS RELIANT BLDG. PROD.HLTH. RELIASTAR RELIASTAR LIFE INS. RELIASTAR LIFE INS. CO. REMINGTON PRODUCTS RENNAISSANCE REPUBLIC INS CO REPUBLIC NATL LIFE RESERVE NAT'L RESOLUTE LIFE INS RESTAT RETAIL CLERKS LOCAL 919 RETAIL PHARMACY PROGRAM RETIRED OFFICERS ASSOC. REYNOLDS & REYNOLDS RIVERSOURCE LIFE INS. CO.

3 PARKWAYR PLAZA PO BOX 99 10 GOULD CTR 2255 RIDGE RD. STE.206 111 WASHINGTON AVE.STE620 P.O. BOX 82617 P.O.BOX 2070 60 MAIN ST P.O. BOX 17250 2727 TURTLE CREEK BLVD 3988 N. CENTRAL EXPY/6210 P.O. BOX 18448 163 ASYLUM ST P.O. BOX 758 6 HYDE ROAD 2ND FL BOX 52057 P.O.BOX 9126 P.O.BOX 2608 P.O. BOX 40007

PHILADELPHIA NORTH QUINCY ROLLINGMEADOW ROCKWELL MINNEAPOLIS LINCOLN MILWAUKEE BRIDGEPORT INDIANAPOLIS DALLAS DALLAS OKLAHOMA CITY HARTFORD WEST BEND FARMINGTON PHOENIX DES MOINES DAYTON LYNCHBURG

PA MA IL TX MN NE WI CT IN TX TX OK CT WI CT AZ IA OH VA

19103 00000 00000 75087 55401 68501 53201 06602 46217 75221 75204 73118 06102 53095 06032 85072 50306 05401 24506

Plus 4 Phone 6436 4586

2173 4839

3123688180 8008280153 2156585440 8882386271 8007737725 8007187322

2035841124 8008482025 7146946194 8883049200 8664361768

6188 3267

4077862777 8003307206 3149684900 8007771195

2617

8883117274 6123725432 8009654148 8004446965 8008863908

4058487931 0758 2830 2057

8002481062 8008422214 8006245060 8002472192 8007363539

8/1/2014

Code Name 823 951 J84 C63 A38 804 845 C28 741 C12 A44 C49 742 504 505 D38 E19 906 521 G97 506 G84 H53 957 995 972 N10 743 E28 L97 994 744 K98 J89 N11 N12

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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RLC CORP BENET FUND RLC CORP HLTH BENE. TRUST RMSCO RMSCO INC. ROADWAY SERVICES ROBERT SHAW CONTROLS ROBERT WEISS/PIONEER ROBEY-BARBER INS. SRVC ROCKBESTOS COMPANY ROLLINS CORP. RONDO PACKING SYSTEM ROOFERS LOCAL 9 HLTH ROTO-PRINT MACHINE CORP ROYAL GLOBE INS CO RURAL SEC LIFE INS CO RX AMERICA RX PRIME CIGNA HLTH. CARE RYDER SYSTEM INC. S & H INS CO S&S HEALTHCARE STRATEGIES SAFECO LIFE INS CO SAFEGUARD ENROLLMENT SAFEHEALTH LIFE SAFETY - KLEEN SAMBA SAMMONS CORP. SERVICES SANDFORD HEALTH PLAN SANDITZ TRAVEL AGENCY INC SANDSEXPO-SILVER ST. MED. SANFORD HEALTH PLAN SANUS SARGENT & COMPANY SAVE RX SB HOWARD AND CO SCH CLAIMS ADMIN

PO BOX 1791 P.O.BOX 1791 P.O. BOX 678 P.O. BOX 6309 POBOX 88 PO BOX 3009 P.O. BOX 2365 P.O. BOX 10100 PO BOX C 2170 PIEDMONT RD. N.E. 209 GREAT HILL ROAD 66 CONN. BLVD. MAIN ST 150 WILLIAM ST PO BOX 5555 369 BILLY MITCHELL RD. S127 P.O. BOX 780 P.O.BOX 025214 3200 WILSHIRE BLVD P.O. BOX 46511 SAFECO PLAZA P.O. BOX 30910 P.O. BOX 61067 777 BIG TIMBER ROAD 11301 OLD GEORGETOWN RD 300 CRECENT CT SUITE 700 221 8TH ST. 137 BANK ST 2073 E. SAHARA AVE. STE.B P.O. BOX 91110 8600 FREEPORT PARKWAY 100 SARGENT DR P.O. BOX 8 P.O. BOX 1627 2600 NORTH LOOP W

WILMINGTON WILMINGTON LIVERPOOL SYRACUSE AKRON MILFORD SOUTH BURLINGTON TAMPA EAST GRANBY ATLANTA NAUGATUCK EAST HARTFORD OCCUM NEW YORK MADISON SALT LAKE CITY HARTFORD MIAMI LOS ANGELES CINCINNATI SEATTLE LAGUNA HILLS ANAHEIM ELGIN NO. BETHEDA DALLAS SHELDON WATERBURY LAS VEGAS SIOUX FALLS IRVING NEW HAVEN FREMONT ROGERS HOUSTON

DE DE PA NY OH CT VT FL CT GA CT CT CT NY WI UT CT FL CA OH WA CA CA IL MD TX IA CT NV SD TX CT NE AR TX

19899 19899 13088 13203 44309 06460 05407 33679 06026 30324 06770 06108 00000 10038 53705 84116 06142 33102 90010 45246 89185 96254 92803 60123 20852 75201 51201 06720 89104 57109 75063 06511 68026 72757 77092

Plus 4 Phone 8006285225 8006285225 8772047086 3154748200 2163848184 2038781721 8882341011 8007497409 4048882718 2037237474 8602890264

1121 5214

0920 6167

6088338080 8007708014 8006225579 3055933537 8007172872 8004267784 8008801800 8009629633 7086978460 3019841440 2146709021 8007525863 8007220292 8007525863 2146218143 2035622151 8662334239 4795248151 7136818877

SCOTT AND WHITE HEALTH PLAN

P.O. BOX 269006

PLANA

TX

75026

8003217974

A28 C30 J48 M38 H73

SCREEN ACTORS GUILD PROD SCRIPT CARD ENTERPRISES SCRIPT CARE SCRIPT WORLD SEABURY & SMITH

3601 WEST OLIVE AVE 448E.6400 S. STE. 400 6380 FOLSOM DR 250 NORTH REDWOOD ROAD 1776 WEST LAKES PKWY

BURBANK SALT LAKE CITY BEAUMONT N. SALT LAKE CITY WEST DES MOINES

CA UT TX UT IA

91510 84107 77706 84054 50398

8007774013 8008727471 8008809902 8019360477 8008825541

B19

SEABURY/SMITH OFC OF ADM

1255 23RD ST NW STE 300

WASHINGTON

DC

20037

8004249883

8/1/2014

Code Name L45 509 511 512 513 514 516 515 I71 N13 F77 G69 979 902 745 H17 L68 L50 E48 517 518 519 520 L54 N30 B83 I88 931 522 C14 D91 G14 M07 G36 L67 E29 F07 I17 I08 523 N14 D22

