DEPARTMENT OF INSURANCE

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	Designated Home State
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

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

Address Information

Type	Address
Business / Home Office	668 24th Avenue Se Minneapolis, MN 55414
Mailing	Attn: Compliance 711 Kasota Ave SeMinneapolis, MN 55414

Internet Information

Type	Address
Business Email	dept-fps-licensing@fairview.org
Internet	www.clearscript.org
Personal Email	apoehls1@fairview.org

Phone Information

Type	Phone
Business / Home Office	(612) 672-6500
Business / Home Office	(612) 672-6500