DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Fairview Pharmacy Services LLC	DOIID	931171	NAIC NPN	16718225

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Pharmacy Benefit Managers	Not Applicable	12/29/2016		3/31/2025
* 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
Pharmacy Benefit Managers	01/15/2025	03/31/2025

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Johnson, Kyle Dean	946025	Administrator - Not Applicable	3/7/2017
Inactive	Merker, Bradlee F	631962	Administrator - Not Applicable	12/29/2016	4/28/2017