SEARS ROEBUCK AND CO SEC BENEFIT LIFE INS CO SEC LIFE & ACCIDENT INS SEC LIFE INS CO OF AMER SEC LIFE INS CO OF DENVER SEC LIFE INS CO OF GA SEC MUT LIFE INS CO OF NY SEC MUTUAL CASUALTY CO SECURE HORIZON SECURITY LIFE INSURANCE CO. SELECT BENEFIT ADMINISTRA SELECT BENEFITS SELF FUNDED PLANS INC. SELF INSURED SER CO SELF-FUNDING ADM SELF-INSURED DENTAL SVCS. SELMAN & COMPANY SELMAN COMPANY SENTARA SENTINEL LIFE INS CO SENTRY INS CO SENTRY LIFE INS CO SERV LIFE INS CO OF OMAHA SETON HEALTHCARE NETWORK SEVEN CORNERS SHEET METAL WORK./LOC 38 SHEET METAL WRKS LOC 15 SHEET MTL WRKRS/NATL HLTH SHENANDOAH LIFE INS CO SIEBA LTD SIERRA CHOICE HLT OF NV. SIGNATURE DENTAL PLAN SIMPLICITY HEALTH PLANS SMC SMITH ADMINISTRATORS SMITHFIELD FOODS HLTH SNAP ON INC SODEXHO SOUTH CAROLINA MEDICAL SOUTH LIFE & HEALTH INS SOUTHEASTERN IND. HEALTH ORG. SOUTHERN ADM. SERVICES

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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HEALTH GP BEN SVS CENTER 700 HARRISON ST SECURITY LIFE BLDG 1200 SECOND AVE S SECURITY LIFE BLDG PO BOX 4087 COURTHOUSE SQUARE 222 S RIVERSIDE PLAZA P.O. BOX 52078 10901 RED CIRCLE DR. P.O. BOX 8339 P.O. BOX 440 2535 WASHING.RD SUTE 1130 PO BOX 389 PO BOX 6596 P.O. BOX 9095 6110 PARKLAND BLVD P.O. BOX 155 PO BOX 61999 1433 SW SIXTH ST 1800 NORTH POINT DR 1800 NORTH POINT DR 1904 FARNAM 1201 WEST 38TH ST. 303 CONGRESSIONAL BOULEVARD P.O. BOX 3619 P.O. BOX 1449 601 N FAIRFAX ST STE 500 PO BOX 11807 P.O. BOX 5000 PO BOX 15645 200 NORTH MARTINGALE RD. 20600 CHAGRIN BLVD SUITE 450 P.O. BOX 1979 P.O. BOX 161125 PO BOX 158 2801 80TH ST.PO BOX 1410 9801 WASHINGTONIAN BLVD. P.O. BOX 11188 2101 HIGHLAND AVE BOX 671 SIHO P.O. BOX 8069

THE WOODLANDS TOPEKA DENVER MINNEAPOLIS DENVER MACON BINGHAMTON CHICAGO PHOENIX MINNETONKA DES MOINES ASHLAND UPPER ST CLAIR DUBUQUE ANNAPOLIS VALLEY STREAM CLEVELAND SCRANTON VIRGINIA BEACH PORTLAND STEVENS POINT STEVENS POINT OMAHA AUSTIN CARMEL DANBURY GOODLETTSVILLE ALEXANDRIA ROANOKE ENDINCOTT LAS VEGAS SCHAUMBURG SHAKER HEIGHTS SEARCY FORT WORTH SMITHFIELD KENOSHA GAITHERSBURG COLUMBIA BIRMINGHAM COLUMBUS COLUMBUS

TX KS CO MN CO GA NY IL AZ MN IA WI PA IA MD NY OH PA VA OR WI WI NE TX IN CT TN VA VA NY NV IL OH AR TX VA WI MD SC AL IN GA

4211

77381 66636 80202 55403 80202 31208 13902 60606 85072 55343 50301 54806 15241 52004 21401 11582 44124 18504 23466 97201 54481 54481 68102 78705 46032 06813 37070 22314 24022 13761 89114 60173 44122 72145 76161 23431 53141 20878 29211 35201 47201 31908

8339

4187

1449

5000 5845

1410

1787 8069

8888873277 8008882461 3038601290 8003284667 3038601290 9127412500 6077233551 8003478600 8003284667 8008687262 8004973699 4128318822 3195561456 8004248611 8005371238 8777356262 8007505973 8002753755 7153466000 7153466000 4023411190 8007497624 8003350477 2038551125 8008314914 7037397000 8004564002 8002524624 7022427300 8006389814 8777471113 8003266442 8008672582 8008095916 4146565868 8007633946 8037986207 8004432980 8004268803

8/1/2014

Code Name G15 C51 L74 I42 D23 524 525 526 C64 I54 K80 K94 747 748 749 527 507 508 750 F72 528 L85 A98 M46 F51 C53 G42 D24 M03 M58 K40 I84 535 K60 K19 907 F01 537 E30 530 531 532

SOUTHERN BENEFIT ADM. SOUTHERN BENEFIT CONSULT SOUTHERN GRAPHIC SYSTEMS SOUTHERN GROUP ADMIN SOUTHERN WESTCHESTER HLTH SOUTHLAND LIFE INS CO SOUTHWESTERN GEN LIFE SOUTHWESTERN LIFE INS SPECIALTY RISK INT'L INC. SPECTERA SPECTERA SPECTERA VISION SPERRY BENEFITS SPERRY-GYROSCOPE SPRAGUE METER SPRINGFIELD LIFE INS ST PAUL FIRE & MARINE INS ST PAUL LIFE INS CO ST RAPHAELS HOSPITAL ST.AUGUSTINE HLTH.CARE STANDARD INS CO STANDARD LIFE AND ACCIDENT INS. CO. STANDARD REGISTER STANDARD SECURITY LIFE STANDARDBRED OWNERS ASSOC STAR ADMINISTRATIVE SERVI STAR MARK STARBRIDGE INS. STARMARK STARMARK STATE FARM HEALTH INS STATE FARM INS STATE FARM MUT AUTO STATE HEALTH PLAN STATE MUTUAL INS. STATE OF OKLAHOMA INS. STATELINE TPA INC STATESMAN NATL LIFE STATEWIDE SCHOOL CO-OP HL STD LIFE & ACCDT INS STD LIFE & CAS OF SC STD LIFE INS OF IND

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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Plus 4 Phone

