Phone: Fax: Phone:

Transcription

1 PENNSYLVANIA MEDICAID MANAGED CARE ORGANIZATION (MCO) DIRECTORY OCTOBER 2017 Healthchoices Physical Health Name of Contractor Contact Information Service Area CVS/Caremark Dental Benefit Mgr: DentaQuest Pharmacy Benefit Mgr: Jason Rottman - CEO 2000 Market Street., Suite 850 Philadelphia, PA MCO Interim Medical Director: Chandra Kee 2000 Market Street, Suite 850 Philadelphia, PA 1910 MCO Contact: Darlene L. DeMore Director, Regulatory Compliance 3721 Tecport Drive Harrisburg, PA MCO Pharmacy Director: Heather Gross MCO Dental Vendor Oversight: Kevin Woodbury AmeriHealth Caritas Pennsylvania Pharmacy Benefit Mgr: Perform Rx Dental Benefit Mgr: Scion Marge Angello, RN Market President AmeriHealth Caritas Pennsylvania 8040 Carlson Road Harrisburg, PA MCO Medical Director: Dr. Gaspere Geraci 8040 Carlson Road Harrisburg, PA MCO Contact: Ellan Baumgartner Director, Regulatory Affairs AmeriHealth Caritas Pennsylvania 200 Stevens Drive Philadelphia, PA Contact Name/Number: Ellan Baumgartner Phone: Fax: rottmanj@aetna.com Phone: cakee@aetna.com Phone: Fax: dldemore@aetna.com Special Needs Unit: Phone: Fax: mangello@amerihealthcaritas.com Phone: Fax: ggeraci@amerihealthcaritas.com Phone: Fax: ebaumgartner@amerihealthcaritas.com Member Services Special Needs Unit: Lehigh/Cap Zone Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry and York Counties Alinda Burrell aburrell@pa.gov TTY: TTY: Lehigh/Cap Zone Jim Peters jamepeters@pa.gov TTY: TTY: Page 1 10/2017

2 Gateway Health CVS/Caremark Pharmacy Benefit Mgr: Dental Benefit Mgr: UCCI Patricia J. Darnley President and Chief Executive Officer Gateway Health Plan, Inc. Four Gateway Center 444 Liberty Avenue, Suite 2100 Pittsburgh, PA Executive Director PA Healthchoices: Jessica Cromer MCO Pharmacy Director: Cindy Pigg Phone: Fax: Lehigh/Cap Zone Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry and York Counties Phone: Phone: MCO Medical Director: Dr. Steven Szebenyi MCO Contact: Leslie Marshall Gov t Liaison, Kristen Stein Gov t Liaison, Jeremy Honhold Gov t Liaison, Joshua Young Business Analyst, Deb Dorsch Mgr, & Donna Schaub Director Gateway Health-5th Floor Four Gateway Center 444 Liberty Avenue, Suite 2100 Pittsburgh, PA Address for all other GHP staff: Gateway Health Four Gateway Center 444 Liberty Avenue, Suite 2100 Pittsburgh,PA Contact Name/Number: Leslie Marshall (412) & Kristen Stein (412) , Joshua Young , Deb Dorsch , Jeremy Honhold & Donna Schuab UnitedHealthcare Community Plan of Pennsylvania Pharmacy Benefit Mgr: Optum Rx Dental Benefit Mgr: DBP Allison Davenport CEO United Healthcare Community Plan of PA The Wanamaker Bldg, Suite Penn Square East United Healthcare Community Plan of PA 2 Allegheny Center Suite 600 Pittsburgh, PA MCO Medical Director: Michael R. Kornhauser The Wanamaker Bldg Suite Penn Square East MCO Contact: Carol Lavoritano Manager, Strategic Programs The Wanamaker Bldg, Suite 400 Phone: Fax: Phone: , , , , & Fax: LMarshall2@gatewayhealthplan.com KStein@gatewayhealthplan.com JHonhold@gatewayhealthplan.com JYoung2@gatewayhealthplan.com DDorsch@gatewayhealthplan.com DSchaub@gatewayhealthplan.com Assistant: Cherisse Wilson Phone: Fax: Allison_davenport@uhc.com Fax: Phone: michael_kornhauser@uhc.com Phone: Fax: SSzebenyi@gatewayhealthplan.com Liz Deluca edeluca@pa.gov TTY: TTY: Lehigh/Cap Zone Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry and York Counties Page 2 10/2017

