Notification of Changes for Business Entity
General Information
Business Entity Name:	UNITED STATES PHARMACEUTICAL GROUP, LLC
Incorporation / Formation Date:
FEIN:	65-1122695
Ohio License Number:	33688
NPN:	8616831
DBA / Trade Name:	CONVEY HEALTH SOLUTIONS
State of Domicile:	DE
County:	NEW CASTLE
Business Address
Address 1:	3411 SILVERSIDE ROAD
Address 2:	RODNEY BUILDING, SUITE 104
City:	WILMINGTON
State:	DE
Zip:	19810
Phone:	954-903-5000
Fax:	954-903-5290
Business Web Site Address:
Business Email Address:	LICENSINGDEPT@CONVEYHS.COM
Mailing Address
Address 1:	P.O. BOX 266290
Address 2:
City:	WESTON
State:	FL
Zip:	33326
Indicate the type of change you are seeking
Address Change:	YES
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	STEVE FARRELL
Title:	CEO
Phone Number:	954-903-5000
Email Address:	LICENSINGDEPT@CONVEYHS.COM