P.O. BOX 1449 P.O. BOX 569710 626 WEST MAIN ST. 200 SOUTH MARSHALL ST 210 GREAT OAKS BLVD. SOUTHLAND CTR PO BX 2220 PO BOX 779 PO BOX 2699/S.W. LIFE BLD 9202 N MERIDIAN ST STE234 2811 LORD BALTIMORE DR. P.O. BOX 30978 P.O. BOX 30978 BOX 2909 LOOP STATION 150 EAST AURORA ST 35 SOUTH AVE 1250 STATE ST METRO SQUARE BLDG 7 & ROB METRO SQUARE BLDG 7 & ROB 1450 CHAPEL ST 1511 N. WESTSHORE BLVD. 1100 S W SIXTH AVE P.O. BOX 1800 PO BOX 1167 P.O. BOX 110 750 MCLEAN AVE. P.O. BOX 55270 P.O. BOX 420 P.O. BOX 55270 P.O. BOX 2942 400 FIELD DR. P.O. BOX 3070 100 STATE FARM PLACE 1 STATE FARM PLAZA P.O. BOX 3823 33 N GARDEN AVE STE1100 4545 LINCOLN BLVD. 1718 INDIAN WOOK CIR. 3815 MONTROSE BLVD P.O. BOX 11-450 P.O. BOX 1820 PO DRAWER 11677 300 E FALL CREEK BLVD

GOODLETTSVILLE DALLAS LOUISVILLE WINSTON SALEM ALBANY DALLAS DALLAS DALLAS INDIANNAPOLIS BALTIMORE SALT LAKE CITY SALT LAKE MINNEAPOLIS WATERBURY BRIDGEPORT SPRINGFIELD ST PAUL ST PAUL NEW HAVEN TAMPA PORTLAND GALVESTON DAYTON PARK RIDGE YONKERS PHOENIX FREEPORT PHOENIX CLINTON LAKE FOREST NEWARK BALLSTON SPA BLOOMINGTON DURHAM CLEARWATER OKLAHOMA CITY MAUMEE HOUSTON ALBANY GALVESTON ROCK HILL INDIANAPOLIS

TN TX KY NC NY TX TX TX IN MD UT UT MN CT CT MA MN MN CT FL OR TX OH IL NY AZ IL AZ IA IL OH NY IL NC FL OK OH TX NY TX SC IN

1449 9710

37070 75356 40202 27101 12203 75201 75221 75221 46260 21244 84130 84130 55426 06720 06604 01101 55102 00000 06511 33607 97204 77553 45401 60068 10704 85078 61032 85078 52733 60045 43058 12020 61701 27702 33755 73105 43537 77006 12211 77553 29730 46205

5386

8008314914 8004513540 5026375443 8003348159 8002277269 2144032000 2149547111 2149547111 8003350611 8002170094 8006383120 8006383120

6122217911

8002014988 1800 1167 0110 5270 5270 2942

8000

0450

8883501488 9374431000 8008223906 9142374990 8007622727 8003711633 8007622727 8005221246 8476151313 8888533267 8667344584 3097662311 8004224658 8778725500 4055213946 8004288194 7135266000 8006797247 18883501488 8033277151

8/1/2014

Code Name 533 534 529 H47 G51 751 752 N47 A08 C90 M39 753 538 N42 539 754 908 540 L03 541 F73 J38 542 543 986 F08 M40 J47 N37 C91 A91 F27 K72 544

L26 M05 545 546 D92 J30 955 A13

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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STD LIFE INS OF MISS STD SECURITY LIFE STD. LIFE/ACCDT OF CA STEELCASE PPO STEELWORKERS HLTH & WELF. STIRLING AND STIRLING STONE CONTAINER CORP STRATEGIC RESOURCE COMPANY STRATEGIC RESOURCES CO. STUDENT PLANS INC. SUMMACARE SUMMIT CORP OF AMERICA SUN LIFE ASSUR/CANADA SUN LIFE FINANCIAL SUN LIFE INS OF AMER SUN LIFE/CANADA GRP CLAIM SUNRISE HEALTH CARE CORP. SUNSET LIFE INS/AMER SUPERIEN HEALTH NETWORK SUPERIOR LIFE INS CO SUPERIOR PLATING CO. SUPERIOR VISION SUPREME LIFE INS/AMER SURETY LIFE INS CO SUSQUEHANNA ADM. INC SUTTER PREFERRED SXC HEALTH SOLUTIONS SYBRA GRP BENE. PLAN SYMETRA-SELECT BEN.ADM OF AMER. SYNCOR ADM. SERVICES SYSTEMED PRES. RX PROG. SYSTEMS & STRATEGIES HLTH T.E.N.J. WELFARE FUND

PEARL & ROACH STS/PO 1729 585 MADISON AVE 4828 RONSON CT/PO 80815 P.O. BOX 232 5 GATEWAY CTR. 7TH FL. 20 ARMORY LANE PICKERING ST P.O. BOX 14079 POBOX 23759 1730 PARK ST. STE 207 TEN NORTH MAIN STREET 1430 WATERBURY RD 1155 METCALF ST/DOMINION P.O. BOX 69421 SUN LIFE BLDG 1 SUN LIFE EXECUTIVE PK P.O.BOX 93098 3200 CAPITOL BLVD P.O. BOX 2090C 720 MONTGOMERY AVE LACEY PLACE P.O. BOX 967 3501 S.M. LUTHER KING DR 1935 S MAIN ST/BOX 30030 P.O.BOX 1523 2805 J ST.SUITE 200 P.O. BOX 3163 1000 CORPORATE DR. STE250 P.O. BOX 54806 P.O. BOX 59350 399 JEFFERSON ROAD 110 BOGGS LANE STE.400 LOCAL 560 PO BOX 8037

JACKSON NEW YORK SAN DIEGO GRAND RAPIDS PITTSBURG MILFORD PORTLAND LEXINGTON COLUMBIA NAPERVILLE AKRON THOMASTON MONTREAL HARRISBURG BALTIMORE WELLESLEY HILLS ALBERQUERQUE OLYMPIA STOW NARBERTH SOUTHPORT RANCHO CORDOVA CHICAGO SALT LAKE CY LANCASTER SACRAMENTO LISLE FT. LAUDERDALE ASHLAND SCHAUMBERG PARSIPPANY CINCINNATI UNION CITY

MS NY CA MI PA CT CT KY SC IL OH CT PA MD MA NM WA OH PA CT CA IL UT PA CA IL FL WI IL NJ OH NJ

39205 14305 92138 49501 15222 06460 06480 40512 29224 60563 44308 06787 00000 17106 21201 02181 87199 98507 44224 19072 06490 95741 60653 84110 17603 95816 60532 33334 54806 60159 07054 45246 07087

TAHOE INS CO

1 E FIRST ST

RENO

NV

89501

TALL TREE ADMINISTRATOR TCC OF SOUTH CAROLINA TEACHERS INS & ANN. TEACHERS' PROT. MUT. TEAMSTER ALLIED BEN.FUND TEAMSTER COUNCIL #84 VA TEAMSTER LOCAL #363 TEAMSTER LOCAL 145

P.O. BOX 71747 P.O. BOX 22557 730 THIRD AVE/BOX 3779 116 N PRINCE ST 160 SOUTH CENTRAL AVE. 8814 FARGO RD. STE.200 9 JOHNSON LANE 2 RESEARCH DRIVE