3 100 Penn Square East MCO Contact: Kiziann Powell Compliance Officer The Wanamaker Bldg, Suite Penn Square East Contact Name/Number: Carol Lavoritano or Kiziann Powell UPMC for You, Inc. Pharmacy Benefit Mgr: Dental Benefit Mgr: ESI Avesis John Lovelace, President of Government Programs & Individual Advantage Products UPMC for You US Steel Tower 600 Grant Street, 55 th Floor MCO Medical Director: Dr. Nicholas Degregorio UPMC for You US Steel Tower-11 th Floor 600 Grant Street MCO Contact: Natalie Sifuentes MA Operations & Government Liaison UPMC for You US Steel Tower-9 th Floor 600 Grant Street Website: Contact Name & No: Paul Kienzle Contact Name & No: Bob Glass Phone Fax: Phone: Fax: Phone: Fax: Phone: Fax: For all correspondence - upmc4uqa@upmc.edu For meeting invites only - sifuentesmn@upmc.edu Mike Wilkinson micwilkins@pa.gov TTY: TTY: Lehigh/Cap Zone Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Lancaster, Lebanon, Lehigh, Northampton, Perry and York Counties Leroy Jefferys lejefferys@pa.gov TTY: TTY: Name of Contractor Contact Information Service Area Pharmacy Benefit Mgr: CVS/Caremark Dental Benefit Mgr: DentaQuest Jason Rottman, CEO 2000 Market Street., Suite 850 Philadelphia, PA MCO Interim Medical Officer: Chandra Kee 2000 Market Street, Suite 850 Philadelphia, PA Phone: Fax: rottmanj@aetna.com Phone: cakee@aetna.com Southeast Zone Counties: Bucks, Chester, Delaware, Montgomery, Philadelphia Page 3 10/2017

4 MCO Contact: Darlene L. DeMore Director, Regulatory Compliance 3721 Tecport Drive, Harrisburg, PA Phone: Fax: Alinda Burrell MCO Pharmacy Director: Heather Gross MCO Dental Vendor Oversight: Kevin Woodbury UnitedHealthcare Community Plan of Pennsylvania Pharmacy Benefit Mgr: Optum Rx Dental Benefit Mgr: DBP Allison Davenport CEO United Healthcare Community Plan of Pennsylvania (West Location) The Wanamaker Building 100 Penn Square East, Suite 410 MCO Medical Director: Michael R Kornhauser The Wanamaker Building 100 Penn Square East, Suite 410 MCO Contact: Carol Lavoritano Manager, Strategic Programs The Wanamaker Building 100 Penn Square East, Suite 400 Assistant: Cherisse Wilson Phone: Fax: Allison_davenport@uhc.com Phone: michael_kornhauser@uhc.com Phone: Fax: clavoritano@uhc.com TTY: TTY: Southeast Zone Bucks, Chester, Delaware, Montgomery and Philadelphia Counties Mike Wilkinson micwilkins@pa.gov MCO Contact: Kiziann Powell Compliance Officer The Wanamaker Building 100 Penn Square East, Suite 400 Contact Name & No: Carol Lavoritano or Kiziann Powell Health Partners Plans Pharmacy Benefit Mgr: Argus Dental Benefit Mgr: Avesis William S. George, President & CEO Health Partners Plans 901 Market Street, Suite 500 MCO Chief Clinical Officer: Dr. Howard Lu 901 Market Street, Suite 500 Phone Fax Kiziann_powell@uhc.com UHCPACompliance@uhc.com Member Services Phone: Fax: wsgeorge@hpplans.com Phone: hlu@hpplans.com TTY: TTY: Southeast Zone Bucks, Chester, Delaware, Montgomery and Philadelphia Counties DHS Contract Mgr. Bethany Garretson bgarretson@pa.gov Page 4 10/2017

