DEPARTMENT OF INSURANCE

Affiliations

Name	Pharmacy Enrollment Services, LLC	DOIID	747406	NAIC NPN	16001438

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Health	2/4/2011	3/31/2027
Active	Non Resident	Agent	Life	2/4/2011	3/31/2027
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	01/15/2025	03/31/2025	01/31/2025	01/31/2025	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Aetna Health Inc. (PA)	660717	Agent - Health	1/21/2020
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	7/15/2020
Active	Aetna Life Insurance Company	301140	Agent - Health	1/21/2020
Inactive	American Equity Investment Life Insurance Company	300389	Agent - Life	4/6/2011	5/2/2012
Inactive	American National Insurance Company	301861	Agent - Health	1/16/2012	6/3/2021
Inactive	American National Insurance Company	301861	Agent - Life	1/16/2012	3/15/2024
Inactive	American Pioneer Life Insurance Company	301782	Agent - Health	5/23/2011	9/13/2012
Inactive	American Pioneer Life Insurance Company	301782	Agent - Life	5/23/2011	9/13/2012
Inactive	Athene Annuity & Life Assurance Company	301798	Agent - Life	4/16/2012	8/13/2015
Active	First Health Life & Health Insurance Company	301735	Agent - Health	7/24/2013
Inactive	Gateway Health Plan of Ohio, Inc.	833424	Agent - Health	11/18/2017	1/1/2019
Inactive	Gerber Life Insurance Company	300529	Agent - Health	6/11/2013	8/13/2021
Inactive	Gerber Life Insurance Company	300529	Agent - Life	6/11/2013	8/13/2021
Inactive	Golden Rule Insurance Company	301943	Agent - Health	8/20/2013	12/13/2014
Inactive	Golden Rule Insurance Company	301943	Agent - Life	8/20/2013	12/13/2014
Inactive	Independent Order of Foresters	300743	Agent - Life	12/13/2011	12/15/2018
Inactive	Marquette National Life Insurance Company	300117	Agent - Health	5/23/2011	9/13/2012
Inactive	Marquette National Life Insurance Company	300117	Agent - Life	5/23/2011	9/13/2012
Inactive	Nassau Life Insurance Company of Texas	300872	Agent - Health	5/23/2011	9/13/2012
Inactive	Nassau Life Insurance Company of Texas	300872	Agent - Life	5/23/2011	9/13/2012
Active	National Western Life Insurance Company	301515	Agent - Life	4/29/2011
Inactive	PacifiCare Life and Health Insurance Company	301304	Agent - Health	2/15/2011	10/31/2011
Inactive	SILAC Insurance Company	300535	Agent - Health	10/10/2012	9/23/2013
Inactive	SILAC Insurance Company	300535	Agent - Life	10/10/2012	9/23/2013
Active	Sentinel Security Life Insurance Company	935789	Agent - Health	10/19/2022
Active	Sentinel Security Life Insurance Company	935789	Agent - Life	10/19/2022
Active	SilverScript Insurance Company	663526	Agent - Health	1/21/2020
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	2/15/2011	6/5/2019
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	9/11/2016	12/20/2018
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	7/15/2018	6/5/2019
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	2/15/2011	12/5/2016
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	9/10/2015	6/5/2019

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Graham, Mark Burnside	638756	Agent - Health	6/11/2018	3/31/2022
Inactive	Graham, Mark Burnside	638756	Agent - Life	6/11/2018	3/31/2022
Active	Graham, Matthew B	640480	Agent - Health	12/17/2024
Active	Graham, Matthew B	640480	Agent - Life	12/17/2024
Inactive	North, Timothy Owen	514133	Agent - Health	2/4/2011	6/11/2018
Inactive	North, Timothy Owen	514133	Agent - Life	2/4/2011	6/11/2018
Inactive	Ramsey, Ryan	1002323	Agent - Health	3/31/2022	12/17/2024
Inactive	Ramsey, Ryan	1002323	Agent - Life	3/31/2022	12/17/2024