SALT LAKE CITY CHARLESTOWN NEW YORK LANCASTER ELMSFORD RICHMOND NEW YORK CITY STRATFORD

UT SC NY PA NY VA NY CT

84171 29401 10017 17604 10523 23229 10956 06615

Plus 4 Phone 6019485300 2123554141 0232 3347

2701

8009561954 8882967493 8004476689 8006466733 8008008121 7087781900 3309968410

8668208408

3098

6172376030 8007593098 8883156045 2032551501 8005073800

0350 3707 1737

4673

7172959201 8004388507 8885465502 8009379272 8004973699 7082911230 8007293784 8007172872 8665603863 8774534201 8008516268 8008422111 7173947156 9145929330 8008520806 8002156212 2033756088

8/1/2014

Code Name 974 A43 F02 N15 956 755 756 757 758 759 760 761 762 763 764 765 A36 766 A14 949 L29 A39 988 A99 920 L66 547 N63 916 767 A87 J42 G22 J90 H71 B43 L88 B48 F94 967 J64 C65

TEAMSTER LOCAL 15/424 TEAMSTER LOCAL 43B TEAMSTER LOCAL 641 WELF. TEAMSTERS GENERAL SE TEAMSTERS LOCAL #106 TEAMSTERS LOCAL 0145 TEAMSTERS LOCAL 0191 TEAMSTERS LOCAL 0443 TEAMSTERS LOCAL 0536 TEAMSTERS LOCAL 0559 TEAMSTERS LOCAL 0617 TEAMSTERS LOCAL 0671 TEAMSTERS LOCAL 0677 TEAMSTERS LOCAL 0798 TEAMSTERS LOCAL 1035 TEAMSTERS LOCAL 1040 TEAMSTERS LOCAL 1102 TEAMSTERS LOCAL 1150 TEAMSTERS LOCAL 340 TEAMSTERS LOCAL 481 TEAMSTERS LOCAL 812 TEAMSTERS LOCAL 876 TEAMSTERS/LOCAL 800 TECHNICOTE HLTH CARE TELECONCEPTS INC TENNCARE TENNESSE LIFE INS TERNIAN TEXTILE WRKS UNION/1196 THAMES VALLEY STEEL THE BRITANNICA CO THE EPOCH GROUP LC THE GUARDIAN THE GUARDIAN THE LOOMIS CO THE MACKINNON CO INC THE MOHEGAN TRIBE THE NEW ENGLAND THE NEW ENGLAND THE NEW ENGLAND BEN GRP THE UMWA H&R FUNDS THIRD PARTY CLAIMS EXP.

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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P.O.BOX 762 27 UNION SQUARE 714 RAHWAY AVE.2ND.FL. 25 LOUSIANA AVENUE N.W. 822 LONGSHORE DRIVE 2 RESEARCH DRIVE 1139 FAIRFIELD AVE 200 WALLACE ST 400 CHAPEL RD. UNIT 2B 400 CHAPEL RD UNIT 2A 130 CENTRAL AVE 18 BRITTON DRIVE 25 RESEARCH DR BOX 3370 PO BOX 131 400 CHAPEL RD 2296 MAIN ST/2ND FLOOR 1587 STEWART AVE. 1330 FAIRFIELD AVE 55 NORTHERN BLVD 60 N.MAIN ST.P.O.BX 5817 445 NORTHERN BLVD 876 HORACE BROWN DR 99 UNIVERSITY PLACE PO BOX 188 36 HOLLY DRIVE P.O. BOX 20007 PO BOX 2465 994 OLD EAGLE SCHOOL RD P.O.BOX 9416 PO BOX 30 310 SOUTH MICHIGAN AVE P.O. BOX 12170 P.O. BOX 2459 7 HANOVER SQUARE 850 PARK RD/PO BOX 7011 23 KULICK RD 5 CROW HILL RD. PO BOX 30466 950 WINTER ST. STE.1300 P.O.BOX 7000 P.O. BOX 389 P.O. BOX 8002

MERIDEN NEW YORK UNION WASHINGTON LAKE CHARLES STRATFORD BRIDGEPORT NEW HAVEN SO. WINDSOR SOUTH WINDSOR JERSEY CITY BLOOMFIELD MILFORD PLAINFIELD SOUTH WINDSOR STRATFORD WESTBURY BRIDGEPORT GREAT NECK WALLINGFORD GREAT NECK MADISON HEIGHTS NEW YORK MIAMISBURG NEWINGTON NASHVILLE HOUSTON WAYNE GAITHERSBURG NEW LONDON CHICAGO OVERLAND PARK SPOKANE NEW YORK WYOMISSING FAIRFIELD UNCASVILLE TAMPA WALTHAM CORAOPOLIS EPHRAIM LITTLE ROCK

CT NY NJ DC LA CT CT CT CT CT NJ CT CT CT CT CT NY CT NY CT NY MI NY OH CT TN TX PA MD CT IL KS WA NY PA NJ CT FL MA PA UT AK

06450 10003 07083 20001 70601 06615 06605 06511 06074 06074 70306 06002 06460 06374 06074 06615 11590 00000 11021 06492 11021 48071 10003 45432 06111 37202 77001 19087 20898 06320 60604 66282 99210 10004 19610 07004 06382 33630 02154 15108 84627 72203

Plus 4 Phone 2032381204 8004412980 9086874488 2026246800 3184334871 2033756088 8009724099 2036249817 2035284159 8602893409 8602430671 2037552906 8605284159 2033802286 5168329200 5164666980 2032697741 5163031455 3135859671 2126741800 5138594448 2036665666 8663114287 8016564599 3012582684

2459 6011

3460 7000 0361

3123477000 9133620040 8005417846 2125988000 6103744040 2018089090 8006643426 8006541731 8002849763 8002849763 8002922288 8009723025

8/1/2014

Code Name B01 J15 E31 C96 013 A25 J54 548 J33

K57 G65 B02 549 550 936 F52 H02 C15 G47 768 406 M52 A77 M51 551 552 553 555 556 559 557 MED 891 560 558 B84 F74 I98 769 G98 091 952

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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THIRD PARTY CLAIMS MGMT THOMAS COOPER AND COMPANY THOMPSON AGENCY THRIFT DRUG INC. THRIVENT FIN. FOR LUTH THURSTON COUNTY MEDICAL TILCON EMPL GRP INS PLAN TIME INS CO/FORTIS

PO BOX 171826 P.O. BOX 22557 763 FARMINGTON AVE. 620 EPSILON DRIVE 4321 NO.BALLARD RD. POBOX 487 P.O. BOX 310903 501W.MICHIGAN AV.PO BX624

MEMPHIS CHARLESTON FARMINGTON PITTSBURG APPLETON OLYMPIA NEWINGTON MILWAUKEE

TN SC CT PA WI WA CT WI

38187 29413 06034 15238 54919 98507 06131 53203

0903 0624

8008823639 8437222115 8008428289 8005815300 4147345721 2063527611 8607568025 8007438463

TOTAL CLAIMS ADM.