5 MCO Contact: Kearline D. Jones VP of Government Relations & Compliance 901 Market Street, Suite 500 MCO Contact: Letitia Robinson Director of Compliance 901 Market Street, Suite 500 Contact Name & No: Kearline D Jones & Letitia Robinson (215) or (215) Keystone First Pharmacy Benefit Mgr: Dental Benefit Mgr: Perform Rx Scion Joanne McFall, Market President Keystone First 200 Stevens Drive Philadelphia, PA MCO Medical Director: Dr. Y. Lily Higgins 200 Stevens Drive Philadelphia, PA MCO Contact: Ellan Baumgartner Director, Regulatory Affairs Keystone First 200 Stevens Drive Philadelphia, PA Contact Name & No: Ellan Baumgartner Phone: Cell : Fax: kdjones@hpplans.com Phone: Fax: ldrobinson@hpplans.com Phone: Fax: JMcFall@amerihealthcaritas.com Phone: Fax: # yhiggins@amerihealthcaritas.com Phone: Fax: ebaumgartner@amerihealthcaritas.com TTY: TTY: (Phil. local calls) Southeast Zone Jim Peters jamepeters@pa.gov TTY: TTY: Name of Contractor Contact Information Service Area Gateway Health Pharmacy Benefit Mgr: Dental Benefit Mgr: CVS/Caremark UCCI Patricia J. Darnley President and Chief Executive Officer Gateway Health Plan, Inc. Four Gateway Center 444 Liberty Avenue, Suite 2100 Pittsburgh, PA Phone: Fax: Southwest Zone Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington and Westmoreland Counties Executive Director PA Healthchoices: Phone: Jessica Cromer MCO Pharmacy Director: Cindy Pigg Phone: CPigg@gatewayhealthplan.com JCromer@gatewayhealthplan.com MCO Medical Director: Dr. Steven Szebenyi Phone: Fax: SSzebenyi@gatewayhealthplan.com Page 5 10/2017

6 MCO Contact: Leslie Marshall Gov t Liaison, Kristen Stein Gov t Liaison, Jeremy Honhold Gov t Liaison, Joshua Young Business Analyst, Deb Dorsch Mgr, & Donna Schaub Director Gateway Health-5th Floor Four Gateway Center 444 Liberty Avenue, Suite 2100 Pittsburgh, PA Address for all other GHP staff: Gateway Health Four Gateway Center 444 Liberty Avenue, Suite 2100 Pittsburgh, PA Phone: , , , , & Fax: LMarshall2@gatewayhealthplan.com KStein@gatewayhealthplan.com JHonhold@gatewayhealthplan.com JYoung2@gatewayhealthplan.com DDorsch@gatewayhealthplan.com DSchaub@gatewayhealthplan.com Contact Name & No: Contact Name/Number: Leslie Marshall (412) & Kristen Stein (412) , Joshua Young , Deb Dorsch , Jeremy Honhold & Donna Schuab Liz DeLuca edeluca@pa.gov TTY: TTY: Pharmacy Benefit Mgr: Dental Benefit Mgr: Jason Rottman, CEO 2000 Market Street., Suite 850 Philadelphia, PA CVS/Caremark DentaQuest MCO Interim Medical Director: Chandra Kee 2000 Market Street, Suite 850 Philadelphia, PA MCO Contact: Darlene L. DeMore Director, Regulatory Compliance 3721 Tecport Drive Harrisburg, PA MCO Pharmacy Director: Heather Gross MCO Dental Vendor Oversight: Kevin Woodbury Phone: Fax: rottmanj@aetna.com Phone: cakee@aetna.com Phone: Fax: dldemore@aetna.com UnitedHealthcare Community Plan of Pennsylvania Pharmacy Benefit Mgr: Optum Rx Dental Benefit Mgr: DBP Allison Davenport, CEO United Healthcare Community Plan of PA The Wanamaker Bldg, Suite Penn Square East United Healthcare Community Plan of PA 2 Allegheny Center Suite 600 Pittsburgh, PA MCO Medical Director: Michael R Kornhauser Assistant: Cherisse Wilson Phone: Fax: Allison_davenport@uhc.com Fax: Phone: Southwest Zone Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington and Westmoreland Alinda Burrell aburrell@pa.gov TTY: TTY: Southwest Zone Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington and Westmoreland Counties Page 6 10/2017

