Notification of Changes for Business Entity
General Information
Business Entity Name:	HUMANA PHARMACY SOLUTIONS, INC.
Incorporation / Formation Date:
FEIN:	452254346
Ohio License Number:
NPN:	16246295
DBA / Trade Name:
State of Domicile:	KY
County:	JEFFERSON
Business Address
Address 1:	500 WEST MAIN STREET
Address 2:
City:	LOUISVILLE
State:	KY
Zip:	40202
Phone:	502-580-1000
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	500 WEST MAIN STREET
Address 2:
City:	LOUISVILLE
State:	KY
Zip:	40202
Indicate the type of change you are seeking
Address Change:	NO
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:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
WILLIAM K. FLEMING	DIRECTOR	286680751	YES		07.01.2015
JOSEPH C. VENTURA	VP & ASST. CORP. SECRETARY	025549873	YES		04.21.2016

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:	J. GREGORY CATRON (BY J. ERWIN)
Title:	VP & CHIEF COMPLIANCE OFFICER
Phone Number:	502-476-1143
Email Address:	JERWIN3@HUMANA.COM