P.O. BOX 21128

FORT LAUDERDALE

FL

33335

1126

8008674446

TOTAL CLAIMS SOLUTIONS TOTAL PLAN SERVICES INC. TOTAL PROGRAM ADM TOWER LIFE & ACCDT TOWER LIFE INS CO TPA OF ARIZONA INC TPA OF FLORIDA TPA OF GEORGIA TPA OF PA TPA OF TEXAS TR PAUL TRANSAMERICA LIFE INS. TRANSAMERICA MINI MED. PLAN TRANS-CARE INTN`L LIMITED TRANSCHOICE PLUS TRANSCONTINENTAL INS TRANSPACIFIC LIFE INS TRANSPORT EMPL. BENEF TRANSPORTATION INS CO TRANS-WORLD LIFE INS TRAVELERS /UNITED HLTH. TRAVELERS INDEM/OF RI TRAVELERS MEDICARE TRAVELERS PLAN ADMIN TRAVELERS PROTECTIVE AUTO TRAVELERS/UNITED HLT.CARE TRIAD TRICARE/CHAMPUS TRISTATE DENTAL TRUE PAUL TRUST THE INS. PROS (TIP) TRUSTMARK TUCKER ADMINISTRATORS

P.O. BOX 10888 P.O. BOX 11379 PO BOX C85013 435 N MICHIGAN AVE TOWER LIFE BLDG P.O.BOX 52100 P.O. BOX 945030 2900 CHAMBLEE TUCKER RD 18 SENTRY PKW.P.O.BOX1127 P.O. BOX 901066 PO BOX 5508 P.O. BOX 93019 P.O. BOX 1279 193-195 HIGH ST ACTON P.O. BOX 99906 CNA PLAZA 3130 WISHIRE BLVD 3670 WILSHIRE BLVD CNA PLAZA 501 FIFTH AVE PO BOX 7045 260 CONSTITUTION PLAZA 100 BARNES RD P O BOX 52100 3755 LINDELL BLVD P.O. BOX 740800 115 GLASTONBURY BLVD. P.O. BOX 870140 P.O. BOX 3370 NYALA FARMS RD P.O. BOX 1007 400 FIELD DRIVE 210T ARROW POINT BLVD

GREEN BAY PORTLAND RICHMOND CHICAGO SAN ANTONIO PHOENIX MAITLAND ATLANTA BLUE BELL FORT WORTH NEWTOWN HURST FORT MILL LONDON W39DD ENGLAND GRAPEVINE CHICAGO SANTA MONICA LOS ANGELES CHICAGO NEW YORK ROCKFORD HARTFORD WALLINGFORD PHOENIX ST. LOUIS ATLANTA GLASTONBURY SURFSIDE BEACH MILFORD WESTPORT GROTON LAKE FOREST CHARLOTTE SUITE #200

WI ME VA IL TX AZ FL GA PA TX CT TX SC CT TX IL CA CA IL NY IL CT CT AZ MO GA CT SC CT CT CT IL NC

54307 04104 23261 60611 78205 85072 32794 30341 19422 76101 06470 76053 29716 00000 76099 60685 90404 90010 60685 10017 61108 06103 06493 85072 63108 30374 06033 29587 06460 06881 06340 60045 28273

0888 7379

8003050406 8008065120 8004685646

0503

5030 1127 2066 9319

2105544400 8002235228 8004679448 7704517550 8004436430 8005440249 8006788161 8777357526 8662823555 8009520095 8664413433 8002622000 2137424411 8002622000

0800 9740

1007

8153950080 8605639692 2033170612 6028661066 3143710533 8005215505 8606524400 8778742273 8004426607 8604455377 8476151300 7045259666

8/1/2014

Code Name G16 962 770 J18 E63 595 596 K59 N26 854 774 H12 K49 N16 N17 H93 H65 I29 N74 L34 M45 N57 M10 B21 E64 F80 H69 G01 F89 E86 G44 271 L43 561 562 563 564 565 566 K31 567 966

TUFTS HEALTH TUFT'S TOTAL HEALTH TWIN TOOL COMPANY TYSON FOODS INC TYSON FOODS INC. U. S. LIFE INS CO. U.S. LIFE INS OF CALIF U.S. NOW U.S. OFFICE OF PERSONNEL MGMT. U.S.HEALTH CARE/AETNA UARCO INC UCHC STUDENT HLTH PLAN UFCW LOCAL 1459 UFCW NORTHERN CALIFORNIA UFCW SOUTHERN CALIFORNIA UHC EMPIRE PLAN UHC OF NORTH CAROLINA ULTRA BENEFITS ULTZ VISION UMR UMR UMR UMR DENTAL PLAN UNDERWRITERS & ADMIN INC UNICARE UNICARE UNICARE UNICARE LIFE AND HEALTH UNICARE LIFE AND HLTH INS UNICARE LIFE/ J. HANCOCK UNICARE/ABC INS TRUST UNICARE/ITT HARTFORD UNIFORM MEDICAL PLAN UNIGUARD-OLYMPIC LIFE UNION BANKERS INS CO UNION CASUALTY INS CO UNION CENTRAL LIFE INS UNION FIDELITY LIFE UNION LABOR LIFE INS UNION LABOR LIFE INS UNION LIFE SER CORP UNION MUTUAL MEDICAL FUND

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State Zip

P.O. BOX 9163 P.O.BOX 9185 INWOOD RD P.O. BOX 2020 BEN.ARO WILLIAMS ST.PO BOX 580 125 MAIDEN LANE 99 S LAKE ST P.O. BOX 260808 P.O. BOX 45 P.O. BOX 981107 P.O. BOX 1950 263 FARMINGTONAVE 33 EASTLAND STREET 1277 TREAT BLVD 6425 KATELLA AVE BOX 1600 2307 WEST CONE BLVD. P.O. BOX 763 P.O. BOX 740800 P.O. BOX 30530 3701 BOARDMAN-CANFIELD RD P.O. BOX 30541 P.O. BOX 8031 PO BOX 6250 PO BOX 5005 P.O. BOX 9016 P.O. BOX 9201 P.O. BOX 833935 P.O. BOX 4046 P.O. BOX 26061 1300 NORTH 17TH ST. P.O.BOX 2999 P.O. BOX 34578 190 QUEEN ANNE N/PO 3400 2551 ELM ST/PO BX 5433 100 AQUILLA CT PO BOX 179 UNION FIDELITY OFC PK P.O. BOX 61593 P.O. BOX 13530 P.O.BOX 3418 270 SYLVAN AVE.