7 The Wanamaker Building 100 Penn Square East, Suite 410 MCO Contact: Carol Lavoritano Manager, Strategic Programs United Healthcare The Wanamaker Bldg, Suite Penn Square East MCO Contact: Kiziann Powell Compliance Officer The Wanamaker Building 100 Penn Square East, Suite 400 Contact Name/Number: Carol Lavoritano or Kiziann Powell UPMC for You, Inc. Pharmacy Benefit Mgr: Dental Benefit Mgr: ESI Avesis John Lovelace, President of Government Programs & Individual Advantage Products UPMC for You US Steel Building 600 Grant Street, 55 th Floor MCO Chief Medical Officer: Dr. Nicholas Degregorio UPMC for You US Steel Tower, 11 th Floor 600 Grant Street MCO Contact: Natalie Sifuentes MA Operations & Government Liaison UPMC for You US Steel Building 600 Grant Street,9 th Floor Website: Contact Name & No: Paul Kienzle Contact Name & No: Bob Glass Phone: Fax: Phone: Fax Phone: Fax: Phone: Fax: Phone: Fax: For all correspondence: For meeting invites only: Mike Wilkinson TTY: TTY: Southwest Zone Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset, Washington and Westmoreland Counties Leroy Jefferys TTY: TTY: Page 7 10/2017

8 Name of Contractor Contact Information Service Area AmeriHealth Northeast Pharmacy Benefit Mgr: Perform Rx Dental Benefit Mgr: Scion Marge Angello, RN Market President AmeriHealth Northeast 8040 Carlson Road Harrisburg, PA MCO Medical Director: Dr. Gaspere Geraci 8040 Carlson Road Harrisburg, PA MCO Contact: Ellan Baumgartner-Flood Director, Regulatory Affairs AmeriHealth Northeast 200 Stevens Drive Philadelphia, PA Contact Name & No: Ellan Baumgartner-Flood Geisinger Health Plan (Geisinger Family) Pharmacy Benefit Mgr: Medlmpact Dental Benefit Mgr: Avesis Steven R. Youso President & CEO 100 N. Academy Avenue Danville, PA David Evans Vice President State Government Programs Geisinger Family 100 N. Academy Avenue Danville, PA MCO Medical Director: Perry Meadows Geisinger Family MCO Contact: Marcy Schmehl HealthChoices Program Manager Geisinger Health Plan 2601 Market Place Harrisburg, PA Contact Name & No: Marcy Schmehl (717) Phone: Fax: Phone: Fax: Phone: Fax: Phone: Phone: Phone: Phone: New East Zone Jim Peters TTY: TTY: New East Zone Bradford, Carbon, Centre, Clinton, Columbia, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne & Wyoming Acting Terry Carpenter TTY: or Page 8 10/2017

9 Pharmacy Benefit Mgr: Dental Benefit Mgr: Jason Rottman, CEO 2000 Market Street., Suite 850 Philadelphia, PA CVS/Caremark DentaQuest Phone: Fax: New East Zone Bradford, Carbon, Centre, Clinton, Columbia, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne & Wyoming MCO Interim Medical Director: Chandra Kee 2000 Market Street, Suite 850 Philadelphia, PA MCO Contact: Darlene L. DeMore Director, Regulatory Compliance 3721 Tecport Drive Harrisburg, PA MCO Pharmacy Director: Heather Gross MCO Dental Vendor Oversight: Kevin Woodbury Phone: Phone: Fax: Alinda Burrell TTY: TTY: Name of Contractor Contact Information Service Area UPMC for You, Inc. New West Zone Pharmacy Benefit Mgr: Dental Benefit Mgr: ESI Avesis John Lovelace, President of Government Programs & Individual Advantage Products UPMC for You US Steel Building 600 Grant Street, 55 th Floor MCO Chief Medical Officer: Dr. Nicholas Degregorio UPMC for You US Steel Tower 11 th Floor 600 Grant Street MCO Contact: Natalie Sifuentes MA Operations & Government Liaison UPMC for You US Steel Building-9 th Floor 600 Grant Street Contact Name & No: Paul Kienzle Contact Name & No: Bob Glass Phone: Fax: Phone: Fax: Phone: Fax: For all correspondence: For meeting invites only: Special needs: Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango & Warren Counties Leroy Jefferys TTY: TTY: Page 9 10/2017

