DEPARTMENT OF INSURANCE

Name	Aetna Medicaid Administrators LLC	DOIID	864675	NAIC NPN	8034127

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Active	Non Resident	Administrator	Not Applicable	12/30/2014		3/31/2026

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date.

Address Information

Type	Address
Mailing	151 Farmington Avenue Rw61 (Roux-Halloran)Hartford, CT 06156
Business / Home Office	4750 S 44th Place, Ste 150 Phoenix, AZ 85040

Internet Information

Type	Address
Business Email	PadillaJL@aetna.com
Internet	aetnabetterhealth.com

Phone Information

Type	Phone
Business / Home Office	(860) 273-2259