WATERTOWN WATERTOWN ROCKY HILL SPRINGDALE BUENA VISTA NEW YORK PASADENA PLANO BOYERS EL PASO BARRINGTON FARMINGTON SPRINGFIELD WALNUT CREEK CYPRESS KINGSTON GREENSBORO WESTBOROUGH ATLANTA SALT LAKE CITY CANFIELD SALT LAKE CITY WAUSAU HARRISBURG BOLINGBROOK ANDOVER OXNARD RICHARDSON SCHAUMBURG GREENSBORO ROSALYN HARTFORD SEATTLE SEATTLE DALLAS OMAHA CINCINNATI TREVOSE KING OF PRUSSIA PENSACOLA LITTLE ROCK ENGLEWOOD CLIFFS

MA MA CT AR GA NY CA TX PA TX IL CT MA CA CA NY NC MA GA UT OH UT WI PA IL MA CA TX IL NC GA CT WA WA TX NE OH PA PA FL AR NJ

02472 02471 06067 72765 31803 10038 91101 75026 16017 79998 60011 06030 01109 94597 90630 12402 28307 01581 30374 84130 44406 84130 54402 17112 60440 01810 93031 75083 60168 27420 22209 06104 98124 98109 75223 68102 45201 19049 19406 32591 72203 07632

Plus 4 Phone 9185

8662469697 8004191000 8006433410 9126492845 8005232767

0045 1107 1950 2348 8863 5238

8031 5005 9201 3933 4046 6061

1578

8006949888 8887676738 8003239930 8008773001 8606792973 80063427000 8005522400 7142202297 8009922583 8007221180 8668587223 8006383120 8004468182 8006365061 8008269781 8003432738 8008776490 8778642273 8004429300 8006270004 8003333304 8004543262 8778642273 8006212993 8605475000 8007626004 8008243577

3530

5135952349 8005235758 8778002956 8007114441 5013761839 2018718400

8/1/2014

Code Name 570 571 A79 L60 858 A73 N18 572 573 M41 574 J10 616 575 J66 D69 K93 775 576 577 578 C92 579 580 581 582 I03 I94 E32 E33 E17 L49 C66 C67 G52 K37 M42 H09 F09 E49

UNION NATIONAL LIFE UNION SECURITY LIFE UNION ST JEAN BAPTISTE UNISON HEALTH PLAN UNISYS BENEFIT UNITED ABRASIVES UNITED ADMINISTRATIVE UNITED AMERICAN INS UNITED BANKERS LIFE UNITED BEHAVIORAL HEALTH UNITED BENEFIT LIFE UNITED BENEFITS HEALTH GR UNITED CENTRAL LIFE INS UNITED COMM TRAVELERS UNITED CONCORDIA UNITED CONCORDIA CO. UNITED EMPLOYEES HLTH UNITED ENGINEERING UNITED EQUITABLE LIFE UNITED FAMILY LIFE INS UNITED FARM BUREAU FAM UNITED FED. OF TEACHERS UNITED FIDELITY LIFE UNITED FIRE INS CO UNITED FNDRS. LIFE/IL UNITED FNDRS.LIFE INS UNITED FOOD & COMMERCE UNITED GROUP PROGRAMS UNITED HEALTH CARE UNITED HEALTH CARE UNITED HEALTH CARE OF UT. UNITED HEALTH INTEGRATED SERVICES UNITED HEALTH LIFE UNITED HEALTH PLAN OF N.E UNITED HEALTHCARE UNITED HEALTHCARE UNITED HEALTHCARE DENTAL UNITED HLTH. CARE OF AZ. UNITED HLTH. CARE OF P.R. UNITED HLTHCARE PLAN/FL.

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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8282 GOODWOOD BLVD 3290 NORTHSIDE PKWY 1 SOCIAL ST BOX F P.O. BOX 1257 P.O. BOX 80905 RT 66 P.O. BOX 5057 P O BOX 8080 PO BOX 567 P.O. BOX 30602 DODGE AT 33RD ST P.O. BOX 2480 2727 ALLEN PKWY 6TH FL 632 N PARK ST P.O. BOX 827399 P.O. BOX 694210 1065 OLD COUNTRY RD ST202 55 SPERRY AVE 8324 SKOKIE 230 HOUSTON ST NW 130 E WASHINGTON 260 PARK AVE. SOUTH 1025 ELM ST 10 E 40TH ST 5900 MOSTELLER DR 5900 MOSTELLER DR P.O. BOX 6010 902 CLINT MOORE RD. P.O.BOX 740800 P.O. BOX 740800 2525 LAKE PARK BLVD P.O. BOX 30783 BOX169050 RT.MN152971 STE 310 475 KILVERT ST P.O. BOX 182281 495 N.KELLER RD STE200 P.O. BOX 30567 P.O. BOX 36439 P.O. BOX 364864 75 VALENCIA AVE.

BATON ROUGE ATLANTA WOONSOCKET MONROEVILLE LONDON WILLIMANTIC SAN JOSE MCKINNEY DALLAS SALT LAKE CITY OMAHA DAYTONA BEACH HOUSTON COLUMBUS PHILADELPHIA HARRISBURG WESTBURY STRATFORD SKOKIE ATLANTA INDIANAPOLIA NEW YORK DALLAS NEW YORK OKLAHOMA CY OKLAHOMA CY CYPRESS BOCA RATON ATLANTA ATLANTA W. VALLEY CITY SALT LAKE CITY DULUTH WARWICK COLUMBUS MAITLAND SALT LAKE CITY PHOENIX SAN JUAN CORAL GABLES

LA GA RI PA KY CT CA TX TX UT NE FL TX OH PA PA NY CT IL GA IN NY TX NY OK OK CA FL GA GA UT UT MN RI OH FL UT AZ PR FL

70806 30327 02895 15146 40742 06226 95150 75070 75221 84130 68131 32115 77019 43215 19182 17106 11590 06497 60076 30303 46204 10010 75202 10016 73112 73112 90063 33487 30374 30374 84120 84130 55816 02886 43218 32751 84130 85067 00936 33134

Plus 4 Phone

5138 8090

0602

8220

5042927600 4042619000 8002258752 8008952017 8002428276 8604567131 4082793131 9725295085 8008882998 8007751000 8003234890 8006699030 6142283276 8003320366 8008668499 5163344142

4046593300 3172637200 2126142000 8173901011

0010 0800

0783 8200

4864

4058439351 4058439351 7142202297 8007289896 8008422979 8002419964 8005215505 8665968447 8005262414 8004221404 8002257951 8004111147 8008249313 8882904747 7877827005 8004321141

8/1/2014

Code Name 776 583 584 984 876 585 F97 586 587 E65 G18 D70 J37 589 G17 B22 590 N19 L42 C16 591 777 592 593 594 568 569 I19 H22 L72 878 771 B85 772 N20 773 F58 F54 M20 H31

UNITED ILLUMINATING UNITED INS CO OF AMER UNITED LIFE & ACCDT UNITED MEDICAL RESOURCES UNITED MINE WK OF AMER UNITED PACIFIC LIFE UNITED PROVIDER SVCS. UNITED STATES FID/GUAR UNITED STATES FIRE INS UNITED STATES LIFE INS. UNITED STATES PLAN ADM. UNITED TEACHERS ASSOC. UNITED TEAMSTER FUND UNITED TRANSP.INS UNITED WISCONSIN GROUP UNITED/ATLANTIC HLTH CARE UNITY MUTUAL LIFE INS UNIVERA HEALTHCARE UNIVERSAL BENEFITS CORP. UNIVERSAL FIDELITY LIFE UNIVERSAL LIFE INS CO UNIVERSAL MFG CO UNIVERSAL UNDERWRITERS UNIVERSE LIFE INS CO UNIVERSITY LIFE/AMER. UNUM UNUM UPMC HEALTH PLAN UPSTATE ADM. SVCS. INC. US ABLE INSURANCE US ADMIN.OF PENN. US ADMINISTRATORS US BEHAVIORAL HEALTH US PROLAM US SCRIPT US SURGICAL USA HEALTH NETWORK USAA USCT ASSOC. CLAIM USI ADMINISTRATOR