10 Website: Gateway Health Pharmacy Benefit Mgr: CVS/Caremark Dental Benefit Mgr: UCCI Patricia J. Darnley President and Chief Executive Officer Gateway Health Plan, Inc. Four Gateway Center 444 Liberty Avenue, Suite 2100 Pittsburgh, PA MCO Medical Director: Dr. Steven Szebenyi MCO Contact: Leslie Marshall Gov t Liaison, Kristen Stein Gov t Liaison, Jeremy Honhold Gov t Liaison, Joshua Young Business Analyst, Deb Dorsch Mgr, & Donna Schaub Director Gateway Health-5th Floor Four Gateway Center 444 Liberty Avenue, Suite 2100 Pittsburgh, PA Address for all other GHP staff: Gateway Health Plan, Inc. Four Gateway Center 444 Liberty Avenue, Suite 2100 Pittsburgh, PA AmeriHealth Caritas Pennsylvania Pharmacy Benefit Mgr: Perform Rx Dental Benefit Mgr: Scion Marge Angello, RN Market President AmeriHealth Caritas Pennsylvania 8040 Carlson Road Harrisburg, PA MCO Medical Director: Dr. Gaspere Geraci 8040 Carlson Road Harrisburg, PA MCO Contact: Ellan Baumgartner Director, Regulatory Affairs AmeriHealth Caritas Pennsylvania 200 Stevens Drive Philadelphia, PA Contact Name/Number: Ellan Baumgartner Phone: Fax: Phone: Fax: SSzebenyi@gatewayhealthplan.com Phone: , , , , & Fax: LMarshall2@gatewayhealthplan.com KStein@gatewayhealthplan.com JHonhold@gatewayhealthplan.com JYoung2@gatewayhealthplan.com DDorsch@gatewayhealthplan.com DSchaub@gatewayhealthplan.com Special Needs Unit Contact Name & No: Contact Name/Number: Leslie Marshall (412) & Kristen Stein (412) , Joshua Young , Deb Dorsch , Jeremy Honhold & Donna Schuab Phone: Fax: mangello@amerihealthcaritas.com Phone: Fax: ggeraci@amerihealthcaritas.com Phone: Fax: ebaumgartner@amerihealthcaritas.com Special Needs Unit: New West Zone Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango & Warren DHS Contract Manager: Liz Deluca edeluca@pa.gov TTY: TTY: New West Zone Jim Peters jamepeters@pa.gov TTY: TTY: Page 10 10/2017

11 Pharmacy Benefit Mgr: CVS/Caremark Dental Benefit Mgr: DentaQuest Jason Rottman, CEO 2000 Market Street., Suite 850 Philadelphia, PA MCO Interim Medical Officer: Chandra Kee 2000 Market Street, Suite 850 Philadelphia, PA MCO Contact: Darlene L. DeMore Director, Regulatory Compliance 3721 Tecport Drive Harrisburg, PA MCO Pharmacy Director: Heather Gross MCO Dental Vendor Oversight Director: Kevin Woodbury Phone: Fax: Phone: Phone: Fax: New West Zone Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango & Warren counties Alinda Burrell TTY: TTY: HEALTHCHOICES BEHAVIORAL HEALTH Name of Contact Contact Information Service Area Scott Suhring, CEO Capital Area Behavioral Health Collaborative, Inc Vartan Way, Suite 206 Harrisburg, PA MCO Contact: James A. Laughman- Executive Director 8040 Carlson Road PO Box 6600 Harrisburg, PA Matt Bauder, HealthChoices Administrator Lehigh County Government Center 17 South 7 th Street, 2 nd Floor Allentown, PA MCO Contact: Diane Marciano General Manager One West Broad Street Suite 100 Bethlehem, PA Lehigh/Capital Zone Phone: Fax: ssuhring@cabhc.org Behavioral Health Subcontractor PerformCare Phone: Fax: jlaughman@performcare.org Phone: Fax: mattbauder@lehighcounty.org Behavioral Health Subcontractor Magellan Behavioral Health Phone: Fax: DEMarciano@magellanhealth.com Cumberland, Dauphin, Lancaster, Lebanon and Perry Counties Elizabeth Ricker Phone: Fax: ericker@pa.gov Lehigh County Lynn Wright Phone: Fax: lynwright@pa.gov Page 11 10/2017

