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GHP ID

Type of GHP

TPA Tax ID

Name/Address of GHP

Rx BIN

Rx PCN

Rx Group

Use your assigned group number from your invoice

D

35-2145715

TLC HDHP* Anthem Blue Cross and Blue Shield P. O. Box 27401 Richmond, VA 23279

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Use your assigned group number from your invoice

U

35-2145715

TLC HDHP* Anthem Blue Cross and Blue Shield P. O. Box 27401 Richmond, VA 23279

610575

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Use your assigned group number from your invoice

Use your assigned group number from your invoice

B

52-0954463

Kaiser Permanente HMO* 2101 E. Jefferson St. 6th Floor East Rockville, MD 20852

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Use your assigned group number from your invoice

U

52-0954463

Kaiser Permanente HMO* 2101 E. Jefferson St. 6th Floor East Rockville, MD 20852

011859

MA015

Use your assigned group number from your invoice

Use your assigned group number from your invoice

D

35-2145715

Key Advantage* Anthem Blue Cross and Blue Shield P. O. Box 27401 Richmond, VA 23279

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CWLTHVA

U

22-3461740

Key Advantage Medco Health Solutions, Inc. 100 Parsons Pond Dr. Franklin Lakes, NJ 07417

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Part II: Group Health Plan Information

2

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