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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1115 BROAD ST 1 E WACKER DR 111 PROSPECT ST P.O. BOX 145804 1425 SCALP AVE. 443 S SHATTO PLACE P.O. BOX 820277 100 LIGHT ST 111 PROSPECT ST PO BOX 15205 P.O. BOX 42011 5508 PK.CREST DR BOX26580 2137-2147 UTICA AVE. 14600 DETROIT AVE P.O. BOX 2013 PO BOX 9027 4969 ONODAGA RD P.O. BOX 23000 710 MAIN ST. 2211 N. HWY 81 PO BOX 241 902 CRESCENT AVE 5115 OAK ST 300 E FIRST ST/PO BX1670 3500 DE PAU ST PO BOX 9500 2211 CONGRESS AVE 112 WASHINGTON PLACE P.O. BOX 6589 P.O. BOX 1650 P.O.BOX 3000 PO BOX 54170 425 MARKET ST. 269 LUDLOW BOX 671 2425 WEST SHAW AVENUE 150 GLOVER AVE P.O. BOX 163930 DEPT60 9800 FREDERICKSBURG RD. REVOLUTION UNIT P.O. BOX 9888

BRIDGEPORT CHICAGO EAST ORANGE CINCINATTI JOHNSTOWN LOS ANGELES FORT WORTH BALTIMORE EAST ORANGE READING HOUSTON AUSTIN BROOKLYN CLEVELAND MILWAUKEE ONTARIO SYRACUSE ROCHESTER PLANTSVILLE DUNCAN MEMPHIS BRIDGEPORT KANSAS CITY RENO INDIANAPOLIS PORTLAND PORTLAND PITTSBURG SYRACUSE LITTLE ROCK CORAPOLIS LOS ANGELES SAN FRANCISCO STAMFORD FRESNO NORWALK AUSTIN SAN ANTONIO BASKING RIDGE SAVANNAH

CT IL NJ OH PA CA TX MD NJ PA TX TX NY OH WI CA NY NY CT OK TN CT MO NV IN ME ME PA NY AR PA CA CA CT CA CT TX TX NJ GA

06604 60601 07019 45250 15904 90020 76182 21202 07019 19612 77242 78755 11234 44107 53201 91762 13215 14692 06479 73533 38106 06608 64112 89505 46268 04112 04112 15219 13217 72203 15108 90054 94105 06904 93711 06856 78716 78288 07920 31412

Plus 4 Phone 3126614640 8002583648 8009504867 8142621010 8008288360

2044 0580

2013

8002213480 8008880332 8008808824 7188591624 2162289400 8004524250 8003433509 8003373338 8884840414 4052558530

7023296171 2077702211 8003311538 4124247500 8003317943 8006480271 8004510929 8187038981 4155475000

3930

8004608988 2034925000 8008723860 8005316978 8002008680 8006313441

8/1/2014

Code Name G61 I26 I23 G73 778 N34 N33 779 597 598 N21 G35 A78 H13 N55 780 619 H32 G78 I90 856 G60 J13 F53 N83

F15 604 599 L53 A29 781 889 G70 C52 600 782 I60 192 D26 K99

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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USI ADMINISTRATORS USI ADMINISTRATORS USI RX USI/CBCA ADMINISTRATOR UTICA MUTUAL INS CO VA MEDICAL BENEFITS VA MEDICAL CENTER VALCO MACHINE CO VALLEY FORGE INS CO VALLEY FORGE LIFE INS VALUE OPTIONS INC. VALUE RX CLAIMS ADM. VALUE RX/EXPRESS SCRIPT VENCOR VIACARE VIKING WIRE VIRGINIA SURETY CO. VISHAY HEALTH PLAN VISION BENEFITS OF AMER. VISION CARE PLAN VISION SERVICE PLAN VISION SERVICE PLAN VISTA HEALTHPLAN VISTA PLAN ADMINISTRATORS

83 WOOSTER HEIGHTS P.O. BOX 33728 675 FOXON RD SUITE 204 P.O. BOX 9000 PO BOX 530 957 CLAIRMONT RD. SUITE 200 555 WO;;ARD AVE 470 COTTAGE GROVE RD CNA PLAZA CNA PLAZA MENTAL HEALTH P.O. BOX 390873 30445 NW HWY STE 300 P.O. BOX 320 P.O. BOX 12489 SHELTER ROCK RD 4850 STREET RD P.O. BOX 8013 300 WEYMAN PLAZA P.O. BOX 30349 P.O. BOX 997100 P.O. BOX 2487 P.O. BOX 819006 P.O. BOX 090540

DANBURY FORT WORTH EAST HAVEN LONDON UTICA ATLANTA NEWINGTON BLOOMFIELD CHICAGO CHICAGO LATHAM BLOOMINGTON FARMINGTON HILLS PUEBLO SAN ANTONIO DANBURY TREVOSE WAUSAU PITTSBURG TAMPA SACRAMENTO COLUMBUS HOLLYWOOD STATEN ISLAND

CT TX CT KY NY GA CT CT IL IL NY MN MI CO TX CT PA WI PA FL CA OH FL NY

06810 76162 06513 40742 13503 30329 06111 06002 60685 60685 12110 55439 48334 81002 78212 06810 19049 54402 15236 33630 95899 43216 33081 10309

VSP VISION

3333 QUALITY DRIVE

RANCHO CORDOVA

CA

95670

8662408390

VYTRA HEALTH CARE W LIFE/FORTIS BEN INS CO WABASH LIFE INS CO WAGE WORKS WALGREEN HEALTH/WELFARE WALLACE SILVERSMITH WAL-MART ASSOC GRP HEALTH WARRENSTEINBORN ASSOC. WASHINGTON DENTAL WASHINGTON NATIONAL WATERBURY PLATING CO WATKINS ASSOC. INDUSTRY WAUSAU INSURANCE CO. WEAVER ASSOCIATES WEB TPA

395 NORTH SERVICE RD P.O.BOX 64271 2929 N MERIDIAN ST 1940 SPRIBGER DR P.O. BOX 545 15 STERLING DR 702 SW 8TH STREET 310 EAST 96TH ST P.O. BOX 75983 1603 ORRINGTON AVE. 114 PORTER ST BOX 2545 P.O. BOX 1738 P O BOX 8013 1200 #3 GATEWAY CTR. P.O. BOX 1928