12 Deborah Nunes, HealthChoices Coordinator Northampton County Dept. of Human Services - HealthChoices Program 2801 Emrick Boulevard Bethlehem, PA Behavioral Health Subcontractor Magellan Behavioral Health MCO Contact: Diane Marciano General Manager One West Broad Street Suite 100 Bethlehem, PA Phone: Fax: dnunes@northamptoncounty.org Phone: Fax: DEMarciano@magellanhealth.com Northampton County Lynn Wright Phone: Fax: lynwright@pa.gov HealthChoices Behavioral Health Name of Contact Contact Information Service Area Michelle Hovis, Executive Director York County Human Services York County Government Center 100 West Market Street, 3 rd Floor,York, PA Lehigh/Capital Zone Phone: Fax: mphovis@yorkcountypa.org Behavioral Health Subcontractor Community Care Behavioral Health Organization (CCBHO) MCO Contact: James Myers Phone: Regional Director Fax: Camp Hill Bypass, suite 100 Camp Hill, PA myersjb2@ccbh.com Edward B. Michalik MH/DD Administrator Berks County MH/DD Program 633 Court Street, 8 th Floor Reading, PA Lydia Singley, Program Director Berks County MH/DD Program 633 Court Street, 8 th Floor Reading, PA Phone: Ext Fax: emichalik@countyofberks.com Phone: Ext Fax: LSingley@countyofberks.com Adams and York Counties Greg Crosson Phone: gcrosson@pa.gov Provider Line: Berks County (Adams County) (York County) (Spanish Line) Behavioral Health Subcontractor Community Care Behavioral Health Organization (CCBHO) MCO Contact: Jim Myers Regional Director 1200 Camp Hill Bypass, Suite 100 Camp Hill, PA Phone: Fax: myersjb2@cchb.com Lynn Wright Phone: Fax: lynwright@pa.gov (Spanish Line) Provider Line: Page 12 10/2017

13 Name of Contact Contact Information Service Area James Gallagher-CEO NBHCC 72 Glenmaura National Boulevard Moosic, PA Northeast Zone Phone: Lackawanna, Luzerne, Susquehanna and Wyoming Counties Behavioral Health Subcontractor Community Care Behavioral Health Organization MCO Contact: Phone: Tina Wydeen, Regional Director Fax: Glenmaura National Boulevard, 2 nd Floor Moosic, PA wydeencr@ccbh.com James Gavin, President and CEO Community Care BHO th Avenue Suite 1300 Cindy Grezeszak, Director of Behavioral Health Department Bucks County Behavioral Health System Bucks County Courthouse Administration Building 600 Louis Drive Suite 102-A Doylestown, PA Behavioral Health Subcontractor Magellan Behavioral Health MCO Contact: Jim Leonard, LCSW, MBA Magellan Behavioral Health of PA 105 Terry Drive, Suite 103 Newtown, PA Provider Line: North/Central State Option Phone: Fax: gavinjg@ccbh.com Southeast Zone Phone: Fax: cgrezeszak@co.bucks.pa.us Phone: Fax: jpleonard@magellanhealth.com David Gabello Phone: Fax: dgabello@pa.gov Bradford, Cameron, Centre, Clarion, Clearfield, Columbia, Elk, Forest, Huntingdon, Jefferson, Juniata, McKean, Mifflin, Montour, Northumberland, Potter, Schuylkill, Snyder, Sullivan, Tioga, Union, Warren and Wayne Counties Scott Liddick Phone: 717: Fax: scliddick@pa.gov Bucks County Scott Anstey Phone: Fax: sanstey@pa.gov Page 13 10/2017

14 Bucks Chester Delaware Philadelphia Donna Carlson, BH Project Director Department of Human Services 601 Westtown Road, Suite 330 P.O. Box 2747 West Chester, PA Phone: Fax: Chester County Behavioral Health Subcontractor: Community Care Behavioral Health Community Care Behavioral Health One East Uwchlan Avenue, Suite 311 Exton, PA William Jerome Burton Phone: Southeast Zone Name of Contact Contact Information Service Area Jonna L. DiStefano, Administrator Delaware County Office of Behavioral Health 20 South 69 th Street, 3 rd Floor Upper Darby, PA Behavioral Health Subcontractor: Magellan Behavioral Health MCO Contact: Jim Leonard, LCSW, MBA Magellan Behavioral Health of PA 105 Terry Drive, Suite 103 Newtown, PA David Jones, Acting Commissioner Dept. of Behavioral Health & Intellectual disability Services 1101 Market Street, 7 th Floor Behavioral Health Subcontractor Community Behavioral Health MCO Contact: Joan Erney-CEO 801 Market St, 7 th Floor LeeAnn Moyer, Deputy Administrator of Behavioral Health Montgomery County Behavioral Health Montgomery County Human Svcs. Center 1430 DeKalb Street, P.O. Box 311 Norristown, PA Phone: Fax: distefanoj@delcohsa.org Phone: Fax: jpleonard@magellanhealth.com Phone: Fax: David.T.Jones@phila.gov Phone: Fax: joan.erney@phila.gov Phone: Fax: lmoyer@mail.montcopa.org Delaware County Scott Anstey Phone: Fax: sanstey@pa.gov Philadelphia County William Jermone Burton Phone: wburton@pa.gov Montgomery County Page 14 10/2017

15 Behavioral Health Subcontractor Magellan Behavioral Health MCO Contact: Jim Leonard, LCSW, MBA Magellan Behavioral Health 105 Terry Drive, Suite 103 Newtown, PA Scott Anstey Phone: Fax: Name of Contact Contact Information Service Area David McAdoo Southwest Behavioral Health Management, Inc New Butler Road New Castle, PA Southwest Zone Phone: Fax: Behavioral Health Subcontractor Value Behavioral Health of Pennsylvania MCO Contact: Dr. Mark Fuller, CEO Phone: Pleasant Valley Road Fax: Trafford, PA Diane Macerelli, Dep. Director of BH Allegheny County Office of Behavioral Health Human Services Building One Smithfield Street, 3 rd Floor Pittsburgh, PA mark.fuller@valueoptions.com Armstrong, Butler, Indiana, Lawrence, Washington and Westmoreland Counties Lee Ann Kohler Phone: Fax: lkohler@pa.gov Armstrong Butler Fayette Greene Indiana Lawrence Washington Westmoreland Phone: Fax: Denise.Macerelli@alleghenycounty.us Behavioral Health Subcontractor Community Care Behavioral Health Organization James Gavin, President and CEO Community Care BHO th Avenue gavinjg@ccbh.com Suite 1300 Lisa Ferris-Kusniar, Administrator Fayette County Behavioral Health 215 Jacob Murphy Lane Uniontown, PA Phone: Fax: lfk@fcbha.org Behavioral Health Subcontractor: Value Behavioral Health of Pennsylvania MCO Contact: Dr. Mark Fuller, CEO 520 Pleasant Valley Road Trafford, PA Phone: Fax: Allegheny County Phyllis Knott Phone: Fax: pknott@pa.gov Fayette County Chris Duncan Phone: Page 15 10/2017