MELVILLE ST. PAUL INDIANAPOLIS LAMBARD DEERFIELD WALLINGFORD BENTONVILLE INDIANAPOLIS SEATTLE EVANSTON WATERBURY ATLANTA WAUSAU PITTSBURG GRAPEVINE

NY MN IN IL IL CT AR IN WA IL CT GA WI PA TX

11747 55164 46208 60148 60015 06492 72716 46250 98125 60201 00000 30301 54402 15222 76099

6316944000 8008002000 8005257662 8775026272 8002072568

3728

0873

0813 1288 7100 2487

0190

1738 8013

8178624911 8004050886 8003838737 8774797594 3157353321 8772228387 8606676743 8002622000 8002622000 8003971630 8002739413 8003478777 8883487421 2103622218 8005235758 8008269781 8004324966 8008653676 8005240910 8008777195 8668478235 8003233165

8004211362 3178481290 8003674104 8008437705 8605759450 8003333841 8008269781 4124712885 8774802432

8/1/2014

Code Name F55 F56 N22 N23 H18 L62 806 L20 601 H50 F57 603 883 N24 B24 605 606 I45 E34 602 C22 A80 J19 B50 K67 B86 783 784 G28 607 G23 A22

884 785 807 609 786 824 610 611

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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WELLCARE WELLCARE WELLCHOICE NEW JERSEY WELLDYNE RX WELLPOINT WELLPOINT RX WELLS FARGO DIV BAKER IND WELLS FARGO THIRD PARTY ADM WEST COAST LIFE INS WEST NATIONAL LIFE INS. WESTCHESTER COUNTY CORP WESTERN FARM BUREAU WESTERN GENERAL SERVICES WESTERN GROWERS WESTERN OHIO HLTHCARE PLN WESTERN PREFERRED LIFE WESTERN STATES LIFE WESTERN TEAMSTERS WELFARE WESTERN UNION FIN. SVCS. WESTERN/SOUTHERN LIFE WESTPORT BENEFITS WEYCO WEYCO INC WEYERHAEUSER WHITE GROUP DENTAL WHOLE HEALTH INSURANCE WHOLE-SALE DISTRIBUTORS WHYCO CHROMIUM CO WILLIAM C BEELER & CO. WILLIAM PENN LIFE/N.Y. WILLIS CARROON

P.O. BOX 4470 P.O. BOX 271000 120 WOOD AVE SOUTH STE 200 P.O. BOX 4517 P.O. BOX 9125 WMS PRESCRIPTION DRUG PLAN P O BOX 601 P.O. BOX 2801 425 CALIFORNIA ST/STE 310 P.O. BOX 982017 10 SAW MILL RD. PO BOX 5087 180 N MICHIGAN AVE. #329 P.O. BOX 7240 6601 CENTERVILLE BUS PKWY 7409 S. ALTON CT/PO 22293 PO BOX 2907 1010 ACOMA ST 1 MACK CENTRE DRIVE 400 BROADWAY P.O. BOX 66743 P.O. BOX 17719 P.O. BOX 30132 EMPL BENE HLTH CARE PLAN P.O. BOX 14067 P.O. BOX 15016 1480 RENAISSANCE DR 670 WATERBURY RD 103 HAZEL PATH 127 CUTTER MILL RD P.O. BOX 291927

KINGSTON TAMPA ISELIN ENGLEWOOD OXNARD CINCINATTI NEW HAVEN CHARLESTON SAN FRANCISCO NORTH RICHARDSON HAWTHORNE DENVER CHICAGO NEWPORT BEACH DAYTON DENVER FARGO DENVER PARAMUS CINCINNATI ST. LOUIS IRVINE LANSING TACOMA JACKSON ALBANY PARK RIDGE THOMASTON HENDERSONVILLE GREAT NECK NASHVILLE

NY FL NJ CO CA OH CT WV CA TX NY CO IL CA OH CO ND CO NJ OH MO CA MI WA MS NY IL CT TN NY TN

12402 33688 08830 80155 93031 45250 06305 25330 94104 76182 10532 80217 60601 92658 45459 80222 58102 80204 07652 45202 63166 92713 48909 98477 39236 12212 60068 06787 37075 11201 37229

WILLIS CARROON CORP.

POBOX 2697 SUITE 800

WICHITA

KS

67201

3162684802

WILLSE & ASSOC. WINCHESTER ELECTRONICS WIREMOLD CO WISCONSIN NATL LIFE WISCONSIN PHYSICIAN SVC WJ JONES ADMIN SERV WOODMEN ACCDT & LIFE WOODMEN/WORLD LIFE SOC

PO BOX 1196 25 HILLSIDE AVE 60 WOODLAWN ST 220 WASHINGTON AVE/PO 740 P.O.BOX 8190 1979 MARCUS AVE STE 101 PO BOX 82288 1700 FARNAM ST

BALTIMORE OAKVILLE W HARTFORD OSHKOSH MADISON LAKE SUCCESS LINCOLN OMAHA

MD CT CT WI WI NY NE NE

21203 06779 06110 54901 53708 11042 68501 68102

8004239791

1200 4517

2801 8017

7401

7632

8002885441 8009687935 8884766986 8884792000 8882097852 8778500185 2038653125 8668695597 4155526200 8007338880 9145928670 3128550785 8007777898 9374399355 7012375700 3036290931 2019865100 5136291492 8005482041 5173497010 8007480003 8008265719 8008001397 8008666126

8005263919 5763286000 8002558109

4142350830 6082219623 5167755420 4024766500 4023421890

8/1/2014

Code Name 954 612 613 614 615 787 789 E87 F84 846 E66 618 617

WOODS & GROOM WORLD BOOK LIFE INS WORLD INS CO WORLD MUT HEALTH/ACCDT WORLD SERVICE LIFE INS WYRE WYND YALE HEALTH PLAN YALE NEW HAVEN HLTH CARE YORK RX./USI ZEBA TRUST ZENITH ADMINISTRATORS ZURICH AMERICAN LIFE ZURICH AMERICAN OF ILL

CONNECTICUT MEDICAID MANAGEMENT INFORMATION SYSTEM ALPHA CARRIER LISTING

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P.O.BOX 2549 MERCHANDISE MART PO BOX 3160 550 W DEKALB PIKE 307 W SEVENTH ST ANTHONY ST P.O. BOX 208217 P.O. BOX 8548 675 FOXON RD. #204 P O BOX 6000 PO BOX 1100 111 W. JACKSON BLVD 111 W. JACKSON BLVD

COLUMBUS CHICAGO OMAHA KING/PRUSSIA FORT WORTH JEWETT CITY NEW HAVEN NEW HAVEN EAST HAVEN HAMPTON COLUMBIA CHICAGO CHICAGO

ID IL NE PA TX CT CT CT CT NH MD IL IL

47202 60654 68101 19406 76102 06351 06520 06510 06513 03842 21044 60606 60606

Plus 4 Phone 8123729955 8007867557 8005231260 8173901011 8603762516 2034320250 2037812702 8887812707 6176203951 8002355805 3128436000 8003237592

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