16 Fax: Name of Contact Contact Information Service Area Southwest Zone Dr. Mark Fuller, CEO Value Behavioral Health of PA 520 Pleasant Valley Road Trafford, PA Phone: Fax: Greene County Gerard Mike, Administrator Beaver County MH/MR Program 1060 Eighth Avenue Beaver Falls, PA Phone: Fax: Chris Duncan Phone: Fax: Beaver County MCO Subcontractor: Value Behavioral Health MCO Contact: Dr. Mark Fuller, CEO 520 Pleasant Valley Road Trafford, PA Phone: Fax: Chris Duncan Phone: Fax: Tina Mann Behavioral Health Services of Bedford & Somerset Counties (BHSSBC) 245 W. Race Street Somerset, PA Behavioral Health Subcontractor PerformCare MCO Contact: James A. Laughman- Executive Director 8040 Carlson Road PO Box 6600 Harrisburg, PA Amy Marten-Shanafelt, Executive Director Blair HealthChoices 120 Holliday Hills Drive Hollidaysburg, PA North/Central County Option Zone Phone: Ext Fax: Phone: Fax: Phone: Fax: Behavioral Health Subcontractor Community Care Behavioral Health Community Care BHO th Avenue Suite Bedford & Somerset Counties Elizabeth Ricker Phone: Fax: ericker@pa.gov Blair County Greg Crosson Phone: Fax: Page 16 10/2017

17 Name of Contact Contact Information Service Area Tracy Selak, Administrator Cambria county BH/ID Program 411 Main Street Johnstown PA cc: Ryan Hildebrand, CFO Behavioral Health of Cambria County Phone: Fax: Behavioral Health Subcontractor MAGELLAN BEHAVIORALHEALTH MCO Contact: Tracy Shultz, MS CEO/Director of Operations, Cambria County Magellan Healthcare, Inc Broad Street, Suite 301 Johnstown, PA Jeff Hartzell, HealthChoices Coordinator Carbon/Monroe/Pike MH/DS Program 724 Phillips Street, Suite 202 Stroudsburg, PA Phone: E tshultz@magellanhealth.com Phone: Ext Fax: jhartzell@cmphc.com Cambria County Angela Douglas Phone: Fax: adouglas@pa.gov Carbon/Monroe/Pike Counties Behavioral Health Subcontractor: Community Care Behavioral Health Organization Beth Pickering, Regional Director One East Uwchlan Avenue, Suite 311 Exton, PA pickeringba@ccbh.com Phone: Jacqueline Miller, HC Director Lycoming/Clinton Joinder Board The Sharwell Building 200 East Street Williamsport, PA Fax: Phone: Fax: jmiller@joinder.org Behavioral Health Subcontractor: Community Care Behavioral Health Community Care BHO th Avenue Suite 1300 John DiMattio, DHS Director Erie County MH/MR Program 154 W. Ninth Street Erie, PA Phone: Fax: jdimattio@eriecountydhs.org Behavioral Health Subcontractor Community Care Behavioral Health Organization th Avenue Suite David Gabello Phone: Fax: dgabello@pa.gov Lycoming & Clinton Counties Scott Liddick Phone: Fax: scliddick@pa.gov Erie County Phyllis Knott pknott@pa.gov Phone: Fax: Page 17 10/2017

18 Name of Contact Contact Information Service Area Melissa Reisinger, Executive Director The Tuscarora Managed Care Alliance Human Services Building 425 Franklin Farm Lane Chambersburg, PA Behavioral Health Subcontractor: PerformCare MCO Contact: James A. Laughman Executive Director 8040 Carlson Road PO Box 6600 Harrisburg, PA Dave McAdoo, Executive Director Northwest Behavioral Health Partnership, Inc New Butler Road New Castle, PA Phone: Phone: Fax: Phone: Fax: Behavioral Health Subcontractor: Value Behavioral Health of Pennsylvania Dr. Mark Fuller, CEO Value Behavioral Health of PA 520 Pleasant Valley Road Trafford, PA Phone: Fax: Franklin & Fulton Counties Angela Douglas Phone: Fax: Crawford, Mercer, Venango Counties Lee Ann Kohler Phone: Fax: Page 18 10/2017